Tactical Medicine News Blog

Background: Typical medical treatment of ACS patients include dual antiplatelet therapy (DAPT) and revascularization with primary percutaneous coronary intervention (PPCI).  Nitroglycerin is first line therapy in the treatment of pain in ACS with morphine as a common adjunct. Morphine helps relieve pain which decreases catecholamines and oxygen demand.  We have written about the use of Morphine in ACS before on REBEL EM and advocated for fentanyl over morphine for pain control in patients with refractory pain to IV nitroglycerin.  However, two new trials have been published in the past month: An observational trial in 300 patients with STEMI receiving morphine and a randomized trial using fentanyl which requires us to revisit the use of opioids in ACS.

We’re taking a look back at the first ever Faculty Incubator Talk with Experts. This Google Hangout session with the legendary Dr. Geoff Norman is an incredible treasure that has been unearthed from the Faculty Incubator Vault! You may be asking yourself, “what does a PhD in nuclear physics know about medical education?” The answer is “plenty!” With Dr. Norman’s help, Drs. Teresa Chan and Jonathan Sherbino (both from McMaster University) take a deep dive into how the brain processes information and how this knowledge can be used in our educational practice.

Two patients with substance-use disorder present to an ED in the United States with a new rash. Which of the following is the most likely exposure? Krokodil (desomorphine) Levamisole-adulterated cocaine Methamphetamine-induced allergic reaction Wound botulism secondary to heroin use

Background: The diagnosis of PE is a tricky thing.  We want to limit over-testing patients and therefore, over-diagnosis. On the other hand, we don’t want to limit testing so much that we miss the diagnosis where treatment would make a difference.  The pulmonary embolism rule-out criteria (PERC) was created to reduce testing in patients who have a very low probability of PE (i.e. prevalence of <1.8%) in which further testing would not be necessary.  There have been many observational trials published on this score but until now there has not been a prospective randomized clinical trial (The PROPER Trial).

Pain management in the ED has become a balancing act. EPs must continually balance adequate pain management with the risks of opioids prescribing. As providers reach into their pain management toolbox it is always nice to have as many options as possible because one size does not fit all. Specifically for the management of acute renal colic, IV preservative-free (cardiac) lidocaine has been gaining popularity as a potential alternative when opioids are unable to get job done or are contraindicated due to co-morbidities or a history of addiction. Is it safe? Does it work?