Tactical Medicine News Blog

Definition: Acute infection of the ascitic fluid in a patient with liver disease without another source of infection Epidemiology: (Runyon 1988, Runyon 1988, Borzio 2001) Incidence 10-25% risk of at least one episode per year 20% risk in those with ascites admitted to the hospital Historically, mortality ~ 50%

A 23-year-old female with no past medical history presents to the ED for the 4th time this month complaining of severe “10-out-of-10” abdominal pain, nausea, and intractable vomiting. She denies alcohol use, but reports she has smoked at least 1 marijuana “bud” daily for the last 3 years. In an attempt to relieve her symptoms, she has increased her marijuana use, however she has found that her pain is actually increasing, and the only thing that appears to help is taking a hot shower or bath. With this statement, the provider immediately considers cannabinoid hyperemesis syndrome (CHS).

Welcome back to Episode 42 of REBEL Cast. In this episode, we will be discussing some studies from the past year that had some interesting results and a couple of papers that are potentially going to change our practice in the near future (In the Pipeline). Again, this 3 part series will be dedicated to discussing current literature and how it can be applied to your clinical practice.

A 3 year-old boy presents with a deep laceration of the distal phalanx, through the nail bed, after slamming his fingers in a car door. He is crying, anxious, and uncooperative. How do you make this situation easier to evaluate and repair? Nail bed and finger laceration repairs can be challenging, and even more challenging in young patients. Preparation is key to getting a good outcome. Here we present a pediatric trick of the trade on immobilizing a finger for digit or nail bed procedures.

Our second case of season 5, The Case of the Difficult Debrief, presented the scenario of a budding simulation educator who had a difficult experience debriefing a cohort of learners. This month’s case was developed in collaboration with the team at Simulcast, an excellent simulation website operated by a team of emergency providers in Australia, whose work includes a online Journal Club based loosely on the MEdIC discussion concept. After reviewing this commentary, we encourage readers to check out their podcast that delves into some of the issues that arose from this month’s MEdIC case. The MEdIC team (Drs. Tamara McColl, Teresa Chan, Sarah Luckett-Gatopoulos, Eve Purdy, John Eicken, Alkarim Velji, and Brent Thoma), hosted an online discussion around the case over the last 2 weeks with insights from the ALiEM community. We are proud to present to you the curated commentary and our expert opinions. Thank-you to all participants for contributing to the very rich discussions surrounding this case!