Tactical Medicine News Blog

The EM Residency Match Advice Series is back with its latest installment! For the first time, our team puts a regional flavor on an episode as we take a deep dive into the Northern California residency programs in Emergency Medicine (EM). These programs infuse multiple opportunities for regional collaboration into the residency experience. Activities include an annual incoming chief resident forum, Nor-Cal Sim Wars, wellness outings, and more! Hosted by Dr. Michael Gisondi, watch the video Google Hangout or listen to the edited Soundcloud podcast version to learn more about each of the programs and this special regional collaboration.

We are proud to present CAPSULES Module 9: Hospital Acquired Pneumonia (HAP), now published on ALiEMU. Here is a summary of the key points from a stellar module by Drs. Jamie Rosini and Matt Stanton. When you’re finished, head over to the Capsules page for even more practical pharmacology for the EM provider.

Welcome to season 5, episode 1 of the ALiEM Medical Education in Cases (MEdIC) series! Our team (Drs. Tamara McColl, Teresa Chan, John Eicken, Sarah Luckett-Gatopoulos, Eve Purdy, Alkarim Velji, and Brent Thoma) is pleased to welcome you to our online community of practice where we discuss the practice of academic medicine! This month, we present a case of a junior resident faced with discrimination while treating a patient who refuses to be seen by a “non-white” or “non-Canadian” physician.

Background: The clinical diagnosis of pulmonary embolism (PE) can be challenging given its variable presentation, requiring dependence on objective testing. Decision instruments such as PERC and the Wells’ score help stratify patients to low or high probability, enabling focused use of CT pulmonary angiography (CTPA) for diagnosis. However, despite these algorithms, there is evidence of increasing use of CTPA along with diminishing diagnostic rate (less than 10%). This combination results in the overdiagnosis of subsegmental PEs, unnecessary exposure to radiation, false positive results and the potential for contrast-induced nephropathy. The YEARS study aims to present a simplified algorithm for evaluation with a two-tiered D-dimer threshold to reduce the numbers of CTPA in all age groups.

Atraumatic low back pain is a common complaint in the ED. For most patients, a thorough history and physical exam is sufficient to exonerate causes that threaten life or neurological function. For a small subset, however, MRI may be required. ALiEM has partnered with the ACEP E-QUAL Network to promote clinical practice improvements through a series of podcasts. In our first installment, we focus on this common presentation. We review highlights from an interview with Dr. Jonathan Edlow, Vice Chair of Emergency Medicine at Beth Israel Deaconess, about the presentation and evaluation of low back pain. Afterward be sure to check out the podcast in full.