Tactical Medicine News Blog

While we congratulated and welcomed the interns with the list of Greatest Hits for Interns, it’s high time we actually congratulate and welcome you… the new Senior Residents! You’ve toiled through call shifts on off-service rotations,  you’ve worked hard reviewing cases with junior residents and getting grilled you about the latest esoteric facts by the seniors!  And now, you’re going to be in charge of other other residents!?!  You are probably equal parts excited and scared… but more to the point you may be wondering – How does one actually be a great senior resident? Well we have some resources for you!

Background: Fluid resuscitation with crystalloid is one of the most basic initial management approaches to adult and pediatric patients with severe sepsis and septic shock. However, which fluid should we be giving, and does it matter?  Should we give an unbalanced, chloride rich solution such as normal saline or a balanced, chloride restrictive fluid, such as lactated ringers, Plasma-Lyte, or Normasol? Interestingly, the 2016 Surviving Sepsis Guidelines, added resuscitation with balanced fluids into the guidelines, although a weak recommendation with low quality of evidence. This recommendation was based on some growing adult data, albeit retrospective, showing that resuscitation strategies using normal saline may be harmful and associated with increased risk of AKI (1), need for CRRT (1) and increased mortality (2-3). The effects of balanced fluids however, have not been studied in the resuscitation of children in severe sepsis and septic shock.

The NIH Stroke Scale is used to assess the severity of a suspected stroke. It includes 11 neurologic exam components that can be quickly performed at the bedside. The second component of the NIH Stroke Scale is testing of voluntary horizontal eye movements, a.k.a., “best gaze”.1 Gaze is usually tested by instructing the patient to follow the examiner’s hand or pointer finger in a horizontal plane from side to side. This assessment assumes that the patient can comprehend instructions and actively participate in the physical exam. But… how do you test gaze if your patient is aphasic or unable to follow commands?

Background: Sore throat is a common presentation to the emergency department as well as primary care clinics.  Corticosteroids inhibit transcription of pro-inflammatory mediators in airway endothelial cells responsible for pharyngeal inflammation and symptoms of pain.  They have been used in other upper respiratory tract infections such as acute sinusitis and croup.  In adults, previous studies with dexamethasone are in combination with antibiotics but studies of children have included dexamethasone without antibiotics.  This study is unique as it is evaluating the benefits of oral corticosteroids for acute sore throat in primary care in the absence of antibiotics

Congratulations, you’ve made it! On July 1, thousands of medical students across the country made the transition to becoming Emergency Medicine residents. It was a particularly competitive year for Emergency Medicine, with 99.7% of first-year spots filled despite a whopping 2,047 positions being offered in 2017 (up by 152 spots compared to last year).1 Now begins the most crucial 3 or 4 years of your medical training that will prepare you for the rest of your career in Emergency Medicine.