Tactical Medicine News Blog

Nothing says “emergency” like a bite from a venomous reptile. If you work in an area populated by snakes, which covers most of the United States and the world, then chances are good that you will see a patient with a snake bite in the Emergency Department (ED). The severity of the symptoms and the treatment vary greatly with different snakes. In this post, we will outline the ED approach to and management of common U.S. snake envenomation.

Angiotensin Converting Enzyme Inhibitors (ACE-I) are prescribed to millions of patients in the US. Though they are relatively safe, upper airway angioedema is one of the life-threatening adverse effects that we see frequently in the Emergency Department. Though this disorder is routinely treated with medications for anaphylaxis (i.e. epinephrine, histamine blockers, corticosteroids) the underlying mechanism of action predicts that these medications will fail. There is no well established treatment algorithm other than airway control if the angioedema is severe and appears to be causing a mechanical obstruction and cessation of the medication. A 2015 phase 2 study published in the NEJM touted the role for Icatibant in the treatment of these patients. Despite being heralded as “the cure,” the data set in this article was small questioning the validity of the findings. Enter the CAMEO study which attempts to further elucidate the benefits of this medication.

Members and mentors of the inaugural, 2016-17 ALiEM Faculty Incubator authored 9 narrative reviews in the Academic Primer Series and Curated Collections for Educators on several important medical education topics, which highlight the most important literature and their defined importance for junior educators and faculty developers. To ensure broad compendiums of articles were obtained on each subject, collections of papers were augmented via an open call for additional papers using Twitter. Subsequently, a selection panel comprised of both junior and seasoned educators utilized a 3-round modified Delphi process to identify the best, most relevant papers for medical educators.

Background: In 2002, the New England Journal of Medicine published two studies that changed the management of post-cardiac arrest patients by showing improved outcomes in patients treated with therapeutic hypothermia (32°C-34°C) for at least 24 hours. (Bernard 2002, Hypothermia 2002).  The landscape changed again in 2013 with the publication of the Targeted Temperature Management (TTM) trial in the New England Journal, which compared post-cardiac arrest hypothermia at 32-34°C and at 36°C and found no difference in outcomes (Nielson 2013). After the publication of the TTM trial, many hospitals changed their cooling protocols to a target temperature of 36°C, however, recently it has been shown that this may pose an increased risk of fever. (Cassamento 2016).

Staying well in the Emergency Department is not only important for physicians, but for the entire healthcare team. This week we are branching out, and taking a look at How Our ED Colleagues Stay Healthy in EM! Jesse Spurr is an Emergency Department Nurse Educator in Brisbane Australia. Jesse is the creator of injectableorange.com and co-creator of simulationpodcast.com, a Teaching Course faculty, and a organising committee member for SMACC. In addition to his “professional hobbies”, Jesse is kept grounded and content with his two kids and superhero wife.