Tactical Medicine News Blog

Background: Many physicians struggle with monitoring accurate continuous blood pressures, cardiac output, and response to fluids in patient resuscitation. Also, due to the invasive nature of most methods presently available (i.e. arterial lines, etc) few patients get this monitoring. Ultrasound has been an amazing addition to our armamentarium, but many, I am sad to say, still don’t feel comfortable with this modality. Recently, finger cuff, non-invasive technology was brought to my attention by Bob Frolichstein (Twitter: @frolichstein), one of my colleagues in San Antonio, TX. Specifically, it has been stated that, finger cuff technology, allows hemodynamic monitoring with both BP and CO continuously available in patients without the need for an arterial line.

Match season came to a close last month – and with that, some 17,000 U.S. medical school seniors earned a PGY-1 position. Most will go on to complete these programs and have happy, successful careers in their chosen specialty. But for a small number, second thoughts will creep in during residency. Maybe a life event changes the way a resident looks at his or her role in providing care; or perhaps exposure to another specialty – EM for example – occurred late in the fourth year of medical school. For these atypical applicants, there is a dearth of resources to help guide a re-match, if you will, and no guide for navigating the policies and politics associated with changing one’s mind.

Background: The treatment of urinary retention is pretty straightforward; place either a Foley catheter or suprapubic catheter to decompress the bladder.  What is less clear, and more often debated, is if we need to clamp the catheter after 200 – 1000mLs of urine output or just allow complete drainage.  Historic teaching has been to do intermittent volume drainage to avoid complications such as hematuria, circulatory collapse, and worsening renal failure.  I distinctly remember being taught this as a resident, but not sure that I ever evaluated the literature until recently. 

The seeds of the Suicide Plant, when ingested, may result in significant toxicity, including the ECG findings shown. Which kind of toxicity does it cause? Anticholinergic poisoning Cardiac glycoside poisoning Cardiac sodium channel blockade Cholinergic poisoning Nicotinic poisoning

Background: Historically the treatment of uncomplicated appendicitis has been appendectomy. The first appendectomy performed dates back to 1735 done by Claudius Amyand. Appendectomy has been the standard treatment for acute appendicitis every since Charles McBurney described it in 1889. However, studies have shown that an antibiotic first strategy may be feasible without increased risk of perforation, sepsis, and/or death.  This other approach is called NOTA (Non-Operative Treatment of Appendicitis).  Past RCTs were from Europe and this is the first NIH grant study to question this in the US. Antibiotic first strategies are used for uncomplicated diverticulitis, but have not been used in uncomplicated appendicitis. Several reasons why this strategy may be preferred include fewer complications, less pain, and less disability than an appendectomy first strategy.  There have been a couple of systematic reviews on the issue of NOTA that came to different conclusions (Varadhan et al. BMJ 2012 and Kirby et al. J of Infection 2015). To date, no US randomized trial has evaluated an antibiotics-first approach in uncomplicated appendicitis until now.