Tactical Medicine News Blog

In this CritCases blog - a collaboration between STARS Air Ambulance Service, Mike Betzner and EM Cases we discuss a challenging case of pulmonary hypertension where a fine balance in volume resuscitation, oxygenation and ventilation is critical. The post CritCases 7 Pulmonary Hypertension – A Fine Balance appeared first on Emergency Medicine Cases.

In this CritCases blog - a collaboration between STARS Air Ambulance Service, Mike Betzner and EM Cases we discuss a challenging case of pulmonary hypertension where a fine balance in volume resuscitation, oxygenation and ventilation is critical. The post CritCases 7 Pulmonary Hypertension – A Fine Balance appeared first on Emergency Medicine Cases.

Background: With the introduction of sepsis 3.0, came the quick sepsis related organ failure assessment (qSOFA) score. The purpose of this score is supposed to be a bedside tool to help predict which patients are at the greatest risk of poor outcomes.  There are three components to this score: Low systolic blood pressure (≤100mmHg), high respiratory rate (22 breaths per minute), and altered mental status (Glasgow coma scale <15).  Interestingly, nowhere in this score is fever.

The PERC rule has been a welcome addition to the emergency department evaluation of patients with chest pain or dyspnea suspected of pulmonary embolism. This has allowed a reduction in D-dimer testing in low risk patients. The traditional saturation cut-off of 95% can pose a challenge for patients seen at higher elevations where mild hypoxemia can be a normal physiologic parameter. At these elevations patients can flunk the PERC rule due to borderline hypoxemia with oxygen saturation levels in the 93-94% range, despite  all other PERC rule criteria being negative. This can result in D-dimer testing and the associated risk of unnecessary CT radiation exposure in the event of a false positive D-dimer.

“Leadership and learning are indispensable to each other.” – John F. Kennedy Every year without exception, a new set of Chief Residents are chosen at each Emergency Medicine program. They are always excited for the position, but hardly prepared for what’s to come. We have now had 2 successful ALiEM Chief Resident Incubators and are extremely excited and thrilled to launch the third 2017-18 ALiEM Chief Resident Incubator. If you are a Chief Resident, here are the top 5 reasons why you should join the Incubator.