Tactical Medicine News Blog

 Physical frailty is a potential risk factor for Parkinson disease, finds cohort study, and the assessment and management of frailty might have clinical significance in the at-risk population. https://ja.ma/3HQTM1j

Scientists at the Japan Advanced Institute of Science and Technology in Ishikawa, Japan have developed an anti-cancer treatment that consists of bacteria that are naturally found inside some tumors. Isolating and then injecting these bacteria into existing tumors appears to provoke a strong immune response that can lead to tumor destruction, without the need for […]

Student researchers at Rice University have developed a paper strip test for hypothyroidism, similar to those that are commonly used for COVID-19 testing. Babies with congenital hypothyroidism require prompt diagnosis and treatment, but in many parts of the world a lack of healthcare resources can mean that the condition can go undiagnosed for long periods, […]

A heavy alcohol drinker, who is well known to your Emergency Department, presents with altered mental status, except that he looks different this time. He looks really bad, stating that he has been vomiting blood. He is hypotensive. He then vomits a copious amount of blood right in front of you. You intubate the [+] The post Trick of Trade: Inflating the Esophageal Balloon of a Blakemore/Minnesota Tube without a Manometer  appeared first on ALiEM.

Background: IV fluids are part of the standard resuscitation bundle in septic shock, however it is unclear if they provide a significant benefit. These patients can have a vasodilated vascular bed and the initial use of fluids is hypothesized to serve two purposes: Augmenting the macrovascular system (stroke volume and cardiac output) and augmenting the microvascular perfusion (capillary blood flow). However, IV fluids are not a benign intervention as they can cause coagulopathy and fluid overload. The CENSER Trial (Link is HERE) was a randomized, double-blind, placebo-controlled clinical trial evaluating the use of early low-dose norepinephrine vs standard care (placebo) in adults with septic shock.  The goal of the trial was to see if early vasopressors improved shock control by 6 hours. Patients were started on low-dose norepinephrine at a median time from ED arrival of 93 minutes compared to 192minutes in the standard care arm.  This resulted in better shock control by 6hrs (76.1% vs 48.4%). The secondary outcome of mortality was not statistically different however numerically favored the early use of norepinephrine. Physiologically it makes sense to initially use lower volumes of fluids and earlier initiation of vasopressors. However, there is a lack of robust evidence to help guide what fluid and vasopressor strategy is best in patients with septic shock.