Tactical Medicine News Blog

In this tenth installment of the EM Match Advice series, we go back to the beginning. As a medical student, how does one know if emergency medicine is the right career choice? Is it all guts, glory, and excitement? Are ONLY working 28 hours per week? Listen to this fascinating discussion with our panelists, facilitated by Dr. Michael Gisondi (EM Program Director at Northwestern). The panelists include Dr. Michele Dorfsman (PD at University of Pittsburg), Dr. Brian Levine (PD at Christiana Care), Dr. Larissa Velez (PD at UT Southwestern), and Dr. Michelle Lin (ALiEM/UCSF).

Background: Welcome back to the September 2016 REBEL Cast. We are back with another episode and I am super excited about this episode because we are going to talk about two papers just published in the Resuscitation Journal on management of refractory ventricular fibrillation. It is a well known fact that the cornerstones for survival from Out-Of-Hospital Cardiac Arrest (OHCA) have always been early, high quality CPR and early defibrillation in patients with shockable rhythms (i.e. Ventricular Fibrillation/Ventricular Tachycardia). Some patients with shockable rhythms may be refractory to standard defibrillation therapy (i.e. refractory VF). Even more frustrating, there is truly a dearth of data on what to do with these patients. One strategy that has been reported more and more in the literature is double sequential defibrillation (DSD). Another issue in cardiac arrest patients is we frequently give boluses of 1mg epinephrine every 3 – 5 minutes as is outlined in the ACLS guidelines.  When patients have minimal cardiac output, the buildup of catecholamines may potentially cause refractory ventricular fibrillation (RVF).  This could be due to an increase myocardial oxygen consumption causing an increase in myocardial ischemia, and ultimately more difficulty in successful defibrillation.  But maybe by blocking the beta-adrenergic receptors in the myocardium, we can block the beta effects of the catecholamines and potentially increase the chances of successful sustained ROSC.

Remember the “OPQRST” mnemonic? It stands for Onset, Provocation/Palliation, Quality, Region/Radiation, Severity, Timing. Not only can it guide your history taking, but charting these descriptors also ensures you can code at an appropriate level. The patient’s history is the first example of the balance between essential information and over-documentation. It should be comprehensive, yet be chief-complaint focused [1]. Below, we outline the components of a thorough and billable history.

This week we are going to be switching things up! In May of 2015, as a part of a bi-annual combined conference with residents and faculty from Saint Louis University and Washington University in St. Louis, they focused on how they stay healthy in Emergency Medicine! St. Louis is a large urban city with its own fair share of stress and wellness. Prior to the conference, a survey containing all the following questions was sent to all of the emergency medicine residents and faculty. 75% of all those polled responded to the survey. Within this post, they share their tips for how to make wellness a part of your everyday routine. Thanks to Dr. Craig Krausz for spearheading this project and putting the post together. Check out how out these two programs stay healthy in EM!

Closed reduction of fractures or dislocations in the hand and wrist can be difficulty to achieve. Gravity can serve as an assistant. Commercial finger traps are available, but can sometimes be hard to find in the Emergency Department. An earlier trick of the trade describes the use of a gauze role to build your own finger trap setup. The following describes a simpler way to build finger traps using a gauze roll.