Tactical Medicine News Blog

In this CritCases blog - a collaboration between STARS Air Ambulance Service, Mike Betzner and EM Cases, Dr. James Brokenshire presents a case of acute unstable Uterine Inversion and discusses key therapeutic maneuvers including the Johnson Maneuver, tocolytics and resuscitation of postpartum hemorrhage. The post CritCases 4 – Uterine Inversion and Postpartum Hemorrhage appeared first on Emergency Medicine Cases.

An 7-year-old girl presents to your Emergency Department (ED) with an ankle inversion injury from while performing gymnastics. Plain films of her ankle show no fracture. It has been a long-held presumption that skeletally immature children with fracture-negative radiographs should be immobilized with a cast given the concern for an occult Salter-Harris 1 fracture. “Children do not get sprains” is a common teaching point. But a recent 2016 JAMA Pediatrics article challenges that premise in a prospective cohort study of 135 pediatric patients.1 Can these injuries be managed more like a sprain, utilizing a removable ankle brace?

“That is part of the beauty of all literature. You discover that your longing are universal longings, the you’re not lonely and isolated from anyone. You belong. ” – F. Scott Fitzgerald If the mark of a person are the people they have directly influenced, then Dr. Ed Newton is in rarefied company. He trained in Emergency Medicine at LAC+USC at a time where there were serious concerns about the legitimacy and the long-term future of the field. After finishing a fellowship in medical toxicology, he has held nearly every position in the LAC+USC Department of Emergency Medicine. He is a former Program Director, Vice-Chair, and Chair. During his time he had played a direct role in shaping the careers of people like Drs. Billy Mallon, Stuart Swadron, Jan Shoenberger, Mel Herbert, and a long list of who’s who in Emergency Medicine. Beyond the department, his influence stretches nationally through his work with AAEM, SAEM, ACEP, ABEM and the AMA and internationally through his work in Haiti, Ghana, Nepal, Mexico, India, and Sierra Leone. Knowing him, you are struck not by his gravitas but by his gentleness and depth of thought. We are excited by the opportunity to have him share his recommendations in this Book Club: Beyond the ED post and to give you a sliver of the Ed Newton that has touched so many of us.

Often in the prehospital setting, naloxone is administered by EMS (or possibly a bystander) to reverse respiratory and CNS depression from presumed opioid overdose. The patient then wakes up, and not uncommonly, refuses transport to the hospital. The question is: Is it safe to ‘treat and release?’ Or, rather, what is the risk of death associated with this practice. Last updated: January 2, 2019

Sometimes what initially appears to be a psychiatric illness turns out to be an organic illness, and vise versa. In our assessment of the patient with altered behaviour, it is critical to drill down and dissect apart the type of hallucinations a patient might be displaying, whether the demented patient is simply suffering from worsening dementia or alternatively has acute delirium (which carries a high mortality rate), and whether their somatic complaints might be due to depression or a psychotic psychiatric illness. In anticipation of our upcoming episode on Medical Clearance of the Psychiatric Patient Dr. Brian Steinhart tells the story of his Best Case Ever, reminding us of some of the clinical clues that can help us in our approach to the patient with altered behaviour, so that we avoid misdiagnosing a psychiatric illness with an organic one, or even worse, an organic illness with a psychiatric one... The post Best Case Ever 48 – Organic vs Psychiatric Illness appeared first on Emergency Medicine Cases.