Tactical Medicine News Blog

The Toxicologist Mindset series features real-life cases from the San Francisco Division of the California Poison Control System. A 21-year-old man with history of opiate abuse was brought in by ambulance after 2 episodes of syncope and 1 episode of self-limited ventricular fibrillation. On initial presentation, the patient was found altered and unresponsive. His mental status improved after the administration of naloxone. On further history, the patient reported ingesting 50 -100 tablets of loperamide (2 mg) daily. A rhythm strip was obtained.  

Background: When it comes to treating community acquired respiratory tract infections, macrolide antibiotics (azithromycin, clarithromycin, and erythromycin) are a common choice of agent. In 2010, 57.4 million macrolide prescriptions were written in the U.S. with azithromycin being the most commonly prescribed individual antibiotic agent overall with ~51.5 million prescriptions (Hicks 2013). With more and more patients being prescribed macrolide antibiotics, an increasing amount of research has been put forth dealing with the safety concerns regarding these medications; specifically the thought that azithromycin use can lead to fatal ventricular arrhythmias. In addition to case reports a 2012 observational study published in the New England Journal of Medicine highlighted an association between  azithromycin use and higher rate of both cardiovascular death and all-cause mortality (Ray 2012). This prompted the US Food and Drug Administration to issue warnings about the use of azithromycin and potential QT-interval prolongation and fatal ventricular dysrhythmias. However, recent studies suggest that these concerns and warnings may not be accurate. A retrospective cohort study comparing older patients hospitalized with pneumonia that were treated with azithromycin to those who received other guideline appropriate antibiotics actually showed a lower risk of 90-day mortality in the azithromycin group. Further, there was no significant difference between the 2 groups in regards to risk of arrhythmia, heart failure or any cardiac event. (Mortensen 2014).

“The more that you read, the more things you will know. The more that you learn, the more places you’ll go.” – Dr. Seuss Dr. Mike Gisondi is the program director of the Northwestern Emergency Medicine Residency as well as a leader in medical education, faculty development, and palliative care. He has been recognized both locally and nationally for his work, receiving the 2014 ACEP National Emergency Medicine Faculty Teaching Award as well as being appointed as the director of the Feinberg Academy of Medical Educators (FAME). For readers of ALiEM he is probably best known as the host of the EM Match Advice Series. Most importantly, for those of us whom he has directly touched, we know him for his caring, support, wit, and depth of thought. We are excited to have Dr. Mike Gisondi share his book recommendations.

Dr. Megan Fix is an emergency physician at the University of Utah. For her, staying healthy is all about maintaining your balance, keeping activating, fostering healthy relationships, and knowing and loving oneself. Despite her busy schedule as the Associate Program Director, she makes a point to still keep family time for her husband and her boys. Her positive attitude about life long learning and going with the flow is something we could all learn from. Here’s how she stays healthy in EM!

The Problem Many residents regularly consume FOAM (Free Open Access Medical Education) and online educational materials independently, without faculty guidance or input. At the same time, residency programs are looking for ways to provide high-quality asynchronous learning opportunities to their residents while remaining compliant with the Emergency Medicine Residency Review Committee (RRC-EM) Accreditation Council for Graduate Medical Education (ACGME) guidelines.