Tactical Medicine News Blog

Welcome to the Orthopedics Upper Extremity Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index the ALiEM AIR Team is proud to present the highest quality orthopedic upper extremity content. Below we have listed our selection of the 14 highest quality blog posts within the past 12 months (as of March 2016) related to orthopedic upper extremity emergencies, curated and approved for residency training by the AIR Series Board. More specifically in this module, we identified 2 AIRs and 12 Honorable Mentions. We recommend programs give 5 hours (just over 20 minutes per article) of III credit for this module.

Welcome to the Orthopedics Lower Extremity Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index the ALiEM AIR Team is proud to present the highest quality orthopedic lower extremity content. Below we have listed our selection of the 3 highest quality blog posts within the past 12 months (as of March 2016) related to orthopedic lower extremity emergencies, curated and approved for residency training by the AIR Series Board. More specifically in this module, we identified 1 AIRs and 2 Honorable Mentions. We recommend programs give 1 hour (20 minutes per article) of III credit for this module.

It is with great pleasure that we announce the first edition of the ALiEM In-Training Exam Prep Book in both PDF and iBook form. This free book was a year-long project from the Chief Resident Incubator, led by the Editors Dr. Michael Gottlieb, Dr. Dorothy Habrat, Dr. Margaret Sheehy, Dr. Samuel Zidovetsky, and Dr. Adaira Chou with the support of Associate Editors Dr. Nikita Joshi and Dr. Michelle Lin. Over 90 EM residents and faculty from the Incubator and across U.S. emergency medicine residency programs contributed board-review type questions. Five practice tests are included for those preparing for the in-training exam (also known as the in-service exam) or even for the ABEM written board exam. You can download the free PDF or iBook below.

The lumbar puncture (LP) procedure is commonly performed in the Emergency Department (ED). While minor complications of LP such as post-procedure headache or back pain occur somewhat regularly, significant complications such as post-procedural spinal hematomas, are rare.1 Despite their low incidence, these spinal hematomas are associated with a significant amount of morbidity for the patient and increased medicolegal risk for the provider.

Background: The best way to resuscitate critically ill patients with fluids has been a hotly debated topic in the FOAMed and Critical Care worlds. Fluids are important to optimize stroke volume and distal tissue perfusion, however, the administration of excessive fluids for shock can increase a patient’s morbidity and mortality by causing volume overload, which may lead to tissue edema and subsequently inadequate blood flow to tissues [1]. Accurately predicting when, whom, and how much fluid to administer remains a very challenging clinical question as only half of critically ill patients increase their cardiac output in response to the administration of fluids (i.e. the patient is preload or fluid responsive) [1]. Clinical signs and pressure/volumetric static variables are unreliable predictors of fluid responsiveness [1]. Ventilator-induced dynamic variables such as stroke volume variation and pulse pressure variation, however, have been shown to be more accurate in predicating fluid responsiveness. These tests can only be applied when several criteria are present (e.g., sinus heart rate, mechanical ventilation with a tidal volume of 8-10cc/kg of ideal body weight). Passive leg raise (PLR) is another method to assess preload responsiveness. PLR produces a temporary and reversible increase in ventricular preload through an increase in venous return from the lower extremities, which mimics fluid administration without actually having to give exogenous fluids. This sounds great in theory, but PLR requires a hemodynamic assessment to be made during the maneuver to determine if the patient is preload responsive or not. There are multiple techniques for assessing changes in stroke volume but the diagnostic performance of each method still remains unknown. The two most commonly described methods are changes in pulse pressure variation and variables of flow.