Tactical Medicine News Blog

The Case of the Terrible Code outlined a scenario where a resident observed a resuscitation that was not going well. Should he intervene even though the code leader was an attending? How? This month the MEdIC team (Brent Thoma, Sarah Luckett-Gatopoulos, Tamara McColl, Eve Purdy, John Eicken, and Teresa Chan), hosted a discussion around these questions with insights from the ALiEM community. We are proud to present to you the Curated Community Commentary and our 3 expert opinions. Thank-you to all our participants for contributing to the very rich discussions last week.

Congratulations to the Class of 2016 graduating class of emergency medicine residents! It is the end of a chapter and a beginning of another. For those of us practicing medicine for so many years, there are many things that we would have done differently… especially in that first year post-residency. In the following infographic, we present crowdsourced reflections and advice for residency graduates from the the UCSF Department of Emergency Medicine faculty.

Background: Hemorrhagic stroke accounts for 11 – 22% of strokes, half of all stroke deaths, and a significant amount of disability in many of the remaining survivors. Spontaneous, non-traumatic, intracerebral hemorrhage (ICH) accounts for 2/3 of hemorrhagic strokes; estimated at > 2 million ICHs each year. To date several studies have suggested that antiplatelet therapy use before ICH might worsen outcomes by increasing the risk of early ICH volume growth, due to platelet dysfunction, and pathophysiologically this makes sense. Platelet transfusion has been used therapeutically in many clinical settings for acute ICH, but there is a paucity of randomized trials investigating its effectiveness for reducing death or dependence. 

Case: A 58 year-old female presents with a one-day history of worsening right lower extremity pain and swelling, and an acute onset of dyspnea. Her past medical history consists of stage IV renal cell carcinoma diagnosed six months previously. Triage vitals are remarkable for a heart rate of 120 beats per minute and a blood pressure of 68/48 mmHg. What is the diagnosis?  

“Medicine is the most information-rich, knowledge-intensive human activity, probably ever.” — Matthew Burton in The Digital Doctor Medicine is becoming an even more information-intensive field as we continue to make new medical discoveries. This, among many other reasons, has prompted increasing efforts over the past couple of decades to develop computerized systems in healthcare. Through this lens, Dr. Robert Wachter examines modern medicine – both the achievements and downfalls that have manifested.