Tactical Medicine News Blog

So much attention is appropriately focused on the anatomy and technique for intraosseous needle placement. In contrast, very little attention is paid to securing the needle. Often this involves a make-shift setup which involves gauze, wraps, and/or tape. This becomes especially important in the prehospital setting where these can be easily dislodged. The following trick stems from a Twitter discussion in 2015 amongst prehospital providers, lamenting this fact.

During your shifts in the pediatric ED, you may encounter a few patients with adrenal insufficiency or adrenal crisis. Some of the most common causes include those patients with Addison disease, pituitary hypothalamic pathology, and those patients on chronic steroids. When these patients get sick or sustain trauma, it is important to consider giving them a stress dose of hydrocortisone. Patients in adrenal insufficiency or crisis can present with dehydration, weakness, nausea, vomiting, confusion, lethargy, and severe hypotension refractory to vasopressors. 1–3

The Problem Delivering a curriculum of core content to interns is both a priority and a challenge. Weekly conference provides time to deliver such a curriculum; however, varied rotation schedules limit consistent conference attendance, and intern-targeted content is inappropriate for upper-level residents. We addressed these challenges by implementing a flipped-classroom intern curriculum using training level-specific breakout sessions and a dedicated resource for asynchronous learning.

The ALiEM Medical Education in Cases (MEdIC) Series has been a regular feature of our website for almost 3 years.  It has been previously featured as a Top 5 What Works abstract at the International Conference on Residency Education in 2014. At the time of our ICRE presentation, we presented our free e-book of our first years’ cases.  Now, it’s time for our second edition.

Background: Severe alcohol withdrawal syndrome (AWS) accounts for only 10% of the roughly 500,000 annual cases of AWS episodes that require pharmacologic treatment. AWS is characterized by an imbalance between inhibitory GABA and excitatory NMDA receptor stimulation secondary to chronic ethanol intake. Treatment is typically centered around supportive care and symptom-triggered benzodiazepines. However, some patients are refractory to benzodiazepines, defined as > 10 mg lorazepam equivalents in 1 hour or > 40 mg lorazepam equivalents in 4 hours. Doses exceeding this threshold provide little benefit and put patients at risk for increase morbidity and mortality, over sedation, ICU delirium, respiratory depression and hyperosmolar metabolic acidosis.