Tactical Medicine News Blog

Background: Irrigation after incision and drainage (I&D) of an abscess in the ED is considered by some sources to be standard care but local practice varies considerably. There are no randomized controlled trials to date that look at the potential benefits of this procedure. Irrigation increases the time required for the procedure and increases pain experienced by the patient.

Dr. Rowe is an emergency physician practicing at the University of Alberta. Having worked in different departments and taken on a number of different leadership roles, Dr. Rowe has certainly figured out a way to keep healthy and stay well. Having been an avid soccer player in the past, he continues to keep up his fitness, by incorporating activity into his daily routine. Keep reading to check out his wellness pearls! Here’s how he stays healthy in EM!

Dr. Kalanithi was a chief resident in Neurosurgery at Stanford University when he was diagnosed with stage IV lung cancer. “When Breath becomes Air,” is a touching chronicle of his initial journey into medicine and neurosurgery and subsequent transition to the role of patient after his cancer diagnosis. This profoundly moving memoir is a tribute to his young life and family that he had to leave behind, but also a sad glimpse of the potential that this promising young doctor and author never will attain.

Background: Peripheral venous cannulation is the most frequently performed procedure in the Emergency Department (ED). The vast majority of patients admitted to the hospital will leave the ED with an intravenous catheter (IV). While these devices typically have a “life-span” of 72 hours from placement, they often fail prematurely as a result of infection, phlebitis, occlusion or dislodgement. IV dislodgement is a particular bane to emergency providers and nurses because it often occurs during the patient’s ED stay requiring repeated cannulation and the associated expenditure of time and resources not to mention the additional pain/discomfort to the patient. Inadequate fixation of the catheter is a likely cause of dislodgement but may also contribute to infection and phlebitis due to small movements leading to microtrauma to the vein. Medical-grade skin glue (cyanoacrylate) has been demonstrated to reduce peripheral arterial line failure rate in prior studies but has not been extensively studied for peripheral IV securing.

Welcome back to the April 2016 edition of REBELCast. For this episode I was lucky enough to get Scott Weingart on the show to talk to us about all things Apneic Oxygenation (ApOx). ApOx is a concept that has been around for some time in the operating room literature, but only recently been gaining acceptance in the ED, especially after the publication of this concept by Scott and Richard Levitan in the Annals of Emergency Medicine in 2011 [1]. Many nay sayers will argue that the OR studies were in controlled settings with elective surgical patients who were not in critical condition. The believers would argue that ApOx makes sense, its low cost,  and low complexity.  To date there has been no randomized controlled trials (RCTs) on ApOx in the ED.  There has been one ICU Trial (i.e. The FELLOW Trial) [2] and an even more recent observational trial in the ED [3] that have been published on the topic of ApOx. So the question remains: Is Apneic Oxygenation Overhyped?