Tactical Medicine News Blog

Background: As emergency providers we must be smarter than our ECG machines. Many times subtle findings on ECGs are not read by the machine, but we must be the experts at making the distinction between findings that require emergent treatment versus more benign etiologies. One specific set of diagnoses that can be very difficult to distinguish from each other is inferior STEMI vs Pericarditis. ECG experts discuss strategies such as looking at morphology of ST-segments (i.e. concavity or convexity), but this is not always accurate. Another, frustrating fact is that ST-elevation in the inferior leads (II, III, aVF) is typically seen with inferior STEMI and pericarditis. We therefore need a finding that has both a high sensitivity and specificity for MI.

Below we have listed our selection of the 6 highest quality blog posts related to 4 advanced level questions on trauma topics posed, curated, and approved for residency training by the AIR-Pro Series Board. The blogs relate to the following questions: When to give tranexamic acid in the trauma patient The pregnant trauma patient Transfusions in the trauma patient Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) In this module, we have 6 AIR-Pro’s and we did not include any honorable mentions to prevent redundancy of the topics covered. To strive for comprehensiveness, we selected from a broad spectrum of blogs identified through FOAMSearch.net.

Background: We have already discussed the value of a good history in assessing patients with chest pain on REBEL EM. What is known about chest pain is that it is a common complaint presenting to EDs all over the world, but only a small percentage of these patients will be ultimately diagnosed with Acute Coronary Syndrome (ACS). This complaint leads to prolonged ED length of stays, provocative testing, potentially invasive testing, and stress for the patient and the physician. For simplicity sake, we will say that, looking at the ECG can make the diagnosis of STEMI. What becomes more difficult is making a distinction between non-ST-Elevation ACS (NSTEMI/UA) vs non-cardiac chest pain. ED physicians have different levels of tolerance for missing ACS with many surveys showing that a miss rate of <1% is the acceptable miss rate, but some have an even lower threshold, as low as a 0% miss rate. Over testing however, can lead to false positives, which can lead to increased harms for patients. In November 2015, a new systematic review was published reviewing what factors could help accurately estimate the probability of ACS.

Dr. Matt Fields is an emergency physician and Director of the Ultrasound Fellowship program at Thomas Jefferson University. For Dr. Fields, a large part about staying well is prioritizing and keeping things in perspective. His strategies for wellness include constant reflection, knowing your limits, and having activities that allow you to decompress. His love for running, allows him to stay active and appreciate his surrounding environment. Check out how he stays healthy in emergency medicine!

As a busy Emergency Physician, I find that I am always happier when I have a mystery novel to read during my free time. I’ve been a mystery fan since I was a kid, growing up on Nancy Drew and Encyclopedia Brown. Below I’d like to share some of my favorites. These authors are chosen for quality and readability with a preference for the prolific. If you like one of their books, you will likely find ten more.