Tactical Medicine News Blog

In the way that we can be inspired and changed by the actions of others, we can be inspired and changed by the books we read. In this series, ALiEM Bookclub: Beyond the ED, we hope to introduce you to a selection of books as seen through our guests’ eyes. Our first guest is Dr. Lewis Goldfrank, Chair of Emergency Medicine at NYU – Bellevue. He is well known as one of the founders of both Emergency Medicine and Medical Toxicology. In addition to his accomplishments within Emergency Medicine, for many he is best known as the spiritual leader of the humanistic mission of Emergency Medicine. We are excited to have him as our inaugural post of this new series.

You are working as an EM resident and have just evaluated a patient with a right long finger DIP joint dislocation. You perform a digital nerve block with 1% lidocaine with 1:100,000 epinephrine, and go to present to your attending before attempting the reduction. Your attending, on hearing about the epinephrine use goes berserk, and says “don’t you know that you shouldn’t use epi in fingers, noses, ears and toes?”. When confronted with this situation we all like to have a one stop valid literature review to produce that validates our practice. Several social media authors have weighed in on this topic, however blogs sometimes don’t cut it for those unfamiliar with the current quality of peer reviewed online content. The use of epinephrine in digital nerve blocks has been shown to increase duration of action for the anesthetic, and to allow the avoidance of bupivacaine, thereby decreasing the pain of the injection. (REBEL flashback)

Case: A 22 year old female presents with a rash on her left arm for several days. She states she has previously had the exact same rash in the exact same location intermittently over the past 2 years. She has no systemic symptoms and has started no new prescription medications, though she has been taking ibuprofen. What is the diagnosis?

I caught up with airway educator, innovator and self-described enthusiast Dr. Richard Levitan at SMACC in Chicago this past June. In this Best Case Ever on Airway Strategy and Mental Preparedness in EM Procedures, Dr. Levitan uses a great save of his in a penetrating trauma case as a basis for discussion on mental preparedness and how we've been thinking about our general approach to emergency procedures the wrong way. Rather than fixating on the final goal of a procedure, which can often be daunting and lead us astray, he suggests a methodical incrementalized and compartmentalized approach to EM procedures that reduces stress and fear, improves confidence and enhances success. He runs through several examples including intubation, cricothyrotomy and initial approach to hypoxia to explain his Simple Incremental Approach to EM Procedures. Could this be a paradigm shift in the way we think about procedures in EM?.... The post Best Case Ever 39 – Airway Strategy & Mental Preparedness in EM Procedures with Richard Levitan appeared first on Emergency Medicine Cases.

I caught up with airway educator, innovator and self-described enthusiast Dr. Richard Levitan at SMACC in Chicago this past June. In this Best Case Ever on Airway Strategy and Mental Preparedness in EM Procedures, Dr. Levitan uses a great save of his in a penetrating trauma case as a basis for discussion on mental preparedness and how we've been thinking about our general approach to emergency procedures the wrong way. Rather than fixating on the final goal of a procedure, which can often be daunting and lead us astray, he suggests a methodical incrementalized and compartmentalized approach to EM procedures that reduces stress and fear, improves confidence and enhances success. He runs through several examples including intubation, cricothyrotomy and initial approach to hypoxia to explain his Simple Incremental Approach to EM Procedures. Could this be a paradigm shift in the way we think about procedures in EM?.... The post Best Case Ever 39 – Airway Strategy & Mental Preparedness in EM Procedures with Richard Levitan appeared first on Emergency Medicine Cases.