Tactical Medicine News Blog

In the first of our series on Highlights from North York General's Emergency Medicine Update Conference, Dr. Kylie Boothdiscusses Backboard and Collar Nightmares. The idea that backboards and c-spine collars prevent spinal cord injuries came from level 3 evidence in the 1960's and there has never been an RCT to prove this theory. In fact a Cochrane review on the topic in 2007 concluded that "the effect of pre-hospital spinal immobilisation on mortality, neurological injury, spinal stability and adverse effects in trauma patients remains uncertain" and that "the possibility that immobilisation may increase mortality and morbidity cannot be excluded". There have subsequently been several observational studies that describe increased morbidity and mortality associated with backboard and collars in a subset of patients. Dr. Booth argues that the time has long past that a major paradigm shift needs to occur toward a safer more rational use of backboards and collars in our trauma patients. The post Episode 66 Backboard and Collar Nightmares from Emergency Medicine Update Conference appeared first on Emergency Medicine Cases.

Case: An 84 year old female presents with five days of a diffuse rash. She had a seizure and was started on phenytoin 2 weeks ago. Her mouth, labia, and medial canthi are involved. There are scattered areas of desquamation comprising less than a tenth of her total body surface area. She is tachycardic and febrile. Her complete blood count differential is normal. What is the diagnosis?

Background: Intravenous morphine use has been reported in nearly one of seven patients hospitalized with acute decompensated heart failure (ADHF). I have anecdotally, even seen physicians giving morphine as a “first-line” agent: Nitroglycerine, Non-Invasive Positive Pressure Ventilation (NIPPV), and Morphine. There is surprisingly little evidence supporting routine use of morphine in ADHF, and no major American cardiology or emergency medicine society has really endorsed or published any recommendations on the treatment of ADHF with morphine. Most of us were taught the acronym “MONA,” Morphine, Oxygen, Nitroglycerin, and Aspirin for treatment of acute pulmonary edema and commonly, quoted physiologic/clinical beliefs for the use of morphine in ADHF are: beneficial hemodynamic effects, managing anxiety/agitation in air hunger, reduction in preload, and maybe to a lesser extent, afterload, and finally, decreasing heart rate. We should also consider the use of morphine in a framework of risk and benefit. For example intravenous morphine can also have some deleterious effects like causing central nervous system suppression, ventilatory depression, and hypotension. The Acute Decompensated Heart Failure National Registry (ADHERE) is a large multicenter registry that records data from patients hospitalized with ADHF with more than 175,000 hospitalizations from over 250 hospitals across America. To be included in this registry patients must be >18years of age, admitted to an acute care hospital and receive a discharge diagnosis of ADHF. Data for this registry are collected by retrospective chart review and entered via an electronic web-based case report form for all consecutive eligible patients.

The Case of the Flirtatious Patient has been sparse in volume of comments but we’ve still had a really interesting set of comments over the past week. We are now happy to present to you the Curated Community Commentary and our two expert opinions. Thank-you again to all our experts and participants for contributing again this week to the ALiEM MEdIC series.

On a Friday night shift, an ambulance brings you a 52 year-old man who had an episode of syncope at a local club. EMS found him confused and hypoxic with poor skin color. The patient was placed on oxygen via face mask en route to your ED without clinical improvement.  On exam, you note a blue [+] The post Methemoglobinemia: Not the Usual Blue Man With Low SpO2 appeared first on ALiEM.