Tactical Medicine News Blog

Acute severe asthma, formerly called status asthmaticus, is defined as severe asthma unresponsive to repeated courses of beta-agonist therapy or subcutaneous epinephrine. It is a medical emergency that requires immediate recognition and treatment. Recently, Anand Swaminathan (Twitter: @EMSwami) gave a lecture to the residents at the University of Texas Health Science Center at San Antonio (UTHSCSA) February 2015. This post is a summary of that lecture on how to manage the crashing asthmatic.

Dr. J. Scott Wieters (@EMedCoach) is a community EM doc turned academician 4 years ago. Looks like Dr. Wieters found his calling. As the Director of Undergraduate Medical Education Texas A&M COM he has received his medical school’s teaching award 4 years yeas in a row, and it’s easy to see why. As a newly FOAMed convert, he has started contributing on the REBELEM blog and has shown some real speaking skills. This up and coming clinician educator was nominated by Dr. Ben Smith. Dr. Wieters took a few moments to graciously share his insights into work, life, and being efficient.

Dr. Chau Pham has got wellness locked down! Throughout her life, she has always somehow created an environment of wellness while adapting to various situations. Most recently she used these skills to weather the many challenges of being a new mother. Despite having two little ones at home, she still wears many other hats, including the Director of Medical Missions for the national charity, Canadians Helping Kids in Vietnam. In person, Dr. Chau Pham has an incredible lightness of being and is totally zen! Here’s how she stays healthy in EM!

Medical students, residents and staff alike have found themselves in conversations with patients about non-medical topics. But what happens when those topics of conversation become too personal? Please join us in discussing the case of the flirtatious patient. We would appreciate your thoughts and advice.

Background: Vasopressors are frequently used in critically ill patients with hemodynamic instability both in the emergency department (ED) as well as intensive care units (ICUs). Typically, vasopressors are given through central venous catheters (CVCs) as opposed to peripheral intravenous (PIV) access due to the concerns about adverse events (i.e. tissue ischemia/necrosis) associated with extravasation through PIVs. In a truly hypotensive, critically ill patient the use of a PIV to administer vasopressors will allow the medication to stabilize the patient sooner and reduce the time to hemodynamic stability. The requirement to start vasopressors through a CVC may delay administration of pressors. Also, performing the insertion of a CVC in a hypotensive patient in an emergency circumstance versus an elective circumstance may increase the risk of adverse events from the procedure itself (i.e. bacteremia, pneumothorax, arterial puncture). Finally, most of the evidence cited for avoiding PIV administration of pressors is a sparse collection of case studies and expert opinion.