Tactical Medicine News Blog

Epistaxis is a common Emergency Department (ED) complaint with over 450,000 visits per year and a lifetime incidence of 60% (Gifford 2008, Pallin 2005). Posterior epistaxis is considerably less common than anterior epistaxis and represents about 5-10% of all presentations. Many patients with posterior epistaxis will be managed with a posterior pack and admitted for further monitoring. Traditional teaching argues that: Patients with nasal packs should be given prophylactic antibiotics to prevent serious infectious complications. Patients with posterior packs should be admitted to the ICU for cardiac monitoring as they are at risk for serious bradydysrhythmias.

A 44-year old woman presents via EMS with a chief complaint of a racing heartbeat. She is placed on a cardiac monitor, which displays a heart rate of 192, and a subsequent EKG reveals she is in SVT. She also complains of chest discomfort and shortness of breath. Her blood pressure is stable, and you decide to treat her with adenosine. As you take a more thorough past medical history, you learn your patient has a history of asthma. One of the EM residents mentions that he thought adenosine should not be given to patients with reactive airway disease.

How I Work Smarter Nominations (Jul 17, 2014-Mar 22, 2015) Today we are taking a break from our regularly schedule program and going meta. FOAM clearly helps break down borders, but sometimes, a look at a map really brings it home. These connections were launched when Dr. Michelle Lin tagged 3 people for their “How I Work Smarter” perspectives, who then each tagged 3 people, and so forth. We have had enough responders (37!) to keep this going for many months. This has cascaded and created a broad virtual international community of smart-working clinicians. Below are more close-up views of the US, UK, and Australia map and a few more insights.

Many residents and medical students are making career decisions that will last a lifetime. Some are aware of the financial considerations while others avoid discussing the topic for fear of being seen as shallow. This month’s ALiEM MEdIC series case considers how we might help a learners as they consider money in medicine. Please join us in discussing the case this month, we would love your thoughts and advice.

This EM Cases episode is Part 1 of The Highlights of The University of Toronto, Divisions of Emergency Medicine, Update in EM Conference from Whistler 2015 with Paul Hannam on Pearls and Pitfalls of Intraosseus Line Placement, Anil Chopra on who is at risk and how to prevent Contrast Induced Nephropathy, and Joel Yaphe on the Best of EM Literature from 2014, including reduction of TMJ dislocations, the TRISS trial (on transfusion threshold in sepsis), PEITHO study for thrombolysis in submassive PE, Co-trimoxazole and Sudden Death in Patients Receiving ACE inhibitors or ARBs, the effectiveness and safety of outpatient Tetracaine for corneal abraisons, chronic effects of shift work on cognition and much more... The post Episode 61 Whistler’s Update in EM Conference 2015 Highlights Part 1 appeared first on Emergency Medicine Cases.