Tactical Medicine News Blog

The acute episode of intoxication and agitation has subsided and your patient is calm. She has been medically cleared and is ready to be moved to a less acute, less monitored portion of the ED to await further assessment and treatment for her underlying psychiatric conditions. As a well-intentioned emergency medicine practitioner, you wish to give your patient the tools she needs to maintain this calm status by restarting her home atypical antipsychotic medication. What is the best way to go about doing this?

Patients with corneal abrasions typically come to the emergency department for eye pain.  Most physicians treat these with topical antibiotics, oral analgesia, and for those who are lucky enough 48 – 72 hour follow up with ophthalmology. Oral analgesia does a poor job of controlling these patients pain. Tetracaine is an esterase type anesthetic with a onset of action of 10 – 20 seconds and a duration of action of 10 – 15 minutes.  Use of topical anesthetics are very effective at reducing pain, but there use is discouraged secondary to poor wound healing of the corneal epithelium.  So what is the evidence for topical anesthetic use on corneal abrasions?

We go through school without realizing if our learning strategies are inefficient even more so when some assessments support these practices as opposed to discourage it. Unfortunately, exams and graduation run the risk of giving us a sense that learning is over, that what we have learned does not change, or that there are not more effective ways of learning. There is no way of unlearning what we have learned in the past, so it’s always a sensible practice to reassess our knowledge on a constant basis. 

You are spending a month in rural Kenya, doing an ultrasound teaching course. Your enthusiastic participants have been ultrasounding every chance they get. Unfortunately, this has caused your ultrasound gel supplies to dwindle. It will be a month before a new shipment of gel arrives from Nairobi. This gel will cost about $5 per bottle, which is a considerable expense for the local hospital’s budget.

Hyperkalemia is an electrolyte abnormality seen in the emergency department as well as in hospitalized patients and it can be associated with adverse clinical outcomes and death if not treated appropriately. It is important to remember that the electrophysiologic effects of hyperkalemia are directly proportional to both the absolute plasma potassium and its rate of rise. However, neither the ECG nor the plasma potassium alone are an adequate index of the severity of hyperkalemia, and therefore providers should have a low threshold to initiate therapy. Classic teaching of the chronological ECG changes of hyperkalemia include: Peaked T waves Prolongation of PR interval Widening QRS Complex Loss of P wave “Sine Wave” Asystole