Tactical Medicine News Blog

Lumbar puncture is a procedure that is commonly performed in the emergency department (ED) for both diagnostic and therapeutic reasons. Post lumbar puncture (LP) headache is one of the most common complications from LPs (6 – 36% incidence) and is essentially a clinical diagnosis based on a history of a dural puncture and the postural nature of the headache with associated symptoms.  Additionally, post LP headaches that are left untreated can cause impaired ability to perform activities of daily living and there are case reports of subdural hematoma, herniation, and death. In terms of the prevention and treatment of post-LP headaches, both are equally important in management. Following, is a discussion of which techniques and preventative measures are evidence based and which are not.

In the last two years, live tweeting from medical and education conferences has become mainstream. What better way to stay up-to-date with what is being taught around the globe! Pioneers like Dr. David Marcus (@EMIMDoc) even archive all of the conferences with hashtags, Twitter handles, and topic focus on his EM IM Doc blog. 

Medical simulation is not just for the clinical learner. Rather, it can have far reaching impact and can contribute meaningfully to the community. In this post, Dr. Beth Thomas describes the work of Hands Up For Health which uses the power of simulation to reach young people. 

    A healthy 4 year-old boy is brought in by mom for a plastic bead up his nose. The mom states, “The last time the other doctors had to be called, and it took forever. Oh, and I have to pick up his brother from school in 30 minutes. Can you get it out, doc?” The patient is squirming even as you take a quick peek at his nose, but you catch a glimmer of the bead up his right nare.

In this episode Dr. Steinhart, (one of my biggest mentors – the doc that everyone turns to when no one can figure out what’s going on with a patient in the ED), & Dr. Dave Dushenski, (a master of quality assurance and data analysis, who would give David Newman a run for his money), discuss the 4 diagnoses that make up the deadly & difficult diagnosis of Mesenteric Ischemia, it’s key historical and physical exam features, the value of serum lactate, D-dimer & blood gas, when CT can be misleading, ED management of Mesenteric Ischemia, the difficult post-ERCP abdominal pain patient, the pitfalls in management of Pancreatitis, the BISAP score for Pancreatitis compared to the APACHE ll & Ranson Score, the comparative value of amylase and lipase, ultrasound vs CT for pancreatitis and much more… The post Episode 42: Mesenteric Ischemia and Pancreatitis appeared first on Emergency Medicine Cases.