Tactical Medicine News Blog
Trick of the Trade: Parting the hair for scalp laceration repair
Posted by Jeff Wiswell, MD on
Trying to suture or staple a scalp laceration is oftentimes a hairy proposition for emergency physicians who repair these types of wounds regularly. Although the “hair apposition technique” method is one option, if one opts for sutures or staples, the most difficult part of the procedure is trying to avoid trapping hair strands within the wound, which may cause wound dehiscense, a foreign body reaction, or a local infection.
ProCESS Study: Identify sepsis early and treat aggressively
Posted by Michelle Lin, MD on
Today, the New England Journal of Medicine just released a landmark paper by the ProCESS (Protocolized Care for Early Septic Shock) trial investigators. There has already been much buzz about this on various blogs and websites, including St. Emlyn’s, MedPageToday, and MDAware. I received an email from my colleague Dr. Michael Callaham, who shared some direct comments and pearls from Dr. Donald Yealy, (professor and chair of emergency medicine from the University of Pittsburgh Medical Center) who was the first author of this writing team. Thank you to Dr. Yealy for allowing me to share your team’s comments with the ALiEM readership.
Article: Elevated INR May Overestimate Coagulopathy in Trauma and Surgical Patients
Posted by William Paolo, MD on
A 55 year old woman presents as the driver of a motor vehicle collision. She has moderate abdominal tenderness diffusely and a seat belt sign, but has a negative abdominal/pelvis CT. Her INR, however, was noted to be 2.1. She is not on any vitamin K antagonists. The surgeons admit her to the hospital to observe for a potential hollow viscus injury and requests that you order 2 units of FFP for her. Seems reasonable… or is it? What is the logic?
Trick of the Trade: Nasopharyngeal Oxygenation
Posted by Bradley Ching, MD on
A 76-year-old obese male with a history of severe COPD presents to your emergency department (ED) in acute respiratory distress. The patient’s large beard prevents an adequate seal with the NIV (non-invasive ventilation) mask, and the patient continues to desaturate. You are fairly sure that this patient will be a difficult airway and optimizing oxygenation prior to and during your intubation attempt would be ideal. Now what?
ALiEM Bookclub: What Doctors Feel
Posted by Jordana Haber, MD on
How do emotions affect the practice of medicine? This is the complex theme behind the latest book by Dr. Danielle Ofri, What Doctors Feel, and the topic of this month’s ALiEM bookclub discussion.