Tactical Medicine News Blog

Pediatric Advanced Life Support (PALS) guidelines were most recently reviewed in Circulation 2010 1 based on the International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science which includes treatment recommendations. Dr. Rahul Patwari nicely summarizes these findings in this series of 8 videos

On August 30th I posted the first case of the MEdIC (Medical Education In Cases) series that will be facilitated by Dr. Teresa Chan (@TChanMD) and I (@BoringEM). The Case of the Difficult Consult involved a junior resident in the emergency department who had a consult go bad. Our readers were thrust into the role of an attending physician wanting to help.

Motivation is one of those important elements in our personalities that helps us have a drive for improvement. Motivation can come in two flavors internal and external. Self determination theory (SDT) is a psychological term which explains people’s internal motivation and determination to their behavior. Edward L. Deci and Richard M. Ryan explored SDT further and determined there were three basic needs in every human, which are universal, not learned, and seen across gender and culture.

Troponin testing is an important component of the diagnostic workup and management of acute coronary syndromes (ACS). The increasing sensitivity of troponin assays has lowered the number of potentially missed ACS diagnoses, but this has also created a diagnostic challenge due to a decrease in the specificity of the test. From 1995 to 2007, the limit of troponin detection fell from 0.5 ng/mL to 0.006 ng/mL (see below graph). Robert Jesse summed up this frustration with the following quote: When troponin was a lousy assay it was a great test, but now that it’s becoming a great assay, it’s getting to be a lousy test.  

Dr. Katerina Pavenski, on Anticoagulant Reversal in Trauma. A leader in Transfusion Medicine from St. Michael's Hospital, Dr. Pavenski tells us about her Best Case Ever in which a straight forward trauma case turns into a 'bloody disaster', after Prothrombin Complex Concentrates (PCCs) were given in an anticoagulant reversal attempt. In the related two-part epic episode on Antiocagulants, Transfusions & Bleeding, Drs. Pavenski, Dr. Jeannie Callum (Head of Transfusion Medicine at Sunnybrook Hospital & Dr. Walter Himmel (also known as 'The walking encyclopedia of EM') cover: Indications for red cell transfusion in different clinical scenarios (GI bleed, cardiac disease, vaginal bleeding etc), Risks of transfusion including Host vs Graft Disease, TRALI & TACO, Indications for Platelet transfusion in different scenarios (hyporoliferative patients vs ITP, invasive procedures with thrombocytopenia), Managing INRs - indications for Vit K, PCC, adjusting Warfarin Dose, liver patients, Apixaban vs Rivaroxiban vs Dabigatran vs Warfarin and reversal of them, Anti-platelet medication-associated intracranial hemorrhage management, Indications for Tranexamic Acid, and much more........ The post Best Case Ever 18: Anticoagulant Reversal in Trauma appeared first on Emergency Medicine Cases.