Tactical Medicine News Blog

The Case A 500-pound morbidly obese male presents to your ED complaining of mild shortness of breath and palpitations. A quick ECG shows SVT with a rate of 160 bpm. His BP is in the 130s systolic, and he is otherwise stable. You know you have a bit of time. Meanwhile, the nurses begin searching for veins to start an IV… 

There are about 8,000 snakebites per year in the United States and 10% are fatal (see comments)! If this doesn’t scare you enough to view these videos, watch these videos to see Dr. Rahul’s Patwari’s amazing digital drawing skills. In addition to a brief 4-minute overview on snake bites, Rahul also goes more in depth about crotalids (rattlesnakes) and elapids (coral snakes) specifically.

Twitter plays a central role in the continuing medical education for many current and future Emergency Medicine physicians. While there are hundreds of active self-identified EM physicians on Twitter (and perhaps thousands more non-self-identified EM doctors, doctors from other specialties, and students with an interest in the field), Twitter-using EM docs are still the exception, not the rule (Lulic I, Kovic I. Emerg Med J, 2013). Despite the many reasons that an EM doctor can benefit from being on Twitter (my slides from recent SUNY Downstate conference), convincing “would-be’s” to sign up for Twitter accounts frequently presents challenges. Here are some suggestions for bringing new voices to the Free Open Access Medical Education (#FOAMed) conversation happening 24-7 on Twitter.

It’s 7 am on a Monday. Your first patient is an 82 year-old woman who was brought in by EMS from an assisted living facility. All EMS can tell you is that she was not acting herself. You enter her room and introduce yourself. “Hello Mrs. Jones. How are you today?” The woman startles, “Well, you see, I went to put my dog out, and then I was just walking, and couldn’t remember. So it’s all coming full circle, and then I ate a sandwich.” Just then EMS rolls in with another patient, a 75 year-old male coming from home, who was found by his wife in his recliner minimally responsive, with a GCS of 6.  He is followed by a 76 year-old female who had a fall from standing three days ago, and has been increasingly confused today, and is currently oriented only to person.

In the Emergency Department, we too often under-estimate our patients’ likelihood for intimate partner violence (IPV). Unfortunately, there is no perfect screening test to detect this. So one must maintain a high index of suspicion. Once you detect it, what questions should you ask to ensure her/his safety and how do you optimize the resources available to her/him?