Tactical Medicine News Blog

The ACLS-recommended dosing strategy of 6 mg, 12 mg, and 12 mg for adenosine may not be appropriate in every situation. There are a few instances when lower or higher dosing should be considered. Caveat: All recommendations are data-based, but many factors affect successful conversion of paroxysmal supraventricular tachycardia (PSVT) including proper line placement and administration technique.

I am in the process of creating a PV card on metacarpal fractures, divided into anatomical areas (base, shaft, neck, head), and am realizing that the EM and orthopedic literature don’t quite agree. Actually they are quite vague on whether reductions should occur in the ED vs orthopedics clinic in the next few days. Do you need to close-reduce all angulated fractures in the ED, which are outside of “acceptable” angulations? What exactly are “acceptable” angulations? Some sources say that angulations of 10, 20, 30, and 40 degrees are acceptable for MC neck fractures and only 10, 10, 20, and 20 degrees are acceptable for MC shaft fractures. These numbers, though, vary from reference to reference.

Subclavian central lines are commonly touted as the central line site least prone to infection and thrombosis. The problem is that they are traditionally performed without ultrasound guidance. They are done blindly because of the transducer’s difficulty in getting a good view with the clavicle in the way.

Below are the next 3 video installments of Dr. Rahul Patwari’s digital whiteboard talks on ACLS. These videos cover: Cardiac arrest (Vfib and Vtach) Cardiac arrest (More of Vfib and Vtach) Cardiac arrest (Asystole and PEA) I love that each video is less than 15 minutes long. Also, even if you aren’t a medical student, these are great refreshers. For instance, don’t forget that atropine is no longer on the 2010 ACLS algorithm for asystole.

“So there’s a patient, and umm…  they are in the hallway, they came to the ED today for breathing problems, I mean dyspnea.  They also don’t speak any English.  So, uh the respiratory rate is normal, and they had a blood clot, er… I mean PE, in the past, but not on coumadin anymore.  Shoot, I forgot to tell you my exam…they had pitting edema for 3 months.  By the way, the labs came back on that other anemic patient in the other hallway, and they are really anemic…” – Anonymous medical student Sounds familiar? Imagine working in a hectic ED while listening to this chaotic presentation.  What’s the secret to presenting patients?