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The ED-AWARENESS Study: Awareness with Paralysis
by Marco Torres
Jun 30, 2022
‘He remembered waking up with someone pulling very hard on his injured leg, which caused severe pain. He thinks he was in the ED. The patient said ...
Tactical Medicine News
Antibiotics in COPD Exacerbations – 2 days vs 7 days
Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are commonly seen in the ED. AECOPD is characterized by a change ...
Tactical Medicine News
The CLASSIC Trial: IV Fluid Restriction in Septic Shock
Background: The Surviving Sepsis Campaign guidelines recommend an initial fixed volume of 30mL/kg of IDEAL body weight within the first 3 hours of ...
Tactical Medicine News
REBEL Core Cast 83.0 – Post-LP Headache
Take Home Points
Post dural-puncture headache affects up to 30% of patients after lumbar puncture.
Suspect PDPH in all patients who recently under...
Tactical Medicine News
REBEL Cast Ep110: The COVI-PRONE Trial – Awake Prone Positioning and COVID-19
Background: Early in the COVID-19 pandemic, clinicians were looking for practical, widely available, and low-cost interventions to help patients wi...
Tactical Medicine News
Tenecteplase vs Alteplase in Acute Ischemic Stroke
Background: At my shop we have changed wholesale to the use of tenecteplase over alteplase for acute ischemic stroke meeting criteria for thromboly...
Tactical Medicine News
EPIC Trial: Electrode Positioning in Cardioverting Atrial Fibrillation
Background Information:
Electrical cardioversion of atrial fibrillation is regularly performed by emergency physicians, intensivists, and cardiolog...
Tactical Medicine News
Traumatic Hemothorax: Pigtail vs Chest Tube
Background: Optimal management of pneumothorax and hemothorax with chest thoracostomy has been widely debated over the last decade. We no longer ...
Tactical Medicine News
REBEL Core Cast 82.0 – Abdominal Aortic Aneurysm
Take Home Points
Consider AAA in patients with acute onset of back or abdominal pain particularly in patients > 50 and in those with a history ...
Tactical Medicine News
Impella Devices 101
Now that I am working up in the ICU, one of the devices that I am frequently coming across is the Impella device. This is not something we get muc...
Tactical Medicine News
The Dirty Epi Drip and IV Flow Rates
Recently, I put out a video on the dirty epi drip (YouTube and TikTok) and in that video I discuss the use of this modality when in a pinch (i.e. c...
Tactical Medicine News
REBEL Core Cast – Basics of EM – Mega Summary – Part 2
Take Home Points
Emergency medicine revolves around the differential diagnosis
History and physical exam should significantly narrow your differen...
Tactical Medicine News
REBEL Core Cast – Basics of EM – Mega Summary – Part 1
Take Home Points
Emergency medicine revolves around the differential diagnosis
History and physical exam should significantly narrow your differen...
Tactical Medicine News
REBEL Core Cast – Basics of EM – Syncope
Take Home Points
Break the differentials down into bad & painless, bad & painful, and other causes – WOMAN-PE
Cardiac causes – mechanical ...
Tactical Medicine News
REBEL Core Cast – Basics of EM – Weakness
Take Home Points
Be prepared to do everything with these cases, if they can’t provide information, dive into their medication list, history, conta...
Tactical Medicine News
REBEL Core Cast – Basics of EM – Dizziness
Take Home Points
Key point is to discern between central and peripheral causes – become familiar with the nuances of one and concentrate on that
A...
Tactical Medicine News
REBEL Core Cast – Basics of EM – Rash
Take Home Points
Examine all parts of the body, even inside the mouth – this can be the difference between benign and life threatening rashes
Trul...
Tactical Medicine News
REBEL Core Cast – Basics of EM – Fever
Take Home Points
Look for the red flags – hypotension, environmental exposures, medications (SS, NMS), SIRS/qSOFA criteria
Be on the lookout for n...
Tactical Medicine News
REBEL Core Cast – Basics of EM – Ankle and Foot Injuries
Take Home Points
Sprains need more support than just an ace wrap – place them in an aircast or a splint
Perform a thorough physical exam – take of...
Tactical Medicine News
REBEL Core Cast – Basics of EM – Leg Pain
Take Home Points
Approach leg pain with the seconds, minutes, hours mindset – think about acute limb ischemia, compartment syndrome, and necrotizi...
Tactical Medicine News
REBEL Core Cast – Basics of EM – Lacerations
Take Home Points
Don’t make bite width to small – look at the curvature of the needle – start the bite at half the curvature of the needle
Don’t p...
Tactical Medicine News
REBEL Core Cast – Basics of EM – Back Pain
Take Home Points
Ask about the red flags: cancer, fever, IVDA, FND, point tenderness, saddle/perianal anesthesia, trauma, urinary retention, bowel...
Tactical Medicine News
REBEL Core Cast – Basics of EM – Vaginal Bleeding
Take Home Points
Get a upreg on any childbearing age female with vaginal bleeding – this is an ectopic pregnancy until proven otherwise
Confirm va...
Tactical Medicine News
REBEL Core Cast – Basics of EM – Lower Abdominal Pain
Take Home Points
Get a upreg on every female patient of child bearing age with lower abdominal pain – this is an ectopic pregnancy until proven ot...
Tactical Medicine News
REBEL Core Cast – Basics of EM – Diffuse and Flank Abdominal Pain
Take Home Points
Diffuse abdominal pain can be anything – keep a broad differential and work from there
Old patient and flank pain = aortic catast...
Tactical Medicine News
REBEL Core Cast – Basics of EM – Epigastric Pain
Take Home Points
Patients don’t necessarily know what’s important – ask lots of questions, find out if they’ve been taking a ton of NSAID’s or Tyl...
Tactical Medicine News
REBEL Core Cast – Basics of EM – Introduction to Abdominal Pain
Take Home Points
Go in thinking sick vs not sick – this can take time to develop and that’s ok, this skill will come as you see more patients
If y...
Tactical Medicine News
REBEL Core Cast – Basics of EM – Vomiting
Take Home Points
Think about causes – is it the head, the belly, or something else leading to the vomiting
Get a upreg on all females of childbear...
Tactical Medicine News
REBEL Core Cast – Basics of EM – Chest Pain
Take Home Points
Take chest pain seriously – ACS and PE patients don’t always appear ill – look for the silent killer cases
Remember 4-2-1 approac...
Tactical Medicine News
REBEL Core Cast – Basics of EM – Asthma
Take Home Points
Wheezing can be absent when severe – be wary of the silent chest = impending respiratory failure
Not everything that wheezes is a...
Tactical Medicine News
REBEL Core Cast – Basics of EM – Shortness of Breath
Take Home Points
Keep a wide differential
Think of the airway, lungs, heart, blood, kidneys, acid/base, brain
Use Wells & PERC consecutively t...
Tactical Medicine News
REBEL Core Cast – Basics of EM – COVID-19
Take Home Points
Constantly evolving disease with various presentations
Identify those that are hypoxic are deliver appropriate oxygen therapy
Giv...
Tactical Medicine News
REBEL Cast – Basics of EM – Cough
Take Home Points
Be aware of the red flags – fever, HIV, hemoptysis, TB risk factors
Is the onset acute or chronic
Characterize sputum production ...
Tactical Medicine News
REBEL Core Cast – Basics of EM – Sore Throat
Take Home Points
Look for the red flags – fever, drooling, neck stiffness, toxic ingestion, uvula deviation, voice changes
Steroids help with swel...
Tactical Medicine News
REBEL Core Cast – Basics of EM – Intoxication
Take Home Message
Do not ignore abnormal vital signs – they can be the harbinger of badness
Watch out for developing withdrawal, treat early and a...
Tactical Medicine News
REBEL Core Cast – Basics of EM – AMS
Take Home Points
Walk in – decide sick/not sick
Do I need help now? If so, call in the troops
Stable – start asking questions – A LOT OF THEM
Inve...
Tactical Medicine News
REBEL Core Cast – Basics of EM – Eye Complaints
Take Home Points
Always check the vital signs of the eye – visual acuities, field of vision, ocular pressure
Go in thinking whether you have to ca...
Tactical Medicine News
REBEL Core Cast – Basics of EM – Head Injury
Take Home Points
Patients >65 or suspected of intoxication are at high risk for bleeds – scan them!!
Epidural has a lucent period – be wary of ...
Tactical Medicine News
REBEL Core Cast – Basics of EM – Headache
Take Home Points
Hypertension rarely causes headache, it’s usually the other way around. Patients with headaches are in pain, and in turn, may hav...
Tactical Medicine News
REBEL Core Cast – Basics of EM – Introduction
REBEL Core Cast – Basics of Emergency Medicine Podcast
Welcome to the EMRA Basics of Emergency Medicine Podcast. I am your host EJ Wright, and the ...
Tactical Medicine News
Massive Acetaminophen Overdose: Are We Giving Enough N-acetyl-cysteine?
Introduction: Acetaminophen, N-acetyl-p-aminophenol, or APAP, is one of the most commonly used medications worldwide. While it is generally safely ...
Tactical Medicine News
Monkeypox…The Basics
Background: Monkeypox is a poxviridae virus closely related to smallpox (variola). It was first described in humans in 1970 and has since become e...
Tactical Medicine News
REBEL Core Cast 81.0 – Priapism
Take Home Points
Priapism is compartment syndrome of the penis. Ischemia and infarction can occur with prolonged priapism and rapid treatment and ...
Tactical Medicine News
Embedding Fonts into Your PowerPoint on Macs
It’s no secret or surprise that I love presentation design. I love to nerd out on it like I do dissecting recent clinical literature. What is sur...
Tactical Medicine News
REBEL Cast Ep109: The RePHILL Trial
Background: Currently, trauma resuscitation focuses on immediate hemorrhage control, resuscitation with blood products (i.e. PRBCs, plasma) and ear...
Tactical Medicine News
Intermittent Fasting and PLEASE Don’t Just Read the Abstract
Background: There are many lifestyle modification strategies available as a way to aid in weight management. Two in particular include calorie res...
Tactical Medicine News
Race Multiplier in the eGFR Equation: What’s the impact for African-Americans?
Kidneys icon – vector web illustration, easy paste to any background
Background: Race is a sociological construct that affects how clinicians deliv...
Tactical Medicine News
RESCUE-Japan LIMIT Trial
Background: The publication of the MR CLEAN trial in January 2015 changed the face of ischemic stroke care. This was the first study demonstrating ...
Tactical Medicine News
REBEL Core Cast 80.0 – Compartment Syndrome
Take Home Points
Compartment syndrome is a life and limb threatening emergency that requires early recognition, prompt diagnosis and immediate man...
Tactical Medicine News
Using the Word “Quiet“ in the ED
Background: For those who believe in superstition, the superstitious belief that saying the word “quiet” while working in the ED will result in a c...
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