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Tactical Medicine News

Trick of the Trade: Managing Epistaxis with Merocel Nasal Packing and an Angiocatheter

by Christopher Joseph
Nov 11, 2022
There are many ways to manage epistaxis. Once nasal clamping and cauterization fail, the next step is to consider using tranexamic acid (TXA) and p...
Tactical Medicine News

In-Office Pediatric Ear Tube Procedures: Interview with Preceptis Medical’s Greg Mielke4

Preceptis Medical, a medtech company based in Minnesota, created the Hummingbird Tympanostomy Tube System. The device allows ear, nose, and throat ...
Tactical Medicine News

Smartphone and Cheap Earbuds for Accessible Newborn Hearing Test

Researchers at the University of Washington have developed a low-cost hearing test for newborns. Traditionally, the equipment for such testing is q...
Tactical Medicine News

Oil-Based Drug Gels Help Patients with Difficulty Swallowing

Researchers at MIT and Brigham and Women’s Hospital have developed a series of oil-based gels that are intended to help those with difficulty swall...
Tactical Medicine News

New Hydrogel Material for Vocal Cord Repair

Researchers at McGill University developed a tough hydrogel that can resist mechanical forces found in the body. However, the material still provid...
Tactical Medicine News

Battery-Free Device Acts as Artificial Cochlea

Researchers at the Huazhong University of Science and Technology in China created a battery-free device that could pave the way for an artificial c...
Tactical Medicine News

SAEM Clinical Image Series: A Rapidly Spreading Rash

A 40-year-old male with a past medical history of HIV presented for evaluation of a non-pruritic rash. Six days ago, he suddenly felt a stinging se...
Tactical Medicine News

Optical Fiber Imaging for Next-Generation Endoscopes

Researchers at the University of Exeter in England have developed a technique to image tissues through an ultrathin optical fiber, potentially allo...
Tactical Medicine News

SAEM Clinical Image Series: Edema Got Your Tongue?

A 57-year-old male presented to the emergency department with a swollen mouth for three hours. He reported never having experienced this before a...
Tactical Medicine News

SAEM Clinical Image Series: Left Ear Mass

A 25-year-old male who was previously healthy presents to the emergency department with a painful left posterior ear mass. The mass began as a “p...
Tactical Medicine News

SAEM Clinical Image Series: The Hemorrhaging Bifurcated Tongue

A 26-year-old male with no past medical history presented to the emergency department for tongue bleeding for one day. Five days prior he had an ...
Tactical Medicine News

SAEM Clinical Image Series: Oral Trauma and Mass

A 38-year-old African American male without a significant past medical history presented with an oral mass. He was struck on the mouth by a wrenc...
Tactical Medicine News

SAEM Clinical Image Series: Worsening Sore Throat

A 40-year-old  male presented to the emergency department (ED) complaining of a sore throat for one week. The patient had presented ten days earl...
Tactical Medicine News

SAEM Clinical Image Series: An Oropharyngeal Mass

A fifty-year-old male presented to the emergency department (ED) unconscious with CPR in progress. Per EMS report, the patient was found down sur...
Tactical Medicine News

Trick of the Trade: Tracheostomy leak temporization

Patients who are tracheostomy and ventilator dependent are at increased risk for complications the longer they remain in this condition. One common...
Tactical Medicine News

Ultrasound for the Win! 18M with dysphagia #US4TW

Welcome to another ultrasound-based case, part of the “Ultrasound For The Win!” (#US4TW) Case Series. In this case series, we focus on a real c...
Tactical Medicine News

PEM Pearls: 5 Tips to Demystify Amoxicillin in Pediatric Infections

Amoxicillin is a penicillin derivative antibiotic against susceptible gram positive and gram negative bacteria. It has reasonable coverage for ...
Tactical Medicine News

SAEM Clinical Image Series: Facial Swelling in a 2 Year Old

[Click for larger view] Chief complaint: Left-sided facial swelling History of Present Illness: A 2-year-old male presents to the emergency de...
Tactical Medicine News

Trick: Peritonsillar abscess drainage 3.0 | All the steps with added variations

A 25-year-old medical student comes in with a muffled voice, sore throat and trismus. You look at the back of her throat and you see the uvul...
Tactical Medicine News

Strep Pharyngitis in Children: Review of the 2012 IDSA Guidelines

Sore throat accounts for a whopping 7.3 million outpatient pediatric visits. Group A Streptococcus (GAS) accounts for 20-30% of pharyngitis cas...
Tactical Medicine News

Tranexamic Acid (TXA) for Everything that Bleeds?

Background: TXA is a synthetic lysine derivative that binds with the lysine site on plasminogen and inhibits fibrinolysis.  TXA is not a new drug. ...
Tactical Medicine News

ACMT Toxicology Visual Pearls: Toxic Mouth Pain

A middle-aged Asian female presents to the emergency department complaining of 2-3 days of mouth pain. She has chewed betel nut for a number of yea...
Tactical Medicine News

ALiEMCards: Tranexamic Acid

Tranexamic acid (TXA) is a synthetic form of the amino acid lysine that binds to receptors on plasmin and prevents it from breaking down fibrin clo...
Tactical Medicine News

Corticosteroids in Pharyngitis – Systematic Review + Meta-Analysis

Background: Sore throat is among the most common complaints in the emergency department (ED). Sometimes, the etiology is bacterial, and in those ca...
Tactical Medicine News

ALiEM AIR Series: Ear, Nose, and Throat (ENT) Module

Welcome to the Ear, Nose, and Throat (ENT) Module! After carefully reviewing all relevant posts from the top 50 sites of the Social Media Index, th...
Tactical Medicine News

PEM Pearls: Regional Facial Nerve Blocks

Regional nerve blocks of the face and ear can be a wonderful choice of analgesia in a child, particularly for wounds that need to be repaired. The ...
Tactical Medicine News

Topical TXA in Epistaxis

Background: Epistaxis is a common Emergency Department (ED) complaint with over 450,000 visits per year and a lifetime incidence of 60% (Gifford 20...
Tactical Medicine News

PEM Pearls: Search & Rescue of Ear Foreign Bodies – Picking the Right Tool

While ear foreign bodies can happen at any age, the majority occur in children less than 7 years of age.1 The younger the patient, the less likely ...
Tactical Medicine News

Epistaxis Management in the Emergency Department: A Helpful Mnemonic

Epistaxis is a common presentation to the emergency department (ED)1 that can be challenging and time consuming. Knowledge of the pearls, pitfalls,...
Tactical Medicine News

Trick of the Trade: A cleaner way to apply dental cement for a tooth fracture

The management of a dental fracture is a core skill of the emergency physician.1 When the enamel is violated and the underlying dentin is exposed (...
Tactical Medicine News

Trick of the Trade: Ear Irrigation in the Emergency Department

Ear irrigation is an important tool for adult and pediatric patients in the Emergency Department (ED) with ENT complaints. Irrigation can be used t...
Tactical Medicine News

Diagnose on Sight: Case of a red, swollen neck

Case: A 78 year-old female with a past medical history of asthma and hypothyroidism presents with a three day history of sore throat and a two day ...
Tactical Medicine News

Trick of the Trade: Extra-oral reduction technique of anterior mandible dislocation

Anterior dislocation of the mandible is a clinical scenario that is not infrequently encountered by the ED provider and requires prompt inter...
Tactical Medicine News

Trick of the Trade: Ear foreign body removal with modified suction setup

A 5 year old boy comes in who has stuck a small unpopped popcorn kernel into each ear. My resident and I discuss  different methods to try to get i...
Tactical Medicine News

Diagnose on Sight: Swollen gums

Case: A 19 year old male with no past medical history presented with 4 days of painful oral lesions, swollen gums that bled easily, and fever. His ...
Tactical Medicine News

Trick of the Trade: Pediatric video laryngoscope for ear foreign bodies

It is near the end of your shift and one of the nurses asks you to see a fellow ED staff member’s nine-year old daughter who has accidentally put a...
Tactical Medicine News

Trick of the Trade: Insect removal from the ear

Insect removal from the ear is a foreign body removal procedure with unique considerations. First, insects are friable. Have you ever squashed a ho...
Tactical Medicine News

AIR Series: HEENT Module 2014

Welcome to the second ALiEM Approved Instructional Resources (AIR) Module! In an effort to reward our readers for the reading and learning they are...
Tactical Medicine News

Trick of the Trade: Nasal foreign body removal using foley catheter

    A healthy 4 year-old boy is brought in by mom for a plastic bead up his nose. The mom states, “The last time the other doctors had to be called...
Tactical Medicine News

Safe dosing of nebulized lidocaine

Serum lidocaine levels correlate well with observed clinical effects. As the concentration increases, lightheadedness, tremors, hallucinations, sei...
Tactical Medicine News

Trick of the Trade: Less traumatic nasopharyngoscopy

A fiberoptic nasopharyngoscope is a handy tool to check patients for suspected foreign bodies (e.g. fishbone stuck in throat) or laryngeal edema. D...
Tactical Medicine News

Trick of the Trade: Massaging a mandibular dislocation back in

Continuing the theme of mandibular dislocation tricks (protecting your thumbs, post-reduction stabilization), Dr. Daniel Gromis from Advocate Chris...
Tactical Medicine News

Trick of the Trade: Ear foreign body

Sometimes classic techniques need to be revisited, especially when I get new photos from the collective readership. Let’s review a painless way to ...
Tactical Medicine News

Trick of the Trade: Stabilizing mandibular relocations

Three weeks ago, I talked about more safely reducing mandibular dislocations. After successful completion of the procedure, how do you make sure t...
Tactical Medicine News

Trick of the Trade: Protecting your thumbs in mandible relocations

Does anyone think that this is generally a bad idea when closed-reducing mandible dislocations? Yes, it's easiest to apply downward pressure on the...
Tactical Medicine News

Trick of the Trade: Peritonsillar abscess aspiration technique using IV tubing

A few weeks ago, I gave a Tricks of the Trade talk for the Stanford-Kaiser Emergency Medicine residents and faculty. I was overwhelmed by the gre...
Tactical Medicine News

Modern EM: Case 1 and 2 – Strep Throat

A sister and brother, aged 7 and 14, respectively present with pharyngitis.  The 7F has sore throat, cough, fever, and post-tussive vomiting for 1 ...
Tactical Medicine News

Trick of the Trade: Pelvic speculum for peritonsillar abscess

Peritonsillar abscess drainage in the ED continues to be one of my favorite procedures to perform. There are several tricks to increase your chance...
Tactical Medicine News

Trick of the Trade: Pediatric ear exam

Performing a physical exam on frightened pediatric patients can often be challenging. I am always thrilled to add more child-whisperer techniques ...
Tactical Medicine News

Trick of the Trade: Dix-Hallpike maneuver variation

The Dix-Hallpike maneuver is used to help diagnose benign paroxysmal positional vertigo (BPPV). Place the gurney's head of the bed down flat. Repos...
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