Don’t Treat Kids as Tiny Adults in Needle Thoracostomy
​Pediatric needle thoracostomy is a rarely performed procedure, but one must know the technique and be prepared to perform it. It can be life-saving in the face of a tension pneumothorax. This is a simple procedure, but a few procedural fine points can guarantee success and safety.Adult Needle ThoracostomyWe have learned only relatively recently that most adult needle thoracostomies fail to accomplish their mission. A 5 cm angiocatheter inserted at the second intercostal space on the midclavicular line has been the Advanced Trauma Life Support guidelines recommendation for at least a decade. Unfortunately, we now know th...
Source: M2E Too! Mellick's Multimedia EduBlog - July 1, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Tactical Emergency Medicine a Possible Career Path for EPs
​The value and importance of our specialty branching out into tactical emergency medicine are not widely discussed, but it can be rewarding to work with law enforcement. Tactical emergency medicine has expanded rapidly over the past two decades. The American College of Emergency Physicians even has an active tactical emergency medicine section. (http://bit.ly/2Dt1spl.) Its goal is to provide a forum for emergency physicians with interest or expertise in tactical medicine and to share information with the college and other organizations. Fellowships in tactical emergency medicine have been developed as part of academ...
Source: M2E Too! Mellick's Multimedia EduBlog - June 1, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Trocar during Times of Trauma
​Seventy-five percent of trauma injuries involve some kind of thoracic insult, a quarter of which need a procedural intervention like a chest tube. (Surg Clin North Am 2007;87[1]:95; http://bit.ly/2HaoX90.) Long-term illness, lung disease, and post-operative complications may cause pleural effusions or a pneumothorax, so treating these conditions quickly can significantly decrease patient morbidity and mortality. Other indications for chest tube placement include:Trauma: Pneumothorax, hemopneumothorax, or tension pneumothoraxLong-term illness: Pleural effusion (cancer, pneumonia)Infection: Empyema, purulent pleuriti...
Source: The Procedural Pause - April 1, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Volunteering with a Little Fun and Holiday Mixed In
​BY LUKE HUSBY, DOOn a cool Monday afternoon, the plane to Dulles, then Frankfurt, and ultimately Bangalore took off. I landed two calendar days later in a place about 40°F warmer, with a weather forecast of "smoke."I was greeted by a driver who only spoke Tamil. He took me to my hotel room less than a mile from the hospital where I was volunteering through congested traffic that held no regard for traffic lines or signs. The ED in Bangalore is essentially a 10-bed department, divided into a high-acuity and low-acuity sections.The high-acuity section of the ED.An entire herd of students flocked to see one p...
Source: Going Global - February 3, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

LITFL Review 229
Welcome to the 229th LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chuck of FOAM. The Most Fair Dinkum Ripper Beauts of the Week Simon Carley and Robert Lloyd have an amazing podcast discussing resilience, mindfulness, stress innoculation, procedural expertise, and more as Robert shares his story of being an Englishman in South Africa. [SO] The ESICM-led Trauma 2016 confere...
Source: Life in the Fast Lane - May 1, 2016 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

LITFL Review 224
Welcome to the 224th LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chuck of FOAM. The Most Fair Dinkum Ripper Beauts of the Week The International Symposium on Critical Care and Emergency Medicine (ISICEM) was held this week, with a number of landmark trials presented- as well as some excellent debates. Adrian Wong and Jamie Strachan of Oxford ICM have an excellent series ...
Source: Life in the Fast Lane - March 20, 2016 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

Research and Reviews in the Fastlane 123
Welcome to the 123th edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature. This edition contains 6 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&am...
Source: Life in the Fast Lane - February 24, 2016 Category: Emergency Medicine Authors: Soren Rudolph Tags: Airway Education Emergency Medicine Intensive Care R&R in the FASTLANE Resuscitation Toxicology and Toxinology Trauma critical care recommendations research and reviews Source Type: blogs

Tension pneumothorax – time to change the old mantra?
Here is your ATMIST handover in resus: 28 year old male, injured 25 minutes ago, penetrating chest trauma, Asherman seal on anterior chest, RR 35, clearly deteriorating, high flow O2 administered.Initial observations: A – moaning, distressed, mask fogging, B – RR is now more like 40, with reduced expansion on the right, and absent breath soundsAre his neck veins distended? Trachea deviated? You are swift, brave and decisive – in goes the 14G cannula, 2nd intercostal space, mid clavicular line and…nothing happens. In fact, the patient continues to deteriorate…What is your next option?Fol...
Source: Life in the Fast Lane - December 2, 2014 Category: Emergency Medicine Authors: Fraser Brims Tags: Education Respiratory 2nd ICS 5th ICS Ian Duffus tension tension pneumothorax Source Type: blogs

Research and Reviews in the Fastlane 048
This study looked at one institution’s discrepancy rate between EP and radiologist plain film reads over 10 years. They found overall an ~3% discrepancy rate on all plain films. This of course does not mean the radiologist was correct in every discrepancy. But it does show we agree most of the time. Most interestingly, the rate of discrepancies requiring emergent change in management was a mere 0.056%! Recommended by: Zack Repanshek Prehospital/Retrieval Braude D et al. Air Transport of Patients with Pneumothorax: Is Tube Thoracostomy Required Before Flight? Air Med J. 2014 Jul-Aug;33(4):152-6. PMID: 250...
Source: Life in the Fast Lane - September 16, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Anaesthetics Cardiology Education Emergency Medicine Pediatrics Pre-hospital / Retrieval Public Health Respiratory Resuscitation Toxicology and Toxinology critical care Intensive Care literature R&R in the FASTLANE recommendati Source Type: blogs

Today, I may have saved a life
Today, I saved a life. And I wish I could tell you a story about fancy heroics — about an exploratory laparatomy, a chest thoracostomy, or a patient that coded and I was the last person to perform the chest compressions that brought them back to life.  But I can’t.  But I can tell you that I saved a life. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - August 23, 2014 Category: Journals (General) Authors: Tags: Education Medical school Psychiatry Source Type: blogs

Low Voltage in Precordial Leads
A patient with was resuscitated from respiratory and cardiac arrest of uncertain etiology, but because she was very difficult to ventilate with BVM ventilation, and there were no ultrasonographic slidings signs, pneumothorax was suspected and bilateral needle thoracostomies were placed. This ECG was recorded:There is sinus tach and very low voltage in the precordial leads.  It is otherwise unremarkable, especially for a patient who was in cardiac arrest.There was a previous ECG available:The low voltage is indeed new, and there is no change in limb lead voltageWhy is there low voltage?Although she was thought to ...
Source: Dr. Smith's ECG Blog - January 11, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs

Searching for Smaug
“My armour is like tenfold shields, my teeth are swords, my claws spears, the shock of my tail is a thunderbolt, my wings a hurricane, and my breath death!“ Smaug, the most powerful, the most cunning, and some would even say the greatest, dragon of the Third Age, had a story steeped in mystery.  By the time an unexpected journey began, Smaug had not been seen for 150 years, but legend had it that he had laid waste to the Lonely Mountain in Erebor, and was feared as a ruthless killer. The obvious questions that ensue from this frightening tale are: Does Smaug really exist, or is he some terrifying myth?...
Source: Life in the Fast Lane - April 4, 2013 Category: Emergency Medicine Doctors Authors: Michelle Johnston Tags: Education eLearning Emergency Medicine Featured Respiratory pneumothorax smaug tension tension pneumo thoracostomy Source Type: blogs

The LITFL Review 089
Welcome to the festive 89th edition! The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the best and brightest from the blogosphere, the podcast video/audiosphere and the rest of the Web 2.0 social media jungle to find the most fantastic EM/CC FOAM (Free Open Access Meducation) around. The Most Fair Dinkum Ripper Beaut of the Week The Skeptics Guide to Emergency Medicine Top spot this week is taken out by The Skeptics Guide to Emergen...
Source: Life in the Fast Lane - January 1, 2013 Category: Emergency Medicine Doctors Authors: Kane Guthrie Tags: Education eLearning Emergency Medicine Featured Health Intensive Care LITFL review LITFL R/V Source Type: blogs

The LITFL Review 089
Welcome to the festive 89th edition! The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the best and brightest from the blogosphere, the podcast video/audiosphere and the rest of the Web 2.0 social media jungle to find the most fantastic EM/CC FOAM (Free Open Access Meducation) around. The Most Fair Dinkum Ripper Beaut of the Week The Skeptics Guide to Emergency Medicine Top spot this week is taken out by The Skeptics Guide to Emergen...
Source: Life in the Fast Lane - January 1, 2013 Category: Emergency Medicine Doctors Authors: Kane Guthrie Tags: Education eLearning Emergency Medicine Featured Health Intensive Care LITFL review LITFL R/V Source Type: blogs