Ambroise Paré, on the battlefield using a ligature for the artery of an amputated leg of a soldier.(Photo Wikipedia)
Under the best of situations major trauma centers can be overwhelmed with dozens of seriously injured patients but for many CMES participants limited resources are an everyday reality. The August EM:RAP podcast titled, “Blast Injuries” by Anand Swaminathan MD and Josh Bucher MD will help you piece together triage and treatments for a mass casualty.
Tactical Combat Casualty Care (TCCC) uses the mnemonic MARCH for military battlefield medicine.
- Massive hemorrhage is managed through the use of tourniquets, hemostatic dressings, junctional devices, and pressure dressings.
- Airway is managed by rapid and aggressive opening of the airway to include cricothyroidotomy for difficult airways.
- Respirations and breathing is managed by the assessment for tension pneumothorax and aggressive use of needle decompression devices to relieve tension and improve breathing.
- Circulation impairment is assessed and managed through the initiation of intravenous access followed up by administration of tranexamic acid (TXA) if indicated, and a fluid resuscitation challenge using the principles of hypotensive resuscitation. TCCC promotes the early and far forward use of blood and blood products if available over the use colloids and discourages the administration of crystalloids such as normal saline (sodium chloride).
- Hypothermia prevention is an early and critical intervention to keep a traumatized casualty warm regardless of the operational environment.
A wounded knight is carried on a medieval stretcher. (Photo Wikipedia)
Who Knew? An early stretcher, possibly made of wicker over a frame, appears in a manuscript from c.1380.
Ambroise Pare (c. 1510-1590) is considered one of the fathers of surgery and modern forensic pathology and a pioneer in surgical techniques and battlefield medicine.
Photo from the website of Fondation Dermatite Atopique.
Eczema, also called Atopic Dermatitis affects 15-20% of children and 1-3% of adults worldwide according to a paper recommended by the National Center for Biotechnology Information (NCBI). The paper titled, “Worldwide variations in the prevalence of symptoms of atopic eczema in the International Study of Asthma and Allergies in Childhood”, was originally published in J Allergy Clin Immunol. 1999 Jan;103(1 Pt 1):125-38.
Photo from Wikimedia.
This common recurrent or chronic inflammatory skin disease is characterized by dry skin with acute flare-ups of eczematous pruritic lesions. Vanessa Cardy MD, Adrien Selim MD and Heidi James MD offer bullet point clues to understanding, diagnosing and treating this disease which impacts not only our patients health but their psychosocial well being. Take a listen or read the August Right on Prime’s: The Generalist: Eczema.
Photo from Wikimedia.
Who Knew? The first dermatology textbook book, “De Morbis Cutaneis”, was written in 1572 by an Italian physician, Girolamo Mercurialis. Translated it means ““Of all skin diseases and waste treatment of the body.”
Glenda, Community Health nurse, Tena, Ecuador.
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The EM:RAP July Introduction by Stuart Swadron MD and Jan Shoenberger MD talks about a case that will blow you away…pneumomediastinum presentation and causes. Can you answer these questions:
- Can pnuemomediastinum occur after forceful expiration?
- Can ECG findings be distorted due to the presence of subcutaneous air?
You will, once you listen to the MP3 file or read the PDF article.
Pneumomediastinum. Photo from Wikicommons.