Care of the acutely ill patient in the austere setting is a hallmark of Global Health Medicine. These videos highlight three different examples of how to apply core concepts of Emergency Medicine to a resource limited environment. Dr. Lagasse describes how to make a homemade tourniquet to control life-threatening hemorrhage, Dr. Teuber shows us alternatives to intravascular volume resuscitation, and Dr. Roche outlines how to manage pneumothorax, hemothorax, and hemopneumothorax with and without vacuum assistanceRead More
Thanks to everybody who contributed to an excellent discussion of the care of the patient on our second “flight.” If you didn’t get a chance to check out the case and the discussion, check it out here. Below is the curated comments from the community and a podcast from Dr. Hinckley and Flight Nurse Practitioner Jason Peng
Q1 - Walk through your initial assessment of this patient. What are the critical aspects of the assessment of this patient?
In response to this question, most everybody wanted to first act on the bleeding wound in the patient’s right antecubital fossa. As explained by Dr. Renne, “I would want to be systematic but efficient, probably using a C-ABCD approach to these kind of critical patients, with the first C being any sort of life-threatening but "C"ontrollable hemorrhage.” Dr. Renne also had a fine point with regards to checking for other potential, as of yet unseen, injuries. This is a patient with multiple stab wounds, it is crucial to conduct a quick, but thorough search for stab wounds to the back, axilla, groin, and/or other locations where significant blood loss could be caused by a stab wound.Read More
Though tourniquets were likely in use since Roman times, the term “tourniquet” was originally turned by Louis Petit, the 18th century inventor of the screw tourniquet. Though numerous design advancements have occurred and new devices have been made in the centuries that have followed, the basic principles of tourniquet use are essentially unchanged. A tourniquet applies an external pressure to a limb (usually) that exceeds the arterial pressure in that extremity. In this way the inflow of arterial blood to an extremity is stopped. For a surgeon, in the setting of a prospective extremity surgery, this allows for the creation of a bloodless operative field. For Emergency Medicine providers, tourniquets can aid in the exploration of extremity wounds, allowing the identification of injuries to tendons, joints, and vascular structures. And perhaps most importantly, tourniquets applied proximal to the site of penetrating traumatic extremity injuries can cease bleeding from arterial injuries.Read More