You are providing medical coverage for a hiking expedition inthe Peruvian Andes. Prior to ascending, an otherwise healthy34-year-old trekker presents to you with acute onset of watery,non-bloody diarrhea, nausea, one episode of vomiting, abdominal cramping, and no documented fever. His vital signs are normal, he takes no medications, and has had no malaria or dengue exposures. He reports frequently eating at roadside stands in Lima over the last few days.
Although the differential diagnosis is broad, with minimal abdominal tenderness and no fever, traveler’s diarrhea is the most likely diagnosis.
Webinar: Tourniquet Conversion: Starting the Conversation
Tourniquet Conversion is a basic skill required by military medics. In Afghanistan and Iraq, the U.S. military had quick evacuation (TACEVAC/MEDEVAC) times and casualties were able to reach definitive care rapidly. Unfortunately, evacuation times are unlikely to remain brief in future military settings. Civilian transport times vary widely from urban to rural areas under normal circumstances, let alone in an active violent incident or an MCI.
Complicating the discussion, there are a plethora of definitions/descriptions being used interchangeably (e.g. TQ down grade, TQ exchange, TQ Upgrade, TQ Replacement, etc…),which adds to the confusion. Tourniquet conversion protocols are not well established in either the military or civilian settings, and training varies greatly between organizations.
This one-hour question-based webinar combined the scientific expertise of Dr. John Kragh and his years of tourniquet research, the hard-earned experience from the Ranger Regiment using their well-established tourniquet conversion procedure, and the current practices of tourniquet conversion in civilian law enforcement / EMS provided by Dr. Mike Shertz, Emergency Physician and EMS medical director.
COROM: An ultramarathoner complaining of headache, fever, and neck stiffness
While working in a remote setting, a 43-year male employee comes to you complaining of headache, fever, and neck stiffness for six days. He arrived in country two days ago. He completed an ultramarathon at Lake Placid, New York, four weeks ago.
CoROM: A case of sudden onset dyspnea in a working dog
CoRom Compass Newsletter August 2021
While providing medical support for an oil field in West Africa, you are frantically brought a 30kg operational canine used for site security. The German Shepherd dog and handler ere conducting bite work training when the K9 rapidly developed ‘weird breathing”,’ seemed increasingly agitated, and now-twenty minutes later -is less responsive and struggling to breathe. The handler denies any recent injury, illness, or obvious envenomation for the K9.
CoROM: Sulfur Mustard Exposure
CoRom Compass Newsletter Summer 2021
HPI: While providing medical coverage for an NGO, an Iraqi security guard presents to your clinic with extensive redness, superficial swelling, and blisters across his right buttock. He states he sat on some ground that was damp about 24 hours ago. He got up when he realized the wet ground had seeped through his pants. About an hour later he noted burring pain across his right buttock. He states the area had been previously mortared by ISIS.
Differential Diagnosis: Thermal burn, contact dermatitis, or chemical warfare vesicant exposure (mustard agent) Article.
CoROM: Case Report, Hepatic abscess
CoRom Compass Newsletter Winter 2020
HPI: A 74-year-old Indian male arrived in the U.S. one month before presenting to the Emergency Department. He described fever to 38.5C for ten days and intermittent right upper quadrant abdominal pain for “years”. Other than visiting family in the U.S., he spent his entire life in urban southern India. He had seen a U.S. physician a week before and had one negative set of malaria thin and thick smears.
In the ED he was well appearing but slightly febrile with moderate RUQ tenderness. His laboratory testing was notable for slight liver function test abnormalities and RUQ ultrasound showed a 10 by 6 cm abscess. Read the entire case report.
On April 5th a 55-year-old male with treated hypertension presented to the emergency department for one week of dry cough, shortness of breath “while talking”, body aches, and fever to 38.5 Celsius. He stated overall, he “felt good”, but didn’t think his symptoms were improving… Read the entire case report.
What belongs in your IFAK?
What items can you leave out?
This article tells you what we keep in our IFAKS. You can also download our e-book for more details, including a packing checklist.
The digital version is available on Outdoorlife.com and was published February 20, 2020
Robservations: Interview with Dr. Mike Shertz of Crisis Medicine
Lead Instructor Mike Shertz, MD-18D sits down with the filming director of our Tactical Casualty Care series, Robert Meyer Burnett to discuss Crisis Medicine’s online courses between filming our two new courses in January 2020.
Robert Meyer Burnett is both Mike’s oldest friend and an independent filmmaker, having directed his own feature film, as well as directing and producing behind the scenes coverage for films such as The Fellowship of the Ring, The Two Towers, Chronicles of Narnia: The Lion, The Witch and The Wardrobe, The Usual Suspects, X-men, X2, and Superman Returns.
Mike sits down to talk about his background, how he created our TC2 series, and how the two new courses (Essential Casualty Care and First Receivers-No Notice Events) fit into our series of online classes.
Realities of gunshot wounds:
What do bullets do in bodies? Dr. Shertz dives into the ballistics and its effects on the body of one of the world’s most widely seen and used rifle rounds. This segment is one portion of his excellent and much larger in-depth series of studies on wound ballistics…
A 23-year-old male presented to the Emergency Department after being bitten on his right thumb an hour before by a Western Rattlesnake (Crotalus oreganus) he picked up as a souvenir while hiking in Eastern Oregon.1He has normal vital signs, minimal bleeding from two parallel punctures, and thumb pain. The patient brought the snake to the ED as proof of the speciation. Read the entire case report.
The Approach to the Active Shooter: Run, Hide, Fight, Treat
A 47-year-old male presents to the Emergency Department with an “abscess” on his back. He returned from 12 days hunting in South Africa one-week prior. He noted tenderness inferior to his scapula during the return trip and identified redness and a “pustule” when he looked in the mirror. Read the entire case report.
ITS: Valuable Medical Resources Online to Learn, Train and Gear Up
…Skills need to be sharpened, so once you’re comfortable with your understanding of the guidelines, be sure to check out the awesome training resources provided by our friends at Crisis Medicine. They offer online and in-person courses following the TCCC and M.A.R.C.H. (Massive hemorrhage, Airway, Respiration, Circulation, and Hypothermia prevention) system… Bryan is currently working through the Crisis Medicine Complete TC2 Online course and a full write-up will be coming to ITS upon completion, to share his experience with it.
ER Cast: How to place and remove a tourniquet with Mike Shertz MD
Emergency MD Rob Orman approached me and asked how to apply an off the shelf, commercially available tourniquet – great to have Rob’s help getting the word out on his ERCast podcast platform to train everyone to stop massive hemorrhage and save lives. Rob’s video proves an untrained bystander can apply a tourniquet, but that some training definitely improves the likelihood you will understand the nuances and will be able to successfully apply a tourniquet in an emergency
Interested in more training? We can help you with that – online classes available now.
Want to hear more from Dr. Orman? You can find his podcast at Hippo Education.
ER Cast: How to place and remove a tourniquet with Mike Shertz MD
Emergency MD Rob Orman approached me and asked step by step through proper technique for packing an actively bleeding gunshot wound. This is especially useful in body areas where it’s difficult to use a tourniquet (such as the groin/bleeding femoral artery).
This is the second ERCast podcast platform featuring Crisis Medicine training to stop massive hemorrhage and save lives
Deep Water Happy: One Teacher’s Bleeding Control Kit
Deep Water Happy: How Teachers can order Hemorrhage Control kits with classroom supply monies
Stimulus Podcast, 05 September 2021
