Abnormal EKG in rural setting

While this was not my personal patient, it came from a very good friend. This was at a facility I used to work at and I thought it made a great case for discussion.

Brugada syndromeHistory and presentation:

31 male. Hx left anterior heavy chest pain, dyspnoea, 2x sync opal episodes. No known medical hx. Heavy smoker. EtOH intoxicated on presentation. Paternal Fam hx cardiac arrest age 53. ECG shows incomplete RBBB, STE V1,V2 coved 2mm, following TWI. ?type 1. Also single PVCs on QAS trace.


The discussion quickly turned to Brugada Syndrome…thoughts?


A good review or primer on Brugada syndrome can be found here:



Krokodil: just nasty

A great look at the spread of this new IV drug and the nasty effects it can have:




Heart rates in avalanche victims

A very interesting look at data collected from heart rate monitors on avalanche victims.





Vampire protocol

I recently came across this and have to say I love the name!

This is basically blood transfusion given by combat paramedics and aeromedical retrieval teams, for use with wounded soldiers.

Adventure Doc Facebook and Blog links

We are happy to report that our Adventure Doc Facebook Page at https://www.facebook.com/AdventureDoc?ref=hl and our blog at http://www.AdventureDoc.net have been combined so you can get the same content on either site.

Morphine and Ketamine in Trauma

As usual, @RFDSDOC gives out good advice, literature and proves he is a guru. This time he looked at pre-hospital analgesia and trauma. Make sure to check out his page at: Prehospitalmed.com

Now back to the article on morphine and ketamine being better than morphine alone:


I routinely use this combination of morphine and ketamine for trauma pain control. I also liked that the article gave realistic advice on doses and titration.


Thanks for bringing this up @RFDSDOC!



Special Operations Medicine Journal

Special operations medicineAn old friend from medical school just turned me on to this amazing resource. You have previously read my thoughts on the Special Operations Forces Medicine Handbook and that I believe it is one of the greatest medical textbooks. Along the same lines, I invite you to visit this website and check out the Journal of Special Operations Medicine.

Clearly, tactical and special operations medicine are coming into their own place as a separate medical discipline. The role of these practitioners involves care of trauma patients, indigenous people and extended care in remote locations, along with many other hats!

This journal is published 4 times per year and should be a lifeline to the Spec-Ops medical provider, from paramedic to doctor. The importance of having their own literature, peer review and method of exchanging information will only help the specialty grow.



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