Efficacy of single-shot ultrasound-guided erector spinae plane block for postoperative analgesia after mastectomy: A randomized controlled study

Conclusion: US guided ESPB is quite effective in reducing perioperative pain in patients undergoing mastectomy. The trial was registered prospectively with CTRI with registration number: CTRI/2018/09/015668.
Source: Saudi Journal of Anaesthesia - Category: Anesthesiology Authors: Source Type: research

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This study had afatal flaw: they did not keep track of all the Non-STEMI patients who were NOT enrolled, but instead were sent for immediate angiogram.  It was done in Europe, where the guidelines suggest taking all shockable arrests emergently to the cath lab.  So it is highly likely that physicians were very reluctant to enroll patients; they did not want them to be randomized to no angiogram.  This strong suspicion is supported by their data:only 22 of 437 (5.0%) patients in this study had OMI.What percent of shockable arrests without STE have an OMI?  This large registry in Circulatio...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
This study had afatal flaw: they did not keep track of all the Non-STEMI patients who were NOT enrolled, but instead were sent for immediate angiogram.  It was done in Europe, where the guidelines suggest taking all shockable arrests emergently to the cath lab.  So it is highly likely that physicians were very reluctant to enroll patients; they did not want them to be randomized to no angiogram.  This strong suspicion is supported by their data:only 22 of 437 (5.0%) patients in this study had OMI. What percent of shockable arrests without STE have an OMI?  This large registry in Circ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
ConclusionGiant bullous emphysema can represent a pitfall in trauma assessment. We recommend that in cases where pneumothorax is suspected, if the patient is clinically stable, imaging studies should be performed prior to chest tube placement.
Source: International Journal of Surgery Case Reports - Category: Surgery Source Type: research
A 60-something presented with hypotension, bradycardia, chest pain and back pain.She had a h/o aortic aneurysm, aortic insufficiency, peripheral vascular disease, and hypertension.  She had a mechanical aortic valve.  She was on anti-hypertensives including atenolol, and on coumadin, with an INR of 2.3. She was ill appearing.  BP was 70/49, pulse 60.A bedside echo showed good ejection fraction and normal right ventricle and no pericardial fluid. Here is the initial ECG:What do you think?This ECG actually looks like a left main occlusion (which rarely presents to the ED alive):  ST Elevation in...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
We report the case of a 28-year-old man admitted to the casualty department at Ngwelezana Hospital, Empangeni, KwaZulu-Natal, South Africa, with a history of vomiting and abdominal pain after ingestion of ~100 mL of an unknown substance, later identified as paraquat, together with an unknown amount of alcohol, in a suicide attempt. He developed respiratory distress associated with lung parenchymal infiltrates that required ventilatory support and later a spontaneous pneumothorax, and died in the intensive care unit. We discuss the importance of a high index of suspicion of paraquat poisoning in rural areas, where paraquat ...
Source: South African Medical Journal - Category: African Health Tags: S Afr Med J Source Type: research
Conclusion: Chronic hydrocarbon inhalation seems to be related to permanent and significant pulmonary sequelae which may persist even after abuse has been discontinued.
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: 1.5 Diffuse Parenchymal Lung Disease Source Type: research
A young man was in a rollover Motor Vehicle Collision, with a chest laceration and chest pain.He underwent a CT scan of the chest:There is a very small pneumothorax anterior to the heartThis image is from slightly lower down:There is a bit of air in the pericardiumA troponin returned elevated, so this ECG was recorded:There is some minimal ST elevation in inferior and lateral leads.  This is consistent with percarditis.  The troponin shows that there is some myocardial damage.  Is it myocardial contusion, or myo-pericarditis?  Or pericarditis as a result of myocardial contusion?6 hours later:There is di...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
CONCLUSIONS: Reports of myocardial injury caused by arterial gas embolism from diving are rare. This case shows coronary air embolism complicating pulmonary barotrauma and may be the first report of pericarditis complicating myocardial injury after an AGE. PMID: 26742261 [PubMed - indexed for MEDLINE]
Source: Undersea and Hyperbaric Medicine - Category: Sports Medicine Authors: Tags: Undersea Hyperb Med Source Type: research
A patient in her early 20s came into the ED holding her right arm near her body with a complaint of right shoulder pain. She said she was punched in the shoulder during a fight the night before. Do you believe her story?     Checking the contour of the scapula reveals a cortical break in body. The undressed physical exam revealed ecchymosis and tenderness near the right scapula. The patient was told a fractured scapula requires more force than a punch, and she then added that she was thrown back against a metal pole during the fight. A CT scan confirmed the diagnosis.     Scapular fracture...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
A 45-year-old woman with a history of medication-controlled essential hypertension, stage 2 chronic kidney disease, type 2 diabetes mellitus, and a pack-a-day cigarette habit presented less than 60 minutes after acute onset of severe shortness of breath that awoke her from sleep. She had felt well the previous day, and went to bed with no complaints.   Around 4 a.m., she woke up from sleep very dyspneic, with moderate chest “discomfort” over her left chest that radiated to her back and was unchanged by position or respirations. She denied other symptoms such as fever, cough, nausea, vomiting, numbness, o...
Source: Spontaneous Circulation - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
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