When a cough just won ’t go away
Who has never had a cough? I bet no one can raise their hand. We see this in clinic all the time. But chronic cough— one that lasts at least eight weeks — can be hard for patients to deal with and difficult for doctors to figure out.
In the October 20, 2016 issue of the New England Journal of Medicine, lung experts describe a step-by-step approach doctors can use to help treat patients with chronic cough. Most often a prolonged cough is due to one of the “usual suspects.” But when it’s not, we have a long list of increasingly rarer conditions that we should run through and rule out. If it isn’t due to any of th...
Source: Harvard Health Blog - November 7, 2016 Category: Consumer Health News Authors: Monique Tello, MD, MPH Tags: Cold and Flu Health Lung disease Source Type: blogs
MKSAP: 62-year-old man is evaluated for declining exercise capacity
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 62-year-old man is evaluated for declining exercise capacity over the past year. He was diagnosed with moderate COPD 3 years ago. His symptoms had previously been well controlled with tiotropium and as-needed albuterol. He has not had any hospitalizations. He is adherent to his medication regimen, and his inhaler technique is good. He quit smoking 2 years ago. All immunizations are up to date, including influenza and pneumococcal vaccination. A chest radiograph performed 3 months ago for increased cough and sp...
Source: Kevin, M.D. - Medical Weblog - August 13, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Pulmonology Source Type: blogs
ST Elevation. What is it?
< div dir= " ltr " style= " text-align: left; " trbidi= " on " > < span class= " s1 " > A young woman was < /span > & nbsp;found down, unresponsive, with legs crossed. & nbsp;She was intubated by medics. & nbsp;A prehospital EKG (not found, but reportedly identical to the first ED ECG below) was read as ***STEMI*** and after prehospital cath lab activation, the patient was transported to the ED. < br / > < div class= " p1 " > < br / > < /div > < div class= " p1 " > On arrival, she was mechanically ventilated and < u > not < /u > in apparent shock. & nbsp;Here is the ED ECG: < /div > < table align= " center " cellpaddin...
Source: Dr. Smith's ECG Blog - July 23, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
MKSAP: 66-year-old man with polyuria and polydipsia
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 66-year-old man is evaluated in the office after being treated in the emergency department for an exacerbation of chronic obstructive pulmonary disease. While in the emergency department, he was noted to have a random blood glucose level of 211 mg/dL (11.7 mmol/L). His HbA1c was 7.8% at the time. A repeat random fingerstick blood glucose level in office is 204 mg/dL (11.3 mmol/L).
The patient reports recent polyuria and polydipsia. He has lost 6 kg (13.2 lb) over the last 3 months. He has chronic epigastric pa...
Source: Kevin, M.D. - Medical Weblog - July 23, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Diabetes Endocrinology Source Type: blogs
Research and Reviews in the Fastlane 141
This study showed that while it’s feasible to acutely lower systolic blood pressure < 140 mm Hg, there’s no benefit to death or disability. Additionally, patients in the aggressive blood pressure treatment arm were more likely to have adverse renal events at 7 days. These results mirror those seen in the INTERACT-2 trial (prior to the statistical shenanigans used to spin the results positively). Based on the best available evidence, we can confidently say that it should not be standard care to aggressively drop blood pressure in these patients.
Recommended by Anand Swaminathan
Further reading The case of ...
Source: Life in the Fast Lane - July 7, 2016 Category: Emergency Medicine Authors: Jeremy Fried Tags: Airway Clinical Research Emergency Medicine Neurology Neurosurgery Pediatrics R&R in the FASTLANE Resuscitation critical care EBM Education literature recommendations research and reviews Source Type: blogs
No Pea'ce in the Pods
Discussion of Recent Literature. Pediatr Emerg Care 2013;29(6):743.Davis MG, Casavant MJ, et al. Pediatric Exposures to Laundry and Dishwasher Detergents in the United States: 2013-2014. Pediatrics 2016;137(5):e20154529.Russell JL, Wiles DA, et al. Significant Chemical Burns Associated with Dermal Exposure to Laundry Pod Detergent. J Med Toxicol 2014;10(3):292.Tags: detergent pod, laundry detergent, vomiting, poisoning, erythema, decontaminationPublished: 7/2/2016 10:06:00 AM (Source: The Tox Cave)
Source: The Tox Cave - July 2, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
LITFL Review 232
Welcome to the 232nd LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chuck of FOAM.
The Most Fair Dinkum Ripper Beauts of the Week
Cliff Reid offers an amazing reflection on training, stress exposure and pushing one self to achieve even in the face of defeat. [AS]
Nadim Lalani writes one of the most incredible pieces I have ever read on courageous collegiality in medicine, a...
Source: Life in the Fast Lane - May 22, 2016 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review LITFL R/V Source Type: blogs
What medications have you been able to stop on the Wheat Belly lifestyle?
I posed this question on the Wheat Belly Facebook page recently and received an overwhelming response. Here, I share a partial list of the responses: medications people have been able to stop by following the Wheat Belly lifestyle.
Just take a look at this incredible list: these represent medications prescribed by doctors to, in effect, “treat” the consequences of consuming wheat and grains. They prescribe drugs to treat the inflammation, swelling, skin rashes, gastrointestinal irritation, high blood sugars, airway allergy, and other abnormal effects all caused by wheat and grains.
The list includes anti-inf...
Source: Wheat Belly Blog - October 6, 2015 Category: Cardiology Authors: Dr. Davis Tags: Wheat Belly Lifestyle asthma cholesterol diabetes drugs gluten grains hypertension prescription medication reflux Source Type: blogs
Extreme Bradycardia after Diarrhea and Dehydration. Best ED treatment?
A patient presented with weakness. He was found to be bradycardic, so this ECG was recorded:There is atrial flutter with 3rd degree AV block and Left ventricular escape. Why is it not slow AV conduction with RBBB? The QRS occurs at different points on the flutter wave. There is complete dissociation due to complete AV block.More historyThe patient has a history of congenital heart disease repaired as a child. He reports having had an extra pacemaker transiently but this was removed at a very young age. The patient describes a history of progressive bradycardia. In recent years, the patient states th...
Source: Dr. Smith's ECG Blog - October 2, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
Rising Cost Of Drugs: Where Do We Go From Here?
The trends are clear: patients and institutions across the nation are concerned about skyrocketing drug prices. This post offers some information about drug pricing, explores the notion of market intervention, and proposes a series of responses to high pharmaceutical costs.
A few jaw-dropping facts quickly illustrate the pattern of rising drug costs. The average annual cost of cancer drugs increased from roughly $10,000 before 2000 to over $100,000 by 2012, according to a recent study in Mayo Clinic Proceedings. Several breakthrough specialty medications and orphan drugs recently approved by the Food and Drug Administratio...
Source: Health Affairs Blog - August 31, 2015 Category: Health Management Authors: Ifrad Islam Tags: Costs and Spending Drugs and Medical Technology Featured Medicaid and CHIP Payment Policy Public Health Big Pharma CMS FDA Gilead Sciences hepatitis C Pricewaterhouse Coopers Source Type: blogs
Test your medicine knowledge: 72-year-old woman with COPD
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 72-year-old woman is evaluated during a routine examination. She has very severe COPD with multiple exacerbations. She has dyspnea at all times with decreased exercise capacity. She does not have cough or any change in baseline sputum production. She is adherent to her medication regimen, and she completed pulmonary rehabilitation 1 year ago. She quit smoking 1 year ago. Her medications are a budesonide/formoterol inhaler, tiotropium, and an albuterol inhaler as needed.
On physical examination, pulse rate is 9...
Source: Kevin, M.D. - Medical Weblog - June 27, 2015 Category: Journals (General) Authors: mksap Tags: Conditions Pulmonology Source Type: blogs
Michigan Baby Dies, Pathologists Confirm Vaccines Responsible
Conclusion
It is very clear that vaccine-related deaths and injuries are being intentionally hidden. Parents of vaccine-injured children are doing their own investigations and coming forward more, seeking the truth denied to them by health officials.
Inform your friends, family and neighbors that this is going on, that children are dying from the vaccines. Be brave. Help preserve your fundamental right to choose what gets injected into you or your child’s body. Making good medical decisions can only be done when you are informed.
Our hearts go out to Danny and his family and all of the other precious children who have su...
Source: vactruth.com - May 14, 2015 Category: Allergy & Immunology Authors: Augustina Ursino Tags: Augustina Ursino Human Top Stories cytokine storm DTaP vaccine Elijah Daniel French L.J. Dragovic M.D. MMR vaccine Vaccine Adverse Event Reporting System (VAERS) Vaccine Death Source Type: blogs
MKSAP: 72-year-old man with dyspnea at rest
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 72-year-old man is evaluated for dyspnea at rest. He has end-stage COPD and is on a home hospice program. He has weight loss, reduced functional capacity, and muscle atrophy. His medications are ipratropium, salmeterol, fluticasone, albuterol as needed, and prednisone. He is uncomfortable, with chronic air hunger that has gradually increased over the past 2 weeks. Otherwise, his symptoms have been stable without change in cough, sputum production, or fever. Following a physical exam, what is the most appropria...
Source: Kevin, M.D. - Medical Weblog - February 7, 2015 Category: Journals (General) Authors: mksap Tags: Conditions Pulmonology Source Type: blogs
Fighting high health costs. Because I can.
Sometime while I was still in high school, my mom began to have trouble breathing. She had never had asthma before; an albuterol inhaler helped for a while. Still, cold season was a nightmare, and later, so was allergy season, and every year seemed to get worse.
After college, I moved back in with my parents. She fought her way through the cold season, dutifully driving 20 miles (and later 40, after being asked to teach at a different campus) to a community college near our town, where she taught as an adjunct.
Continue reading ...
Your patients are rating you online: How to respond. Manage your online reputation: A socia...
Source: Kevin, M.D. - Medical Weblog - February 3, 2015 Category: Journals (General) Authors: Christen McCurdy Tags: Patient Hospital Intensive care Patients Source Type: blogs
