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8 tips to save money on generic drugs
80 percent of prescriptions in the U.S. are for generic medications. Generics are supposed to be less expensive alternatives to brand name drugs. However, prices for certain generics are rapidly increasing. 50 percent of generic medications increased in price in the last year and 10 percent more than doubled in cost during the same time period. Among them are thyroid replacement hormone, doxycycline, digoxin and other heart medications, tetracycline, albuterol (pill form), and certain medications for blood pressure and high cholesterol. Continue reading ... Your patients are rating you online: How to respond. Manage you...
Source: Kevin, M.D. - Medical Weblog - December 6, 2014 Category: Journals (General) Authors: Martine Ehrenclou, MA Tags: Meds Medications Patients Source Type: blogs

Research and Reviews in the Fastlane 058
This study (n=60) randomized patients in the ED getting IV opioids to morphine (0.1 mg/kg) + placebo or morphine (0.1 mg/kg) + ketamine (group 1 0.15 or group 2 0.30 mg/kg). Patients in the ketamine arm had significantly decreased pain without significant adverse effects, although the group with the higher dose of ketamine had a seeming increase in side effects without added analgesic benefit. The literature is mounting that low dose ketamine has utility in the acute analgesia armamentarium but selecting the right population will likely be key (and more is not better). Recommended by: Lauren Westafer Further Listening: Cli...
Source: Life in the Fast Lane - November 20, 2014 Category: Emergency Medicine Authors: Soren Rudolph Tags: Education R&R in the FASTLANE Review Source Type: blogs

MKSAP: 72-year-old woman with severe 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 - November 1, 2014 Category: Journals (General) Authors: mksap Tags: Conditions Pulmonology Source Type: blogs

Research and Reviews in the Fastlane 050
This study compared bedside US by EPs vs radiology US vs CT as the INITIAL test in patients expected with nephrolithiasis. It found there was no difference in serious outcomes between the groups, but the rate of serious outcomes was overall very low. Obviously patients that got only an US had lower radiation exposure and lengths of stay. But what is interesting is that 40% of patients with an initial ED US went on to get a CT also. This study does not state that patients should ONLY undergo US, just that it should be the INITIAL test. If it cuts down on our CT ordering, it sounds like a good start. (Zack Repanshek) Recomme...
Source: Life in the Fast Lane - September 29, 2014 Category: Emergency Medicine Authors: Jeremy Fried Tags: Cardiology Clinical Research Emergency Medicine Infectious Disease R&R in the FASTLANE Radiology Resuscitation critical care Education Intensive Care literature recommendations Research and Review Source Type: blogs

Pacemaker Panic #2
ECG Exigency 016 A 68-year old woman presents by ambulance to the Emergency Department. Per the ambulance crew, she was brought from home after experiencing 7 out of 10 chest discomfort and weakness. She has a history of hypertension that is well controlled with furosemide, and has a pacemaker because her “heart used to go funny.” The ambulance crew are basic life support only, so the patient has received 324mg of aspirin, and oxygen by nasal cannula. Upon arrival she is seated upright on the stretcher breathing rapidly, with the following vitals: heart rate 107, blood pressure 180/110, respirations 20 and slightly lab...
Source: Life in the Fast Lane - September 19, 2014 Category: Emergency Medicine Authors: Mat Goebel Tags: Cardiology Clinical Case ECG Education Emergency Medicine EKG failure hyperkalaemia hyperkalemia pacemaker pacer pacing ppm Source Type: blogs

MKSAP: 32-year-old man with cough and nasal congestion
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 32-year-old man is evaluated for a 3-day history of productive cough, sore throat, coryza, rhinorrhea, nasal congestion, generalized myalgia, and fatigue. His sputum is slightly yellow. His two children (ages 3 years and 1 year) had similar symptoms 1 week ago. He is a nonsmoker and has no history of asthma. On physical examination, temperature is 37.5 °C (99.4 °F), blood pressure is 128/76 mm Hg, pulse rate is 92/min, and respiration rate is 14/min. There is bilateral conjunctival injection. The nasal mucos...
Source: Kevin, M.D. - Medical Weblog - September 14, 2014 Category: Journals (General) Authors: mksap Tags: Conditions Primary care Source Type: blogs

Crack the Case
Conclusion The patient received antibiotics, steroids, and nebulized albuterol during his hospital admission. His symptoms and chest x-ray findings improved within 24 hours. Blood cultures were negative, and antibiotics were discontinued. He was discharged home with instructions to discontinue use of crack cocaine and given a prescription for oral steroids and an albuterol inhaler.Tags: tachycardia, scattered rhonchi, wheezing, emergency medicine, crack, cocainePublished: 9/2/2014 11:24:00 AM (Source: The Tox Cave)
Source: The Tox Cave - September 2, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Inhaled medications: Nefarious reasons for the lack of competition
Check out the prices for nebulizer solutions of albuterol and budesonide (generic Pulmicort). They are totally affordable. $4 for a month for albuterol. $14 for a month for budesonide respules. Pulmicort respules used to be very expensive. Now even the branded budesonide is less than 10% of a monthly cable bill. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - August 29, 2014 Category: Journals (General) Authors: John F. Hunt, MD Tags: Meds Medications Pulmonology Source Type: blogs

MKSAP: 25-year-old man with slowly progressive solid-food dysphagia
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 25-year-old man is evaluated for a 5-year history of slowly progressive solid-food dysphagia that is accompanied by a sensation of food sticking in his lower retrosternal area. He has compensated by modifying his diet and avoiding fibrous meats. He has not lost weight, and he has not had trouble drinking liquids. He has had episodes of food impaction that he manages by inducing vomiting. He has had no difficulty initiating a swallow and has not had chest pain, odynophagia, reflux symptoms, or aspiration of foo...
Source: Kevin, M.D. - Medical Weblog - August 10, 2014 Category: Journals (General) Authors: mksap Tags: Conditions GI Source Type: blogs

Research and Reviews in the Fastlane 041
This study prospectively validated whether an age-adjusted D-dimer cutoff was associated with an increased diagnostic yield of D-dimer in elderly patients with suspected PE. Compared with a fixed D-dimer cutoff, the combination of pretest clinical probability assessment with age-adjusted D-dimer cutoff was associated with a larger number of patients in whom PE could be considered ruled out with a low likelihood of subsequent clinical venous thromboembolism. So if this is not your clinical practice already, maybe time to use age adjust d-dimer values? Recommended by: Jerremy Fried Read More: Age Adjusted D-Dimer Testing (RE...
Source: Life in the Fast Lane - July 29, 2014 Category: Emergency Medicine Authors: Soren Rudolph Tags: Clinical Research R&R in the FASTLANE critical care Emergency Medicine Intensive Care literature recommendations research and reviews Source Type: blogs

MKSAP: 35-year-old man with nonproductive cough and fever
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 35-year-old man is evaluated for a 2-week history of nonproductive cough and fever. He has a 20-year history of asthma. Three weeks ago, he visited friends in Indiana. He has no dyspnea, hemoptysis, or worsening of his baseline asthma symptoms. His only medication is an albuterol inhaler as needed. On physical examination, temperature is 38.0 °C (100.4 °F), blood pressure is 130/70 mm Hg, pulse rate is 88/min, and respiration rate is 16/min. Crackles are heard in both lungs. Laboratory studies show a normal ...
Source: Kevin, M.D. - Medical Weblog - March 15, 2014 Category: Family Physicians Tags: Conditions Infectious disease Source Type: blogs

Complaint of Weakness. Alert. Hemodynamically Stable. What is it?
A male in his 60's, dialysis patient, complained of weakness. He was alert and had no SOB or Chest pain. BP was 85/57 with a pulse of 65. Here is his ECG:What is it? See below.This is pathognomonic for hyperkalemia and is nearly end stage, almost a complete sine wave morphology. It seems miraculous that a patient can have this ECG and not be in profound shock, but it is true. He may die at any moment though.His potasssium was 8.8 mEq/L.There were access problems, but he did get insulin, glucose, bicarb, calcium gluconate, and albuterol, all while preparing emergency dialysis. The treatme...
Source: Dr. Smith's ECG Blog - February 20, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs

Popular Quotes By Famous People (Had They Been a Doctor or a Nurse).
Ever wonder what Bill Clinton or Martin Luther King or Jesus would have said if they were a doctor or a nurse? Ever wonder what their famous quotes would have sounded like had they been in the medical field? The Happy Hospitalist has. Doctors and nurses are different. Their training changes them. In some ways for the good and and some ways for the bad. For many , they develop a different sense of humor. That's good for you because that's how we found out what Bill Clinton actually would have said if he tried albuterol instead of marijuana. We discover what Martin Luther Kin...
Source: The Happy Hospitalist - January 4, 2014 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs

Notes to myself – 2
Pentobarb coma – BIS should be 10-20 and SR (suppression ratio) should be 70-80 Consider lev albuterol Should give vaccines after coiling of spleen or before if possible No calcium channel blockers post MI definitely and post op in general Toradol inhibits spine healing Don’t do endoscopes with patients in supine position don’t ambulate patients with known dvt’s. wait 2-3 days until clots get stuck. dvt’s even with filter get heparin as much as possible for post phlebitic syndrome and to retard new clot formation diffuse alveolar hemorrhage – secondary to chemo, goodpasture’s, wege...
Source: Inside Surgery - December 31, 2013 Category: Surgeons Authors: Editor Tags: General Source Type: blogs