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Long QT Syndrome with Continuously Recurrent Polymorphic VT: Management
A young woman presented with intermittent shocks from her implantable defibrillator.  She was intermittently unconscious and unable to give history.   The monitor showed intermittent polymorphic ventricular tachycardia.    The physician was presented with this ECG at the same moment he was observing the repeated syncope:Time zeroIt is a bigeminal rhythm with a very bizarre PVC.  The PVC has an incredibly long QT, but the intervening native rhythms do not.  However, when I saw this (it was texted to me), it immediately reminded me of this case, so I knew by sheer recognition that it was lo...
Source: Dr. Smith's ECG Blog - July 8, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs

The problem with medical TV shows. A surgeon sets the record straight.
I never really watched medical shows, even before and during medical school. I watched maybe one season of ER, a couple of seasons of Grey’s Anatomy and House MD and maybe one episode each of Private Practice, Chicago Hope, Emily Owens MD and other random medical shows. The only medical show I made an exception for was Scrubs, because it was funny and poignant and the closest to replicating what life is actually like in a hospital (but still a long shot I’m afraid!). Oh, and I want to be able to whistle like Dr. Cox. I’m sure like every profession, seeing your own profession on the big or little screen is...
Source: Kevin, M.D. - Medical Weblog - July 7, 2015 Category: Journals (General) Authors: Tags: Physician Mainstream media Surgery Source Type: blogs

There is no shame in honest work, no matter what the job description is
When my sister, Jessica, was a nurse anesthetist student at the University of New England, she had the opportunity to rotate at Johns Hopkins, and she seized it. She was young and fairly new to the medical world and so she did not recognize at first the name of the neurosurgeon with whom she would be working — Dr. Ben Carson. After receiving multiple comments from numerous people about how great it was that she would be working with him, she did what any other 20-something year old would do … she Googled him. Naturally, she found out that he was very accomplished in his field; he was the fi...
Source: Kevin, M.D. - Medical Weblog - July 6, 2015 Category: Journals (General) Authors: Tags: Physician Hospital Surgery Source Type: blogs

Learning to Take the Heat at #smaccUS
We managed to get an elite team together to run the ‘Learning to Take the Heat’ workshop at SMACC Chicago. Our team consisted of: Anand Swaminathan (@EMSwami) Chris Hicks (@HumanFact0rz) Jason Brooks (@PhenomenalDocs) Jesse Spurr (@Inject_Orange) The “Learning to take the Heat” team as well as myself, with the able assistance of Ali Gould (@intransition2). The focus of the workshop was to develop an understanding of how stress affects the performance of health professionals when caring for the critically ill, and more importantly, how we can teach others to handle stress. Recomm...
Source: Life in the Fast Lane - July 2, 2015 Category: Emergency Medicine Authors: Chris Nickson Tags: Education ali goould anand swaminathan chris hicks Chris Nickson jason brooks jesse spurr SMACC stress inoculation workshop Source Type: blogs

Research and Reviews in the Fastlane 089
This study found that athletes with pathologic TWI (except those in aVR, III, V1) were likely to have underlying cardiac pathology (45% of patients). Hypertrophic cardiomyopathy was the most common finding (81% of cardiac pathology). These authors recommend that all athletes with pathologic TWI be referred for further cardiac testing. Recommeded by Anand Swaminathan The R&R iconoclastic sneak peek icon key The list of contributors The R&R ARCHIVE R&R Hall of famer You simply MUST READ this! R&R Hot stuff! Everyone’s going to be talking about this R&R Landmark paper A...
Source: Life in the Fast Lane - July 1, 2015 Category: Emergency Medicine Authors: Soren Rudolph Tags: R&R in the FASTLANE critical care Education Emergency Medicine Intensive Care recommendations research and reviews Source Type: blogs

Should I become an anesthesiologist? Read this first before you decide.
In case you were wondering — robots won’t replace anesthesiologists any time soon, regardless of what the Washington Post may have to say. There will definitely be a place for feedback and closed-loop technology applications in sedation and in general anesthesia, but for the foreseeable future we will still need humans. I’ve been practicing anesthesiology for 30 years now, in the operating rooms of major hospitals. Since 1999, I’ve worked at Cedars-Sinai Medical Center, a large tertiary care private hospital in Los Angeles. So what do I think today’s medical students should know about my ...
Source: Kevin, M.D. - Medical Weblog - June 25, 2015 Category: Journals (General) Authors: Tags: Physician Surgery Source Type: blogs

High Prescribing Connecticut APRN Charged With Accepting Kickbacks; Comes On Heels Of Connecticut Sunshine Law Targeting APRNs
The U.S. Attorney’s Office of the District of Connecticut has announced that an Advanced Practice Registered Nurse (APRN) practicing in the state has admitted to receiving $83,000 in kickbacks—mostly as a speaker at dinner programs—by an unnamed drug manufacturer. The press release states that Heather Alfonso was a “heavy prescriber” of a drug used to treat cancer pain. They noted that a review of Medicare Part D prescription drug events for prescribers of the drug showed that Alfonso was responsible for more than $1 million in claims and was the highest prescriber of the drug in Connecticut. ...
Source: Policy and Medicine - June 25, 2015 Category: American Health Authors: Thomas Sullivan Source Type: blogs

A patient secretly records his colonoscopy. It cost this doctor her job.
A patient undergoing a colonoscopy pressed “record” on his smartphone before being sedated, hoping to capture instructions from his physicians after the procedure.  What he heard instead was shocking: “In addition to their vicious commentary, the doctors discussed avoiding the man after the colonoscopy, instructing an assistant to lie to him, and then placed a false diagnosis on his chart.” The incident cost his anesthesiologist $500,000 in the ensuing malpractice and defamation trial. The recording has to be heard to be believed. Your patients are rating you online: How to ...
Source: Kevin, M.D. - Medical Weblog - June 24, 2015 Category: Journals (General) Authors: Tags: Video GI Malpractice Source Type: blogs

HIT Newser: Prison time for HITECH fraud
By MICHELLE RONAN NOTEBOOM CVS Health acquires Target’s healthcare biz CVS Health will pay $1.9 billion to acquire Target’s healthcare businesses, including 1,600 pharmacies and 80 MinuteClinic health clinics. CVS Health also just opened its Boston-based Digital Innovation Lab, which will focus on developing cutting-edge digital services and personalized capabilities that offer an accessible and integrated personal pharmacy and health experience. CVS is making big strides to position itself as both a digital innovator and major provider of primary care services. Look for them to continue to build on existing ...
Source: The Health Care Blog - June 22, 2015 Category: Consumer Health News Authors: michelle Tags: THCB Uncategorized HIT Newser Meaningful Use Source Type: blogs

Questioning the commitment today’s physicians have to medicine
Dr. Margaret Wood, who chairs the Department of Anesthesiology at Columbia University Medical Center, has published a wonderful article titled “Women in Medicine:  Then and Now,” in the journal Anesthesia and Analgesia. I think I speak for many of us in admitting that Anesthesia and Analgesia doesn’t occupy a prominent place on my bedside table. Many readers may have missed Dr. Wood’s article. That’s a shame, because it isn’t just about anesthesiology, and speaks to issues in medicine independent of specialty or gender. Continue reading ... Your patients are rating y...
Source: Kevin, M.D. - Medical Weblog - June 21, 2015 Category: Journals (General) Authors: Tags: Physician Surgery Source Type: blogs

Super Docs
Guest post by Tane Eunson – A student of the game (5th year M.B.B.S.) As a typical kiwi bloke, I’m a dyed-in-the-wool rugby fanatic (pardon the sheep reference). So when opportunities with two Super Rugby franchises arose for me in the past year, I picked the ball up and sprinted for the posts. As an ‘intern’ with the franchises, I was part of the ‘athletic performance’ teams. The hierarchical structures differed subtly within each team, but they both comprised the team doctor, two physiotherapists, two strength and conditioning coaches and a number of other interns in the varying discip...
Source: Life in the Fast Lane - June 19, 2015 Category: Emergency Medicine Authors: Mike Cadogan Tags: Medical Specialty Sports Medicine rugby Super Docs Super XV Tane Eunson Source Type: blogs

JellyBean 029 with John Hinds
Softly spoken. Well balanced. As an anaesthetist and intensivist you might be forgiven for thinking that Dr John Hinds would be a little risk averse. But not if you’d been to his utterly hilarious talk about madness and mayhem on the very small roads of Ireland. John Hinds is a jack of all trades. I like those kinds of jacks. This is a brilliant example of the sort of extremely cool thing that you can do with a medical, nursing or paramedic qualification. John carries about 25Kg strapped to himself and sends himself along stone walled Irish lanes at eye-watering speeds. John puts his life at risk in order to take a ...
Source: Life in the Fast Lane - June 16, 2015 Category: Emergency Medicine Authors: Doug Lynch Tags: JellyBean Podcast Web Culture John Hinds Source Type: blogs

New titles in Dental Anatomy, Dental Hygiene, and Examination Questions
Mosby's comprehensive review of dental hygiene / Michele Leonardi Darby (ed). 7th ed, St. Louis, Mo.: Elsevier/Mosby, 2012. A total of 2,500 review questions including four online timed practice exams --all with answers and rationales for remediation -- make this book stand out as a student favorite. Already known for its in-depth coverage, an easy-to-use outline format, and expert authorship, this review parallels the NBDHE with case studies, the "testlet" format for community health and research content, an emphasis on computer-based testing, and coverage of dynamic areas such as infection control and local an...
Source: DentistryLibrary@Sydney - June 15, 2015 Category: Dentistry Tags: New books Source Type: blogs

LITFL Review 186
Welcome to the 186th 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 The importance of grit in medicine can’t be stated enough. Mike Lauria discusses the concept and its import. [AS]   The Best of #FOAMed Emergency Medicine Excellent lecture on the non-utility of backboards and collars via Anton Helman...
Source: Life in the Fast Lane - June 14, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

Research and Reviews in the Fastlane 087
Welcome to the 87th edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature. This edition contains 6 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&...
Source: Life in the Fast Lane - June 10, 2015 Category: Emergency Medicine Authors: Soren Rudolph Tags: R&R in the FASTLANE critical care Education Emergency Medicine Intensive Care recommendations Review Source Type: blogs

The Hugest of the Huge Hematomas
Welcome to our new series, “Guts and Gore.” That title should serve as a warning that some of the videos we will use as teaching tools may be controversial and not for weak stomachs. We hope, however, that part of why you became an emergency provider was to handle sticky situations like the ones we will present. People like us have the ability to ignore blood and copious discharge, and instead focus on saving and improving the lives of our patients. Rarely are you thanked for this ability, and we hope this series on guts and gore will improve your technique, even when the going gets tough.   The Approach n...
Source: The Procedural Pause - June 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Did Dr. Virginia Apgar worry about work-life balance?
By KAREN SIBERT, MD Dr. Margaret Wood, who chairs the Department of Anesthesiology at Columbia University Medical Center, has published a wonderful article titled “Women in Medicine:  Then and Now“, in the journal Anesthesia and Analgesia. I think I speak for many of us in admitting that Anesthesia and Analgesia doesn’t occupy a prominent place on my bedside table. Many readers may have missed Dr. Wood’s article. That’s a shame, because it isn’t just about anesthesiology, and speaks to issues in medicine independent of specialty or gender. Here are some of my favorite...
Source: The Health Care Blog - June 1, 2015 Category: Consumer Health News Authors: John Irvine Tags: THCB Source Type: blogs

Developing Standards ‘Of, By, And For’ Older Adults: Reflections On Patricia Gabow’s Narrative Matters Essay
Imagine three people: a healthy 30-year-old, a 60-year-old with high blood pressure, diabetes and arthritis, and a 90-year-old who is frail and has dementia advanced to the point where her speech often doesn’t make sense. If I lined them up, any doctor could instantly tell me which was which. Ditto if each broke a bone and I showed the physicians only their x-rays. And if I asked the clinicians to predict each patient’s risk of complications and adverse events based on nothing more than the few words above, they would again rapidly and reliably make accurate assessments. Yet, for the most part, our health syste...
Source: Health Affairs Blog - May 29, 2015 Category: Health Management Authors: Louise Aronson Tags: Health Professionals Hospitals Narrative Matters Organization and Delivery Aging End-of-Life Care Health Policy Patricia Gabow standards of care Source Type: blogs

Is your anesthesiology practice poised for success?
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. Earlier this year, I spoke to an audience of physician anesthesiologists about setting up a basic quality assurance (QA) program within their departments. At the end of the presentation, one physician anesthesiologist stated that his group “will not let anyone out of the operating room (OR) to do QA.” He further described how any activity not related to clinical work takes a back seat to the group’s mandate that the physician anesthesiologists must first “generate revenue in the ORs.” Continue reading ... Y...
Source: Kevin, M.D. - Medical Weblog - May 28, 2015 Category: Journals (General) Authors: Tags: Policy Surgery Source Type: blogs

Government backs down on some requirements for digital medical records
EHR utopian dreams have taken some pronounced hits in recent years.In recent months, the hyper-enthusiasts and their government allies have had to eat significant dirt, and scale back their grandiose but risible - to those who actually have the expertise and competence to understand the true challenges of computerization in medicine, and think critically - plans.(At this point I'll give them the benefit of the doubt and not call the utopians and hyper-enthusiasts corrupt, just stupid.) USA Today published this article today outlining the retreat:Government backs down on some requirements for digital medical recordshttp://w...
Source: Health Care Renewal - May 27, 2015 Category: Health Management Tags: Bob Wachter David Blumenthal healthcare IT difficulties healthcare IT dissatisfaction Healthcare IT experiment Jayne O ' Donnell Sally Murphy USA Today Source Type: blogs

Research and Reviews in the Fastlane 085
This study was a retrospective cohort study of 298 patients with confirmed PE. In this population, a 45% were HST negative while 55% were positive. From the HST-negative group, there were no death, CPR or need of thrombolysis compared with 6% of mortality and 9% of CPR or thrombolysis in the HST-positive group. It appears that HST is a good prognosis biomarker in patients with pulmonary embolism. Recommended by: Daniel Cabrera Emergency medicineLin BW. A Novel, Simple Method for Achieving Hemostasis of Fingertip Dermal Avulsion Injuries. J Emerg Med 2015. PMID: 25886984 Fingertip avulsion injuries are typically fru...
Source: Life in the Fast Lane - May 27, 2015 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Airway Anaesthetics Cardiology Clinical Research Education Emergency Medicine Intensive Care R&R in the FASTLANE Social Media critical care examination literature recommendations research and reviews Source Type: blogs

Research and Reviews in the Fastlane 084
Welcome to the 84th edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature. This edition contains 6 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&...
Source: Life in the Fast Lane - May 21, 2015 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Airway Anaesthetics Education Emergency Medicine Intensive Care R&R in the FASTLANE Toxicology and Toxinology Trauma critical care examination research and reviews Source Type: blogs

FDA OPDP Issues Fifth Letter of Caution for the Year, Cites Oak Pharmaceuticals For Exhibit Banner
Almost like clockwork, the Food and Drug Administration’s Office of Prescription Drug Promotion (OPDP) has released its fifth enforcement letter of 2015—they have issued one letter in January, February, March, April, and now, as of the past week, one in May. OPDP sent the Untitled Letter to Oak Pharmaceuticals, Inc. (a subsidiary of Akorn, Inc.) regarding the company’s barbiturate anticonvulsant, Nembutal. View the promotional material here. The agency found that Oak’s table exhibit banner was misleading because it omitted “important risk information associated with the use of Nembutal,”...
Source: Policy and Medicine - May 21, 2015 Category: American Health Authors: Thomas Sullivan Source Type: blogs

Research and Reviews in the Fastlane 083
 Welcome to the 83rd edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.This edition contains 6 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the ...
Source: Life in the Fast Lane - May 14, 2015 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Anaesthetics Education Emergency Medicine Intensive Care Pediatrics R&R in the FASTLANE Resuscitation Trauma Wilderness Medicine critical care examination literature recommendations research and reviews Source Type: blogs

Implementing Health Reform: Clarifying Requirements For Coverage Of Contraceptives And Other Preventive Services
The Affordable Care Act requires nongrandfathered individual and group insurers and group health plans to cover certain preventive services without cost sharing. Specifically, it requires coverage of: evidence-based items and services given an “A” or “B” rating by the United States Preventive Services Task Force (USPSTF) with respect to the individual involved; immunizations as recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control; children’s preventive care and screenings as recommended by Health Resources and Services Administration (HRSA) guidel...
Source: Health Affairs Blog - May 12, 2015 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage contraceptives Prevention Source Type: blogs

Why I Hate Secure Email Portals
Many health care enterprises are using secure email ‘portals’ to send, or should I say ‘tell the recipient to come get,’ information and attachments in a way they were told would be ‘HIPAA Compliant’. What I mean by ‘portal’ is a third party to which plain text and any attachment is sent over a secure connection (‘plain text’ is unencrypted information; it can be formatted text that is just not encrypted). The ultimate recipient receives an email inviting them to visit the portal to see the content over a connection that is also encrypted. For example, if the hos...
Source: Waking Up Costs - May 11, 2015 Category: Anesthesiology Authors: J. Clark Venable, M.D. Tags: Privacy Rant Security Software Source Type: blogs

Stu Marshall on Airway Strategies
Stuart Marshall is an anaesthetist with a PhD in Human Factors and is the Clinical Director of Simulation Education at The Alfred (based at the Australian Centre for Health Innovation). In this FOAM video, created for the Critically Ill Airway (CIA) course, Stu provides an interactive guide to how an airway expert develops a strategies for airway management.CIA airway strategy from Stu Marshall on Vimeo.Feel free to discuss your plans for the scenarios presented in the video. Depending on your context, your plans may be quite different to those described…The next CIA course is December 8th and 9th 2015, registr...
Source: Life in the Fast Lane - May 11, 2015 Category: Emergency Medicine Authors: Chris Nickson Tags: Airway Anaesthetics Emergency Medicine Intensive Care airway strategies CIA critically ill airway stuart marshall Video Source Type: blogs

A physician anesthesiologist reports in from Afghanistan
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. As a physician, you never quite get used to being paged in the middle of the night. The shrill tones emitted via a radio frequency device that seems squarely stuck in the 1980s are almost always the first sign of something gone wrong, especially when serving as a military physician. 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 - May 4, 2015 Category: Journals (General) Authors: Tags: Physician Surgery Source Type: blogs

Cochlear Implants and MRI: Growth Trend Leads to Design Revolution
By Darla Franz, MA, & Rebecca Novak Tibbitt, MPH MED-EL   Cochlear implants (CIs) are an increasingly common option for people with severe to profound hearing loss. Approximately 324,200 people worldwide had received implants as of December 2012, according to the U.S. Food and Drug Administration (FDA). In the United States, an estimated 58,000 adults and 38,000 children have received cochlear implants (National Institute on Deafness and Other Communication Disorders; bit.ly/NIDCD-CI). Recent research has shown that the number of older adults in the United States who are potential candidates for cochlear implantat...
Source: R&D Blog - May 4, 2015 Category: ENT & OMF Tags: Blog Posts Source Type: blogs

Airway Lessons from the Austere Environment
The Critically Ill Airway course, run by The Alfred ICU and Monash University, is taking place this week. Among the lineup of elite instructors is Dr Brent May (@docbrent), who  has created a 12 minute video lecture on ‘Airway Lessons from the Austere Environment’.Brent is a trauma anaesthetist at The Alfred, a retrieval physician with Adult Retrieval Victoria, and is Chief Medical Officer for the Australian Formula 1 Grand Prix, Motorcycling Australia and Karting Australia. I asked Brent to speak on this topic because I believe that all airway practitioners can benefit from the lessons...
Source: Life in the Fast Lane - May 4, 2015 Category: Emergency Medicine Authors: Chris Nickson Tags: Airway Anaesthetics Education Emergency Medicine Intensive Care Pre-hospital / Retrieval austere environment brent may critically ill airway course prehospital Source Type: blogs

Cardiac Pacemaker
Cardiac pacemaker is a device meant to give regular electrical pulses to the heart when the normal pacemaker function of the heart is defective. The normal pacemaker of the heart is the sinoatrial node (SA node) situated in the upper part of right atrium. It gives out regular electrical pulses to the heart at a rate between 60 – 100 per minute. These pulses are conducted down the right atrium to the atrioventricular node (AV node), which is the relay station for the pulses. In the AV node the pulses are delayed and sent further down the conduction system known as the bundle of His and bundle branches (right and left)...
Source: Cardiophile MD - May 2, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: ECG / Electrophysiology Source Type: blogs

pre-op
Some people need to gain some interpersonal skills.Yesterday, morning I had my pre-admission appointment at the hospital.First I checked in with admissions, gave them my insurance info, requested a private or semi-private room, if available and declined to rent a TV or phone (note to self: make sure to pack phone and charger and load up tablet with mindless videos).Next we went to the pre-surgery unit (not it's official name but you get the idea) where we met with a bunch more people (last time, I remember going from room to room instead of having folks come to us but my memory of the last time is extremely untrustworthy)....
Source: Not just about cancer - May 1, 2015 Category: Cancer & Oncology Tags: brain metastasis breast cancer cancer blog health care metastatic Source Type: blogs

Tenosynovitis: Two-Touch Diagnosis
Today you are the fast-track provider, and you are on the hunt for procedures. You notice a 35-year-old woman signing into triage with a chief complaint of wrist pain.   This patient looks otherwise healthy, is pushing a stroller with her right hand, and is carrying a second child on her left. What’s the emergency? There isn’t one, but it is an emergency to this patient because she cannot push that stroller another day! If she cannot push the stroller, then she cannot get the kids to day care. And, if she cannot get the kids to day care, then she cannot go to work. Ask anyone with children, it is an emerge...
Source: The Procedural Pause - May 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Cardiac Catheterisation Laboratory
Cardiac catheterisation laboratory – place where angiography and inteventions are done Cardiac catheterisation laboratory is the place where angiography (imaging of blood vessels and the heart) and interventions are done. It is akin to the theatre for surgical procedures and has to be maintained in a sterile (free of micro organisms causing infection). Cardiac catheterisation laboratory (cathlab) is a comprehensive setup used for diagnostic and therapeutic (treatment) cardiac catheterisation. Cardiac catheterisation is the process in which small tubes are introduced into various chambers of the heart under local anes...
Source: Cardiophile MD - May 1, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Source Type: blogs

Connecticut Delays Sunshine Reporting For APRNs Until 2017
Connecticut recently passed a law requiring manufacturers to report their transfers of value made to advance practice registered nurses (APRNs) practicing in Connecticut. This group includes nurse practitioners, clinical nurse specialists, nurse anesthetists, and nurse midwives. APRNs are excluded from the reporting obligations under the Federal Physician Payments Sunshine Act, but Connecticut passed this disclosure requirement as part of a new initiative allowing APRNs to practice and prescribe independently of physicians. This law was originally supposed to go into effect July 1, 2015. On Friday, April 24,...
Source: Policy and Medicine - April 28, 2015 Category: American Health Authors: Thomas Sullivan Source Type: blogs

Airway Courses Galore!
Everyone who looks after critically ill patients needs to be able to manage airway crises. We all want to be better at it. We all can get better at it. Fortunately, there are plenty of courses around to help us become ‘expert enough‘. Fortunately, you can’t do too many airway courses Here are the courses I’m teaching on this year:I’ve designed a simulation-based course called the Critically Ill Airway course run by The Alfred ICU and Monash University. It focusses on cross-specialty team-based management of airway crises in the critically ill, beyond the operating...
Source: Life in the Fast Lane - April 27, 2015 Category: Emergency Medicine Authors: Chris Nickson Tags: Airway Anaesthetics Emergency Medicine Intensive Care ACE airway management CIA course critically ill airway criticlally ill Source Type: blogs

Atrial Septal Defect (ASD)
Atrial septal defect (ASD) is one of the commonest congenital heart diseases in the adult. It is a defect in the septum separting the two upper chambers of the heart. The defect in the septum between right and left atrium can be in various locations. The commonest variety which occurs almost in the centre is known as ostium secundum type. If it occurs at the lower end, it is called ostium primum variety. Ostium primum defect is often associated with a cleft of the mitral valve and leakage of the mitral valve (mitral regurgitation). There is another type of defect known as sinus venosus ASD. Sinus venosus ASD can ...
Source: Cardiophile MD - April 24, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs

An “A” for Effort
We’ve all heard of getting an “A” for effort. At least it was an “A,” right? But how meaningful is that grade if you still fail? I remember a patient I shall refer to as David. I didn’t know David very well at all. He was a patient in the Medical Intenstive Care Unit (MICU). He was not on my team. In fact, I didn’t really have a team. I was cross-covering the patients who were already admitted for a strech of 6 nights. At the start of each shift, the primary team would hand me a list and “sign out” their patients to me. They would tell me about pertinent, active issues...
Source: JeffreyMD.com - April 22, 2015 Category: Internal Medicine Authors: Dr. Jeff Tags: My Life Residency death doctor dying effort icu micu patients resident life Source Type: blogs

HIMSS15: The Patient Takes Center Stage
The following was originally posted by Lisa Suennen on Venture Valkyrie. Back in 2012 I wrote a blog post called SXSW: Woodstock for Geeks, which became the opening chapter of Tech Tonics, the book I wrote with David Shaywitz. In this piece, I pointed out the marked differences between SXSW vs. HIMSS, both of which I had recently experienced.   I said that HIMSS was best described as “a festival of old-school techno weenies recognizable in the wild by their big company expense accounts and the blue and gray suits that barely cover their pocket protectors.” In contrast, I experienced SXSW as an event t...
Source: Disruptive Women in Health Care - April 20, 2015 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Innovation Technology Source Type: blogs

Research and Reviews in the Fastlane 079
This article is a meta-analysis looking at a relatively new technique: POC Ultrasound. This review found that for ED intubations, US had a sensitivity of 98% and a specificity of 94%. The question, however, should be whether this technique is faster than End Tidal CO2, which is extremely reliable.Recommended by: Anand SwaminathanRead More: Ultrasound for Verification of Endotracheal Tube Location (ALiEM)The R&R iconoclastic sneak peek icon keyThe list of contributorsThe R&R ARCHIVER&R Hall of famer You simply MUST READ this!R&R Hot stuff! Everyone’s going to be talking about thisR&R Land...
Source: Life in the Fast Lane - April 16, 2015 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Airway Emergency Medicine Infectious Disease Intensive Care Pediatrics Respiratory Toxicology and Toxinology Trauma critical care Education literature R&R in the FASTLANE recommendations research and reviews Source Type: blogs

Joint Commission Implements Mandatory Universal Patient Helmet Regulations.
Baltimore, MD - In an effort to reduce injuries and deaths related to in-hospital falls,  the Joint Commission notified hospitals last week of strict new universal  helmet regulations for all hospitalized patients, without exception.Patient death or serious injury associated with a fall while being cared for in a health care setting has been a recognized since 2002 as one of 27 original never events as defined by the National Quality Forum (NQF).  The complete list was revised in 2011 to include 29 never events, but falls by confused old naked men have continued to result in serious injuries despite end...
Source: The Happy Hospitalist - April 12, 2015 Category: Internal Medicine Authors: Tamer Mahrous Source Type: blogs

LITFL Review 177
Welcome to the 177th 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 WeekMichelle Johnston manages to capture, in her superbly eloquent style, the heartbreak of the Wrong type of Swiss Cheese. Errors must be prevented, yes. But not at the cost of our humanity. [SO] The Best of #FOAMed Emergency MedicineThe April issu...
Source: Life in the Fast Lane - April 12, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

What does it mean to be a health care leader?
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. Clearly, physicians are the leaders of the health care team.  We were educated and trained for that role. But on the business and political sides of health care, maybe not so much. One reason is that the word “leadership” has a lot of different meanings.   A leader in one area is not automatically a leader in another area.  Requisite skill sets vary greatly for various situations. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social me...
Source: Kevin, M.D. - Medical Weblog - April 10, 2015 Category: Journals (General) Authors: Tags: Physician Surgery Source Type: blogs

Research and Reviews in the Fastlane 078
Welcome to the 78th edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.This edition contains 7 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&...
Source: Life in the Fast Lane - April 9, 2015 Category: Emergency Medicine Authors: Anand Swaminathan Tags: LITFL R&R in the FASTLANE critical care Emergency Medicine recommendations research and reviews Source Type: blogs

Integrating Care At Every Point Along A Patient’s Surgical Journey
In the United States, the full continuum of care before, during, and after surgery is expensive, fragmented, and associated with a high number of complications. We believe the current segmented care model must become an integrated care model based on excellent coordination throughout the entire perioperative system, from the minute the surgeon and the patient decide a procedure is needed until the patient is discharged and transferred to his or her primary care provider or medical home. This new model, which was originally proposed by the Perioperative Surgical Home (PSH) of the American Society of Anesthesiologists, is bu...
Source: Health Affairs Blog - April 7, 2015 Category: Health Management Authors: Zeev Kain and Jason Hwang Tags: All Categories Chronic Care Innovations in Care Delivery Nurses Physicians Policy Quality Source Type: blogs

American Pharmacists Association Votes to Discourage Pharmacists from Participating in Executions
On March 30, 2015, the American Pharmacists Association (APhA) House of Delegates – the group’s representative assembly – adopted a policy discouraging pharmacists from participating in executions. The APhA policy is only one sentence long: “The American Pharmacists Association discourages pharmacist participation in executions on the basis that such activities are fundamentally contrary to the role of pharmacists as providers of health care.” In defending the new policy, APhA Executive Vice President and CEO, Thomas E. Menighan, BSPharm, MBA, ScD (Hon), FAPhA, stated, “Ph...
Source: blog.bioethics.net - April 7, 2015 Category: Medical Ethics Authors: Hayley Dittus-Doria Tags: Health Care Pharmaceuticals Bioethics and the Law capital punishment drug safety syndicated Source Type: blogs

Brain Death: Legal Obligations and the Courts
I just published "Brain Death: Legal Obligations and the Courts"  with Christopher M. Burkle (Department of Anesthesiology, Mayo Clinic) in Seminars in Neurology 2015; 35(2): 174-179.  The whole issue is on brain death. Here is the abst... (Source: blog.bioethics.net)
Source: blog.bioethics.net - April 3, 2015 Category: Medical Ethics Authors: Thaddeus Mason Pope Tags: Health Care medical futility blog syndicated Source Type: blogs

General Guidelines Related to Abscess Incision and Drainage: Part II
Greetings! We’re excited to continue our series on abscess incision and drainage. This procedure should be loved and adored, because another abscess is waiting just behind the curtain. This month we will highlight (in video format) the final cut of abscess incision and drainage. We will follow up with some additional videos in the months to follow focusing on scalp, vaginal, and facial abscesses. And, just when you think you have seen it all, we will reveal a few more surprises.     The Approach ·         Identification of an abscess appropriate for I&D ...
Source: The Procedural Pause - March 31, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Pearls for Abscess Incision and Drainage
Part 2 in a Series Abscess incision and drainage should be loved and adored by all emergency providers because another abscess is waiting just behind the curtain. This month we highlight general guidelines for abscess incision and drainage, and show how to treat one in the video below. We will follow up with some additional videos in the months to come focusing on scalp, vaginal, and facial abscesses. And, just when you think you have seen it all, we will reveal a few more surprises.   Axillary abscess from hidradenitis. Photo by Martha Roberts.   The Approach n  Identification of an abscess appropriate ...
Source: The Procedural Pause - March 31, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Executions, Doctors, The U.S. Supreme Court, And The Breath Of Kings
This report concluded that even though prison officials decided to inject the drugs into Lockett’s femoral vein (which is a more difficult and risky procedure), Lockett’s surface and deep veins had “excellent integrity.” Another execution that was scheduled to occur that same night has now been stayed for six months, pending an investigation into Mr. Lockett’s execution. On July 23, 2014, Arizona encountered a problem with the same drug in the execution of Joseph Wood, wherein the condemned inmate allegedly gasped for almost two hours before dying. The executions have prompted two important bu...
Source: Health Affairs Blog - March 26, 2015 Category: Health Management Authors: I. Glenn Cohen Tags: All Categories Health Law Policy Politics Public Opinion States Source Type: blogs