The LITFL Review 154
The LITFL Review is 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. Welcome to the 154th edition, brought to you by: Anand Swaminathan [AS] (EM Lyceum, iTeachEM) Brent Thoma [BT] (BoringEM and Academic Life in EM) Chris Connolly [CC] Chris Nickson [CN] ( iTeachEM, RAGE, INTENSIVE and SMACC) Joe-Anthony Rotella [JAR]...
Source: Life in the Fast Lane - October 28, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Education LITFL R/V Source Type: blogs
Research and Reviews in the Fastlane 055
This study demonstrates a higher success rate (100% vs. 88%) and lower pneumothorax rate (0% vs. 5%) in comparing ultrasound guided versus landmark technique for placement. Although the ultrasound guided method may be technically difficult to learn and take some time investment, that time is repayed in the shorter time to accessing the vessel and lower complication rate. Recommended by: Anand Swaminathan Emergency medicineRosen P. The biology of emergency medicine. JACEP. 1979 Jul;8(7):280-3. PubMed PMID 449164 Peter Rosen has called this ‘the only good article I have ever written’. This is Rosen’s rati...
Source: Life in the Fast Lane - October 28, 2014 Category: Emergency Medicine Authors: Soren Rudolph Tags: Anaesthetics Clinical Research Emergency Medicine Intensive Care Neurology Resuscitation Trauma critical care Education literature R&R in the FASTLANE recommendations Research and Review Source Type: blogs
Steps to Avoid Anesthesia's Complications
Patients undergoing surgery are unlikely to be harmed by anesthesia, but potential complications can be dangerous. Giving drug and health histories is key. Doctors and nurses are ramping up training. (Source: WSJ.com: The Informed Patient)
Source: WSJ.com: The Informed Patient - October 27, 2014 Category: Consumer Health News Tags: FREE Source Type: blogs
New books. No.1 is an eBook, No.3 is print & electronic
Ultrasonic periodontal debridement: theory and technique. / Marie D. George. Ames, Iowa: John Wiley & Sons Inc., 2014. This is the first textbook to focus exclusively on this fundamentally important component of periodontal therapy. George, Donley, and Preshaw provide a comprehensive resource for dental students, dental hygiene and therapy students, and periodontal residents, as well as practicing dental hygienists and dentists who are looking to increase their familiarity and skills with ultrasonic instrumentation. Local anesthesia for dental professionals / Kathy B. Bassett. 2nd ed, Pearson: Boston, 2014. The 2nd ed...
Source: DentistryLibrary@Sydney - October 24, 2014 Category: Dentists Tags: E-books New books Source Type: blogs
New books. No.1 is an eBook, No.3 is print & electronic
Ultrasonic periodontal debridement: theory and technique. / Marie D. George. Ames, Iowa: John Wiley & Sons Inc., 2014. This is the first textbook to focus exclusively on this fundamentally important component of periodontal therapy. George, Donley, and Preshaw provide a comprehensive resource for dental students, dental hygiene and therapy students, and periodontal residents, as well as practicing dental hygienists and dentists who are looking to increase their familiarity and skills with ultrasonic instrumentation. Local anesthesia for dental professionals / Kathy B. Bassett. 2nd ed, Pearson: Boston, 2014. ...
Source: DentistryLibrary@Sydney - October 24, 2014 Category: Dentistry Tags: E-books New books Source Type: blogs
What I love about being an anesthesiologist
I wear a lot of hats in my job. Though I’m a physician who specializes in the practice of anesthesiology, I don’t spend all day every day at the head of an operating room table. Many days I spend in an administrative leadership role or conducting research studies. These functions support the best interests of my patients as well as the science and practice of anesthesiology. On my clinical days that I spend in hands-on patient care, I provide anesthesia for patients who undergo surgery and other invasive procedures. I also treat acute pain as a consultant. Some of my colleagues in ...
Source: Kevin, M.D. - Medical Weblog - October 21, 2014 Category: Journals (General) Authors: Edward R. Mariano, MD Tags: Physician Surgery Source Type: blogs
Research and Reviews in the Fastlane 054
Conclusions Wrong? (emlitofnote) Critical Care, CardiologyGuyton AC. Regulation of cardiac output. Anesthesiology. 1968; 29(2): 314-26. PMID: 5635884 The modern emphasis on echo might make you think that the heart determines cardiac output. This classic paper by Guyton shows that unless the heart is failing, it has a permissive role in determining cardiac output. The real determinants are (1) the degree of vasodilation of the peripheral vasculature, especially veins, and (2) the filling of the circulatory system, indicated by the mean systemic filling pressure. Gotta love those Guyton curves! Recommended by: Chris ...
Source: Life in the Fast Lane - October 20, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Cardiology Clinical Research Education Emergency Medicine Infectious Disease Intensive Care Neurology Neurosurgery Obstetrics / Gynecology Orthopedics Pediatrics Trauma critical care literature R&R in the FASTLANE recommendat Source Type: blogs
Research and Reviews in the Fastlane 053
This study combines the results from the WARFASA and ASPIRE trials looking at aspirin prophylaxis. The results are promising. Aspirin 100 mg reduced the rate of recurrent VTE from 7.5%/year to 5.1%/year (HR = 0.68) without a significant change in bleeding rate (0.5%/year vs 0.4%/year). We often see patients in the ED with a history of unprovoked VTE who are on no long-term prophylaxis. This article argues that we consider aspirin for all these patients. Recommended by: Anand Swaminathan Trauma Stevens AC, Trammell TR, Billows GL, Ladd LM, Olinger ML. Radiation Exposure as a Consequence of Spinal Immobilization and Extri...
Source: Life in the Fast Lane - October 14, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Alternative Medicine Anaesthetics Cardiology Education Emergency Medicine Haematology Intensive Care Neurology Pediatrics R&R in the FASTLANE Respiratory Resuscitation Toxicology and Toxinology Trauma critical care literature Source Type: blogs
Finding My Purpose through My Wife’s Breast Cancer
In the spring of 2000 Susan, my wife then of 33 years (now of 48), was diagnosed with breast cancer. It all started with her annual check-up and her internist saying she felt something “funny” in Susan’s right breast. She suggested Susan see a breast surgeon. While I was surprised, I wasn’t alarmed. It was going to be Susan’s fourth breast biopsy. Unlike the three previous ones, this one was done as an out-patient procedure in one of the then relatively new surgical centers now found in shopping centers everywhere. No frozen section this time, just wait to hear wh...
Source: Disruptive Women in Health Care - October 14, 2014 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Cancer Source Type: blogs
LITFL Review 152
The LITFL Review is 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. Welcome to the 152nd edition, brought to you by: Anand Swaminathan [AS] (EM Lyceum, iTeachEM) Brent Thoma [BT] (BoringEM and Academic Life in EM) Chris Connolly [CC] Chris Nickson [CN] ( iTeachEM, RAGE, INTENSIVE and SMACC) Joe-Anthony Rotella [JAR]...
Source: Life in the Fast Lane - October 14, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Review LITFL R/V Source Type: blogs
Outpatient anesthesia in elderly patients: What to watch for
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. More than 75 percent of operations in the U.S. occur in an outpatient setting. Outpatient, or ambulatory care, can take place in a number of different settings, including physician offices, outpatient surgery centers, or hospital or non-hospital-based outpatient clinics. With more and more elderly patients undergoing outpatient procedures, it’s important to consider the unique risks of geriatric anesthesia care. Not only have the organs in older patients begun their steady decline, but these patients also experience other...
Source: Kevin, M.D. - Medical Weblog - October 12, 2014 Category: Journals (General) Authors: Nina Singh-Radcliff, MD Tags: Conditions Geriatrics Surgery Source Type: blogs
Glenn Greenwald: Why Privacy Matters
Glenn Greenwald just did an excellent TED Talk: Glenn Greenwald was one of the first reporters to see the Edward Snowden files. In this searing talk fresh from the TEDGlobal stage, Greenwald makes the case for why you need to care about privacy, even if you’re “not doing anything you need to hide.” The post Glenn Greenwald: Why Privacy Matters appeared first on Waking Up Costs. (Source: Waking Up Costs)
Source: Waking Up Costs - October 11, 2014 Category: Anesthesiology Authors: Clark Tags: Privacy Source Type: blogs
Why are so many people opposed to epidurals?
To put this post in perspective the pain of childbirth is said to be equivalent of amputating a finger. The joint statement of the American Congress of OB/GYN and the American Society of Anesthesiologists sums pain control during labor and delivery quite nicely: “There is no other circumstance where it is considered acceptable for an individual to experience untreated severe pain, amenable to safe intervention, while under a physician’s care. In the absence of medical contraindication, maternal request is a sufficient medical indication for pain relief during labor.” Continue reading ... Your patients ar...
Source: Kevin, M.D. - Medical Weblog - October 10, 2014 Category: Journals (General) Authors: Jennifer Gunter, MD Tags: Conditions OB/GYN Source Type: blogs
Sleeping on a cloud—advanced clinical anesthesiology solution uses Microsoft Azure as its technological foundation
As a physician, I have a great deal of respect for my colleagues who specialize in anesthesiology. While surgeons may get all the glory for what they do in an operating room, they couldn’t do their job without the anesthesiologist. These specialist doctors...(read more) (Source: HealthBlog)
Source: HealthBlog - October 9, 2014 Category: Technology Consultants Authors: hlthblog Source Type: blogs
Research and Reviews in the Fastlane 052
This study looked at compliance with discharge instructions. Surprisingly (or maybe not so), 39% of pediatric patients returned to play (RTP) on the day of the injury. RTP is widely recognized as a risk for recurrent and more severe concussions as well as significant morbidity. It is the duty of the Emergency Physician to stress the importance of discharge instructions as well as the importance of appropriate follow up. Recommended by: Anand Swaminathan PediatricsSingleton T et al. Emergency department care for patients with hemophilia and von Willebrand disease. J Emerg Med. 2010; 39(2): 158-65. PMID: 18757163 Bleeding...
Source: Life in the Fast Lane - October 9, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Administration Anaesthetics Cardiology Clinical Research Education Emergency Medicine Haematology Infectious Disease Intensive Care International Emergency Medicine Microbiology Neurosurgery Obstetrics / Gynecology Ophthalmology Source Type: blogs
Research and Reviews in the Fastlane 051
Welcome to the 51st 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 10 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&R p...
Source: Life in the Fast Lane - October 6, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Anaesthetics Cardiology Education Emergency Medicine Gastroenterology Infectious Disease Intensive Care Pre-hospital / Retrieval Respiratory Resuscitation critical care literature R&R in the FASTLANE recommendations Research an Source Type: blogs
Positioning is Everything
Part 1 of a Mini-Series on Lumbar Puncture We love breaking down and simplifying complicated procedures so you can perform them easily and efficiently. The next few blog posts will focus on strengthening your practice. We want to give appropriate and safe care. We also want to consider patient satisfaction, dignity, and comfort when we complete any procedure. This month, we are focusing on procedures that require perfect patient positioning. Half the battle of any procedure is setting up your stage to perform, no matter how complex or simple the task at hand may be. Successful procedures are all about positio...
Source: The Procedural Pause - October 1, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Move In Your Seat: Healthy Meeting Tips at MANA Conference
This morning’s Michigan Association of Nurse Anesthetists started off with a line dance and fun. Eliz presented “Move Your Bootie” and shared strategies to move in your seat during meetings to keep the blood flowing and increase attention. Participants in the 7 am session ended with a line dance and smiles. Later in the day Eliz will share stress management tips in “Juggling Stress“. Were you in the audience? Share a Woo Hoo or “I will because…” statement in a comment below. Thanks! Motivational Women’s Wellness Speaker Eliz Greene works with busy people to impro...
Source: Embrace Your Heart Wellness Initiative - September 27, 2014 Category: Cardiology Authors: Eliz Greene Tags: Award Winning Blog Events & Media Juggling Stress Move Your Bootie Programs for nurses Source Type: blogs
Medicines or Poisons?—Why Cannabinoids Can Both Help and Hurt You
This is the final post of a 3-part series on the science of medical marijuana. Check out Part 1: What’s Wrong with “Medical Marijuana”? and Part 2: Making Medicine from Marijuana. People who write about the health benefits of marijuana sometimes think it’s ironic that a plant containing compounds that could treat disease (like THC or CBD) is banned by the government for being unsafe. But in fact many effective, FDA-approved medicines are closely related to illegal, harmful drugs and are sometimes even made from the same sources. That’s because there’s a fine (and sometimes fuzzy) line be...
Source: NIDA Drugs and Health Blog - September 22, 2014 Category: Addiction Authors: The NIDA Blog Team 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 slig...
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
Curbing prescription pain medication abuse by working together
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. I recently heard a story on the news about a grandmother of eight who had gotten addicted to heroin after being prescribed an opioid painkiller, Oxycontin, for hip pain. It sounds extreme, but unfortunately to those of us in the pain medicine field, it’s all too familiar. Every year in September we acknowledge people struggling with pain during National Pain Awareness Month. It’s an important month dedicated to the roughly 100 million people suffering from chronic pain in the U.S. It’s also important to a...
Source: Kevin, M.D. - Medical Weblog - September 18, 2014 Category: Journals (General) Authors: Asokumar Buvanendran, MD Tags: Physician Pain management Source Type: blogs
Observations from being “the family.”
It’s been a trying week for our family. You learn things when your people need healthcare. It’s an entirely different perspective. I am doctor; I’ve been a patient, but this was the first time being “the family.” Without going into details, (see her guest post), my wife Staci came to need the best that American healthcare has to offer. Let’s say it was a non-preference-sensitive decision to proceed with a major surgery. As I write this, things are stable and well here at home. Here are some observations of the experience: People in the business of delivering healthcare are good people. E...
Source: Dr John M - September 16, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
Guest post — 10 observations from a 49 year-old falls risk.
It finally happened. After years of sitting at John’s bedside through multiple serious bike crashes, I had one of my own. I’ve had plenty of time to build up a ridiculous amount of smugness about why he crashes and I don’t. “John is reckless; Staci is cautious. John rides like an airplane engine on a shopping cart; Staci uses her head.” I was mountain biking in Cherokee Park. A storm front was moving in so the temperature and humidity were dropping and it was breezy. I felt so good! Like Rose and Jack on the bow of the Titanic. I was queen of my body and that trail. I passed a real mountain bi...
Source: Dr John M - September 16, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
ACO Update: What Challenges Lie Ahead?
In June, we noted that Accountable Care Organizations (ACOs) have proliferated throughout the United States in the past few years, but they are still a comparatively new model for delivering low-cost, high quality care. As of mid-2013, there were over 4 million beneficiaries covered by Medicare ACOs. Additionally, a report identified 537 ACOs, and found that the number of physicians, nurse practitioners, and physician assistants participating in ACOs exceeds 190,000. Currently, there are nearly 289,000 total healthcare providers and business personnel aligned with ACOs. Despite these growing numbers, two interesting articl...
Source: Policy and Medicine - September 16, 2014 Category: American Health Authors: Thomas Sullivan Source Type: blogs
Public Disclosure Bar Blocks Recovery in Stryker False Claims Act Case
The U.S. Court of Appeals for the Eighth Circuit rejected a whistleblower suit against Stryker Corp. and other pain pump manufacturers because the allegations were based on information that had already been made public. The Court upheld the District Court in ruling that the plaintiff failed to pass the “public disclosure bar” necessary for whistleblowers to recover under the False Claims Act (FCA). Whistleblowers are able to share in the government's recovery when they are integral to the discovery of the fraud. The Eighth Circuit referenced a frequently cited quote in its opinion, which describes the pub...
Source: Policy and Medicine - September 16, 2014 Category: American Health Authors: Thomas Sullivan Source Type: blogs
Research and Reviews in the Fastlane 048
This study looked at one institution’s discrepancy rate between EP and radiologist plain film reads over 10 years. They found overall an ~3% discrepancy rate on all plain films. This of course does not mean the radiologist was correct in every discrepancy. But it does show we agree most of the time. Most interestingly, the rate of discrepancies requiring emergent change in management was a mere 0.056%! Recommended by: Zack Repanshek Prehospital/Retrieval Braude D et al. Air Transport of Patients with Pneumothorax: Is Tube Thoracostomy Required Before Flight? Air Med J. 2014 Jul-Aug;33(4):152-6. PMID: 250...
Source: Life in the Fast Lane - September 15, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Anaesthetics Cardiology Education Emergency Medicine Pediatrics Pre-hospital / Retrieval Public Health Respiratory Resuscitation Toxicology and Toxinology critical care Intensive Care literature R&R in the FASTLANE recommendati Source Type: blogs
Anesthesiologist’s Review of the Facts in the Joan Rivers Case
By KAREN SIBERT, MD Since the death of comedian and talk-show host Joan Rivers, more information has surfaced about the events on the morning of August 28 at Yorkville Endoscopy. But key questions remain unanswered. News accounts agree that Ms. Rivers sought medical advice because her famous voice was becoming increasingly raspy. This could be caused […] (Source: The Health Care Blog)
Source: The Health Care Blog - September 15, 2014 Category: Consumer Health News Tags: THCB Airway Laryngospasm Larynx Polyp Propofol Tumor Yorkville Endoscopy Source Type: blogs
Joan Rivers: Pushing the limits of outpatient care
There are minor operations and procedures, but there are no minor anesthetics. This could turn out to be the one lesson learned from the ongoing investigation into the death of comedian Joan Rivers. Ms. Rivers’ funeral was held on September 7. Like so many of her fans, I appreciated her quick wit as she entertained us for decades, poking fun at herself and skewering the fashion choices of the rich and famous. She earned her success with hard work and keen intelligence — she was, after all, a Phi Beta Kappa graduate of Barnard College. Ms. Rivers was still going strong at 81 when she...
Source: Kevin, M.D. - Medical Weblog - September 15, 2014 Category: Journals (General) Authors: Karen S. Sibert, MD Tags: Physician Surgery Source Type: blogs
It’s now night 3 of 6. Six straight days — er, nights — covering the ICU patients here at one of the local county hospitals. Night 1 was great. Occasional calls here and there from nurses for little things that did not require much brain power. I am also working with an intern. He is covering the non-ICU patients. Night 1 went well for him too. I think I saw him watching tv shows on his iPad during the down time. Night 2 was definitely busier for the both of us. For me, there was one patient who pretty much required my attention the entire night. And when I finally failed at placing a functional arterial ...
Source: JeffreyMD.com - September 13, 2014 Category: Medical Students Authors: Dr. Jeff Tags: Residency medicine nightshifts Source Type: blogs
New books received this week
Local anesthesia for dental professionals / Kathy B. Bassett. 2nd ed, Pearson: Boston, 2014. For courses in Pain Control, Local Anesthesia in Dentistry, and Nitrous Oxide Sedation (minimal sedation) in Dentistry. Local Anesthesia for Dental Professionals, 2/e provides a user-friendly, primary resource for instructors and students of pain control. This text is appropriate for both dental and dental hygiene students and provides step-by-step instructions that are also useful to practicing clinicians seeking to improve their skills or learn new injection techniques. In addition to the superb illustrations, step-by-step appro...
Source: DentistryLibrary@Sydney - September 12, 2014 Category: Dentists Tags: New books Source Type: blogs
Research and Reviews in the Fastlane 047
In this study, the research team collected pooled urine (read many people used the urinal they collected from) from a popular nightclub area in London and analyzed the specimens for the presence of illicit drug compounds. The goal was to determine whether this method could be used to track patterns and monitor trends in recreational drug use. Recommended by: Anand Swaminathan Emergency Medicine, Critical Care, Anaesthetics Hindman BJ et al. Intubation Biomechanics: Laryngoscope Force and Cervical Spine Motion during Intubation with Macintosh and Airtraq Laryngoscopes. Anesthesiology. 2014; 121(2):260-71. PMID...
Source: Life in the Fast Lane - September 9, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Clinical Research Education Emergency Medicine R&R in the FASTLANE critical care Intensive Care literature recommendations Research and Review Source Type: blogs
What Killed Joan Rivers? Piecing Together a Medical Mystery
KAREN SIBERT, MD There are minor operations and procedures, but there are no minor anesthetics. This could turn out to be the one lesson learned from the ongoing investigation into the death of comedian Joan Rivers. Ms. Rivers’ funeral was held yesterday, September 7. Like so many of her fans, I appreciated her quick wit as […] (Source: The Health Care Blog)
Source: The Health Care Blog - September 8, 2014 Category: Consumer Health News Tags: THCB Demerol Hypotension Joan Rivers Midazolam outpatient care Propofol Wellness Yorkville Endoscopy Source Type: blogs
Physician Payments Sunshine Act: Organizations Respond to CMS
September 2nd marked the last day for comments on CMS’ proposed rule to eliminate the accredited continuing medical education (CME) exemption from Sunshine Act reporting. In an overwhelming display of support for the exemption, over 800 comments were submitted encouraging the agency to either maintain or expand the current exclusion. -Total comments supporting maintenance or expansion of the CME exemption: 820 -Total comments supporting elimination of the CME exemption: approximately 20 -Percentage of comments supporting the CME exemption: 98% We have followed this issue closely, and recentl...
Source: Policy and Medicine - September 8, 2014 Category: American Health Authors: Thomas Sullivan Source Type: blogs
Anesthesia outside the operating room: A growing trend
I opened my obligatory late-afternoon email to find my work schedule for the next morning: three general anesthetics for MRIs. My heart sank. A week before, I had been assigned to the new neurosciences MRI suite for a 6-hour interventional radiology procedure, followed by another intervention in the CT scanner. My first thought: Who is trying to punish me? 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 - September 7, 2014 Category: Journals (General) Authors: Dawn Baker, MD, MS Tags: Physician Radiology Surgery Source Type: blogs
Joan Rivers Out of ICU and “Comfortable” Likely Ominous
Although we are not participating in the care of comedy legend Joan Rivers, we have noted news reports that her daughter Melissa has said her mother is out of the ICU and being kept comfortable. Rivers was hospitalized six days ago after suffering cardiac arrest and a prolonged anoxic period (brain without oxygen.) She was placed in a hypothermic coma (lowered body temperature) as is standard for the first 24-48 hours after arrest in an attempt to salvage brain and cardiac function. However, reading between the lines of this recent statement, this is likely an ominous development and could signal the start of a comfort car...
Source: Inside Surgery - September 4, 2014 Category: Surgery Authors: Editor Tags: Anesthesia Medical News Wire Uncategorized ativan comfort care dying ICU Joan Rivers morphine Source Type: blogs
Contrasting American EDs with the World’s Largest Hospital
By Zubair Chao, MD Dr. Thomas Cook and I escaped the dry heat of South Carolina to land in Chengdu, China, home of West China Hospital, in July 2012. He was set to teach an emergency ultrasound class, and I was on a global mission as part of my emergency medicine residency. Some say it is the largest hospital in the world, boasting 5,000 beds, nearly 100 operating suites, and a large outpatient center, which, on any given day, has about 10,000 patients. West China Hospital The ED at West China Hospital recently moved to its new home in a larger, more modern facility. It sees about 160,000...
Source: Going Global - September 3, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Go Mental: Head and Neck Anesthesia
As we approach the end of summer, we pay tribute to a special nerve block. This particular block is crucial for treating lower lip lacerations that may be related to slips and falls at the pool or skateboarding. We are going to ask you to go mental, as in blocking the mental nerve of the face. The mental nerve is an extension of the inferior alveolar nerve, which branches primarily off the trigeminal nerve. It is a sensory nerve that provides sensation to the lower chin and lip. It does not supply sensory innervation to the lower teeth, although some patients report mild anesthesia to their teeth. Three branches com...
Source: The Procedural Pause - September 3, 2014 Category: Emergency Medicine Tags: Blog Posts 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
Mini-Sims for Critical Care
Conclusion The bottom line is clear: a copy of this book should be in every ICU. We need to ‘make sim happen’ in the workplace and this book is a great entry point. However, nothing replaces the need for clear learning objectives and a skilled teacher, so I encourage clinicians to seek further training in simulation education… Books and mannequins don’t teach themselves. Disclosures The authors of the book provided LITFL with a review copy free-of-charge. The post Mini-Sims for Critical Care appeared first on LITFL. (Source: Life in the Fast Lane)
Source: Life in the Fast Lane - August 31, 2014 Category: Emergency Medicine Authors: Chris Nickson Tags: Book Review amuth samuel Charlie Corke in situ simulation mini-sims for critical care nick simpson Source Type: blogs
Kids and Cutting to Air
This is a guest post written by Dr Mike Cameron FACEM, a Queensland-based emergency physician. It was the mid-1980s and I was almost at the end of my third year as a doctor. I was working in England, about an hour’s motorcycle ride North of London, in a district hospital of a few hundred beds. I remember it was cold. That night I was the Anaesthetic Senior House Officer (SHO) on call. I had done a few cases in Theatre but I had got out before midnight and things were looking pretty good sleep-wise. Labour Ward had a couple in early labour but no epidurals required. I was on a 1:2 roster, but my Registrar and I altern...
Source: Life in the Fast Lane - August 30, 2014 Category: Emergency Medicine Authors: Chris Nickson Tags: Anaesthetics Emergency Medicine child cricothyroidotomy mike cameron paediatric surgical airway trick of the trade Source Type: blogs
Balloon mitral valvotomy – the modern treatment for mitral stenosis
Inflated balloon across the mitral valve Long back, mitral stenosis (narrowing of the valve between the left atrium and left ventricle) used to be treated by a surgery known as closed mitral valvotomy in which the surgeon used to open the chest and introduce a mechanical device to enlarge the narrowed valve through the tip of the left ventricle. Currently this procedure has become obsolete and almost extinct with the development of balloon mitral valvotomy (BMV). In this procedure, balloon at the tip a long tube (balloon catheter) is used to enlarge the narrowed valve. The balloon catheter for this procedure is introduced ...
Source: Cardiophile MD - August 30, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis MD, DM, FACC, FRCP Edin, FRCP London Tags: Heart Disease FAQ Source Type: blogs
Masimo rainbow DCI-mini Hemoglobin Spot-Check Sensor Cleared in Europe, Japan
Masimo has received European and Japanese regulatory approvals to introduce the rainbow DCI-mini non-invasive hemoglobin (SpHb) sensor. Intended for infants and small kids weighing 3 to 30 kg (6.6 lbs to 66 lbs), the sensor connects to Masimo’s Pronto monitor that displays the readings. Finger sensors for hemoglobin have only been available for patients 10 kg (22 lbs) and larger, making catching anemia difficult in small kids without the drama of drawing blood. The DCI-mini is clipped onto to a child’s finger, or a toe on smaller kids, and provides spot-check readings at any time. Masimo hopes that the new...
Source: Medgadget - August 29, 2014 Category: Technology Consultants Authors: Editors Tags: Anesthesiology Cardiology Critical Care Pediatrics Source Type: blogs
Technology, Lower Reimbursements Reduce Number of Radiology Positions
I have blogged before about the shrinking residency and job opportunities in radiology (see: Job Prospects Dimming for Residents in Radiology; Defining the Underlying Problems; Radiology Jobs Trend Downward; Blame Technology and Reimbursement). Also see this: Job Prospects Are Dimming for Radiology Trainees. This seems to be the result of a number of factors including: (1) incumbent radiologists are able to work more efficiently due to RIS/PACS support; (2) some radiologists have reportedly postponed their retirement due to the financial downturn in 2008; (3) teleradiology enabled some radiologists to find part-time o...
Source: Lab Soft News - August 29, 2014 Category: Pathologists Authors: Bruce Friedman Tags: Healthcare Delivery Healthcare Information Technology Source Type: blogs
The RUC. "an Independent Group of Physicians?" - But It Includes Executives and Board Members of For-Profit Health Care Corporations and Large Hospital Systems
Introduction We just discussed how a major story in Politico has once again drawn attention to the opaque RUC (Resource Based Relative Value System Update Committee) and its important role in determining what physicians are paid for different kinds of services, and hence the incentives that have helped make the US health care system so procedurally oriented. (See the end of our last post for a summary of the complex issues that swirl around the RUC.)The Politico article covered most of the bases, but notably omitted how the RUC may be tied to various large health care organizations, especially for-profit, and how the...
Source: Health Care Renewal - August 28, 2014 Category: Health Management Tags: AMA boards of directors conflicts of interest health care prices healthcare executive hospital systems perverse incentives regulatory capture RUC Source Type: blogs
My University of Michigan Experience
By: Ethel Osei-Tutu, medical student, University of Cape Coast, School of Medical Sciences, Ghana Editor’s Note: For more information on the Ghana–Michigan medical student exchange program, see “Perceptions of Ghanaian Medical Students Completing a Clinical Elective at the University of Michigan Medical School” by Abedini, Danso-Bamfo, and colleagues, published in the July issue. The University of Cape Coast, School of Medical Sciences (UCCSMS) began a yearly exchange program with the University of Michigan (UMich) in 2012. Four final-year students from UCCSMS are selected each ...
Source: Academic Medicine Blog - August 28, 2014 Category: Universities & Medical Training Authors: Guest Author Tags: Featured Trainee Perspective international exchange program international medical education patient centered care University of Cape Coast School of Medical Sciences University of Michigan Medical School Source Type: blogs
How Much Is My Colonoscopy Going to Cost? $600? $5,400?
By JEANNE PINDER How much does a colonoscopy cost? Well, that depends. If you’re uninsured, this is a big question. We’ve learned that cash or self-pay prices can range from $600 to over $5,400, so it pays to ask. If you’re insured, you may think it doesn’t matter. Routine, preventive screening colonoscopies are to be […] (Source: The Health Care Blog)
Source: The Health Care Blog - August 27, 2014 Category: Consumer Health News Tags: THCB Anesthesia Billing Colonoscopy Facility fee Gastroenterology Labs pricing Source Type: blogs
The Smallest Drugs
Here is the updated version of the "smallest drugs" collection that I did the other day. Here are the criteria I used: the molecular weight cutoff was set, arbitrarily, at aspirin's 180. I excluded the inhaled anaesthetics, only allowing things that are oils or solids in their form of use. As a small-molecule organic chemist, I only allowed organic compounds - lithium and so on are for another category. And the hardest one was "Must be in current use across several countries". That's another arbitrary cutoff, but it excludes pemoline (176), for example, which has basically been removed from the market. ...
Source: In the Pipeline - August 27, 2014 Category: Chemists Tags: Chemical News Source Type: blogs
This is what lifelong learning in medicine should look like
He left a little early to stop by the cath lab to see his patient before her procedure. Cordial “hellos,” “good mornings,” and “any last questions?” were mentioned before she signed her consent. The team was working feverishly to prepare her for her procedure. “Have you met the anesthesiologist yet?” was next, and almost on cue, the anesthesiologist arrived and took over for a bit. 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 27, 2014 Category: Journals (General) Authors: Wes Fisher, MD Tags: Physician Heart Source Type: blogs
Will dermal rolling get rid of acne scars? The Beauty Brains Show episode 45
What is dermal rolling? Does it really get rid of acne scars? And most importantly, is it safe and effective to do it to yourself at home? Click below to play Episode 45 or click “download” to save the MP3 file to your computer. Show notes The Cosmetic Categories Game Tune in as I try to stump Randy in a new game that features beauty products, beauty brands and beauty ingredients. Question of the week: Will dermal rollers get rid of acne scars? Chris asks…Does dermal rolling really work to remove acne scars and can you do it at home? How does dermal rolling/micro needling work? A dermal roller is ...
Source: thebeautybrains.com - August 26, 2014 Category: Consumer Health News Authors: Perry RomanowskiThe Beauty Brains Tags: Claims Podcast Problems Safety Source Type: blogs
Small Molecules - Really, Really Small
Mentioning such a small compound as pirfenidone prompts me to put up the graphic shown below: these are the smallest commonly used drugs that I can think of. (OK, there's cocaine as a nasal anaesthetic - no, really - but that's where I draw the line at "commonly used". Nominations for ones that I've missed are welcome, and I'll update the list as needed. Note: four more have been added since the initial post, with more to come. This sort of thing really makes a chemist think, though - some of these compounds are very good indeed at what they do, and have been wildly successful. We need to keep an open mind about ...
Source: In the Pipeline - August 25, 2014 Category: Chemists Tags: Drug Industry History Source Type: blogs