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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

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 ap...
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

SGR Repeal: Bipartisan Leaders Announce Repeal To Be Considered Before March 31 Deadline
Conclusion Legislation to permanently repeal the Medicare SGR is an exciting breaking story. We will continue to follow the legislative and political developments as this issue dominates Washington in the coming days. There is currently no “patch” in the wings should this effort fail.         (Source: Policy and Medicine)
Source: Policy and Medicine - March 25, 2015 Category: American Health Authors: Thomas Sullivan Source Type: blogs

Why Australia and New Zealand Intensive Care Rocks!
Here is one possible reason:Australia & New Zealand total domination, thru @ANZICS_CTG, of critical care trial enrollment http://t.co/428s46SrAR pic.twitter.com/Y9bfIVvrK3— Jack Iwashyna (@iwashyna) March 18, 2015From Bellomo et al, 2007Hats off to the ANZICS CTG and all the clinicians across Australia and New Zealand who enrol their patients in trials as we strive to learn more about how to help our patients.Bellomo R, Stow PJ, Hart GK. Why is there such a difference in outcome between Australian intensive care units and others? Curr Opin Anaesthesiol. 2007 Apr;20(2):100-5. Review. PubMed PMID: 17413391.The...
Source: Life in the Fast Lane - March 18, 2015 Category: Emergency Medicine Authors: Chris Nickson Tags: Education ANZICS CTG Australia new zealand trials Source Type: blogs

Why can’t physician anesthesiologists, nurse anesthetists, and anesthesiologist assistants just get along?
American anesthesiology reached a significant milestone last year, though many of us probably missed it at the time. In February, 2014, the number of nurse anesthetists in the United States for the first time exceeded the number of physician anesthesiologists. Not only are there more nurses than physicians in the field of anesthesia today, the number of nurses entering the field is growing at a faster rate than the number of physicians. Since December, 2012, the number of nurse anesthetists has grown by 12.1 percent compared to 5.8 percent for physician anesthesiologists. The numbers — about 46,600 nurse anesthetists...
Source: Kevin, M.D. - Medical Weblog - March 10, 2015 Category: Journals (General) Authors: Tags: Physician Surgery Source Type: blogs

An informed patient is a safer patient
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. The health care landscape is changing, and now more than ever we as physicians should be focused on quality of care and ensuring the safety of our patients. Anesthesiology was the first medical specialty to champion patient safety as a specific focus. Over the past century, physician anesthesiologists have advanced patient safety through innovative research, science and technology advancements. In 1999, the Institute of Medicine report “To Err is Human” singled out the medical specialty of anesthesiology for its sig...
Source: Kevin, M.D. - Medical Weblog - March 9, 2015 Category: Journals (General) Authors: Tags: Physician Hospital Surgery Source Type: blogs

Go Slow On Reference Pricing: Not Ready For Prime Time
Editor’s note: This post is part one of two on reference pricing.  The use of reference pricing by health insurers and employee health benefit plans stands high on the policy and regulatory agenda because it is gaining popularity, particularly now that federal agencies have blessed its use by large group insurers and self-insured plans, while imposing only relatively lax requirements. The purpose of reference pricing is to enable patients to “shop” for care and to spur provider competition by creating a group of “designated” in-network providers that agree to abide by the reference p...
Source: Health Affairs Blog - March 9, 2015 Category: Health Management Authors: David Frankford and Sara Rosenbaum Tags: All Categories Business of Health Care Competition Consumers Employer-Sponsored Insurance Health Care Costs Health Reform Hospitals Payment Pharma Spending Source Type: blogs

LITFL Review 172
Welcome to the 172nd 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 WeekDi McMath writes a touching post reminding us all to build and maintain our resilience in “caring for the invisible wounds”. Thanks to Minh Le Cong for the tip! [SO]The Best of #FOAMed Emergency MedicineNice review of core content on skin...
Source: Life in the Fast Lane - March 8, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

Physician anesthesiologists do more than just “put you to sleep”
There have been huge advances in patient safety, but that doesn’t mean there is no risk when it comes to having surgery and anesthesia. Each year there are more than 100 million operations and procedures performed with anesthesia.  Doctors who specialize in anesthesia — we’re known as physician anesthesiologists — play a critical role in keeping patients safe and comfortable before, during, and after surgery. 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 - March 8, 2015 Category: Journals (General) Authors: Tags: Physician Surgery Source Type: blogs

Does Experience Matter? Study Finds Same Mortality Rates For Experienced and New Surgeons
Are the patient outcomes of newly trained surgeons comparable to the outcomes of experienced surgeons performing the same types of surgery at the same hospitals? A new study examined this question and came to a surprising conclusion: there were "no statistical difference between the patient mortality rates of new and experienced surgeons."  Researchers at the University of Pennsylvania went to great lengths to make sure they only tested for a surgeon's "experience." The study summary (available here) briefly describes the statistical method the researchers employed: [T]he research team accesse...
Source: Policy and Medicine - March 6, 2015 Category: American Health Authors: Thomas Sullivan Source Type: blogs

Security for me but not for thee?
Bruce Schneier has penned another excellent piece on encryption called The Democratization of Cyberattack. He makes the point that technology can be developed by governments for what we consider ‘good’ uses, but that others will be able to do the same things. And he give excellent examples, too. If you’re at all interested in the topic, please go read the article. Here’s just one quote: We can’t choose a world where the US gets to spy but China doesn’t, or even a world where governments get to spy and criminals don’t. We need to choose, as a matter of policy, communications systems...
Source: Waking Up Costs - March 2, 2015 Category: Anesthesiology Authors: J. Clark Venable, M.D. Tags: Privacy Security Source Type: blogs

Owning Procedural Expertise
Emergency medicine, since its inception as a specialty, has continuously redefined itself by absorbing intellectual and procedural expertise traditionally owned by other specialties. Whether it is performing advanced airway procedures formerly unique to anesthesia, reducing and splinting various orthopedic dislocations and fractures, or managing urological emergencies such as priapism or otolaryngology procedures, emergency physicians have relentlessly expanded their procedural expertise. Some consultants have forced our hands by delaying or being reluctant to see these emergencies in the emergency department. Others willi...
Source: M2E Too! Mellick's Multimedia EduBlog - March 2, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Owning Procedural Expertise
Emergency medicine, since its inception as a specialty, has continuously redefined itself by absorbing intellectual and procedural expertise traditionally owned by other specialties. Whether it is performing advanced airway procedures formerly unique to anesthesia, reducing and splinting various orthopedic dislocations and fractures, or managing urological emergencies such as priapism or otolaryngology procedures, emergency physicians have relentlessly expanded their procedural expertise. Some consultants have forced our hands by delaying or being reluctant to see these emergencies in the emergency department. Others willi...
Source: M2E Too! Mellick's Multimedia EduBlog - March 2, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Why Can’t We All Just Get Along?
By KAREN  SIBERT, MD American anesthesiology reached a significant milestone last year, though many of us probably missed it at the time. In February, 2014, the number of nurse anesthetists in the United States for the first time exceeded the number of physician anesthesiologists. Not only are there more nurses than physicians in the field […] (Source: The Health Care Blog)
Source: The Health Care Blog - February 25, 2015 Category: Consumer Health News Tags: THCB Anesthesiologist Assistant Anesthesiologists Nurse Anesthetists Physicians Source Type: blogs

A fifth operation and permanent menopause
Number of days since surgery: 13Pain level: manageableMood: relieved!It's been quite a while since I last wrote but, as usual, plenty has happened! I've been put into chemical menopause, taken out of chemical menopause, put back into chemical menopause again and now I'm recovering from yet more major surgery. And I'm finally in permanent menopause.Last April, as an attempt to control the high level of pain I was having, my oncology surgeon put me on a course of Prostap injections (you can read more about this in my previous blog post). His thinking was that by temporarily shutting down my remaining ovary he could see wheth...
Source: Diary of a Cancer Patient - February 24, 2015 Category: Cancer & Oncology Source Type: blogs

Medtronic Subsidiary ev3 Pays $1.25 Million to Settle Allegations Related To Promotion
Earlier this month, Minnesota-based ev3 agreed to pay $1.25 million to the Department of Justice to settle False Claims Act (FCA) allegations related to the company’s promotion of their atherectomy device, Silverhawk. The whistleblower complaint was initially filed in 2009, and alleged that Fox Hollow Technologies (purchased by ev3 in 2007), induced hospitals to bill Medicare for more expensive inpatient codes rather than outpatient codes when billing the Silverhawk procedure. The "Silverhawk Plaque Excision System" is a catheter device that has the ability to strip and collect plaque within a patient&rsquo...
Source: Policy and Medicine - February 24, 2015 Category: American Health Authors: Thomas Sullivan Source Type: blogs

Do you want a doctor or a demotivated test-taking machine?
Last week, my best friend took the recertification exam in anesthesia, the so-called MOCA exam.  Like a good doobie, she paid her $2,100, paid her nanny extra so she could study, took a day off in which she missed the funeral of a friend’s husband, and took the test.  Wow, she must be the most awesome, most well-read, most skilled, most enthusiastic anesthesiologist ever now!  Well, she always was, but the test didn’t make her that way.  In fact, there is a large body of evidence that suggests such testing requirements have the potential to reduce the quality of her work. Continue ...
Source: Kevin, M.D. - Medical Weblog - February 20, 2015 Category: Journals (General) Authors: Tags: Education Surgery Source Type: blogs

How the advent of propofol changed the meaning of the term ”sedation”
“Twilight! She has to have twilight,” insisted the adult daughter of my frail, 85-year-old patient. “She can’t have general anesthesia. She hasn’t been cleared for general anesthesia!” We were in the preoperative area of my hospital, where my patient — brightly alert, with a colorful headband and bright red lipstick — was about to undergo surgery. Her skin had broken down on both legs due to poor circulation in her veins, and she needed skin grafts to cover the open wounds. She had a long list of cardiac and other health problems. Continue reading ... Your patients are ratin...
Source: Kevin, M.D. - Medical Weblog - February 19, 2015 Category: Journals (General) Authors: Tags: Meds Surgery Source Type: blogs

How the advent of propofol changed the meaning of the term “sedation”
“Twilight! She has to have twilight,” insisted the adult daughter of my frail, 85-year-old patient. “She can’t have general anesthesia. She hasn’t been cleared for general anesthesia!” We were in the preoperative area of my hospital, where my patient — brightly alert, with a colorful headband and bright red lipstick — was about to undergo surgery. Her skin had broken down on both legs due to poor circulation in her veins, and she needed skin grafts to cover the open wounds. She had a long list of cardiac and other health problems. Continue reading ... Your patients are ratin...
Source: Kevin, M.D. - Medical Weblog - February 19, 2015 Category: Journals (General) Authors: Tags: Meds Surgery Source Type: blogs

Having surgery? Here’s how to manage your medications.
A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com. Before undergoing surgery, you should carefully discuss your medications with your surgeon and physician anesthesiologist. You may fare better during the operation and the early recovery phase if you continue required medications, but you might need to avoid some medications that could interfere with your anesthesia. Three medical conditions and associated medications that should help improve your chances of a speedy and healthy recovery are examined below. Continue reading ... Your patients are rating you online: How to respo...
Source: Kevin, M.D. - Medical Weblog - February 16, 2015 Category: Journals (General) Authors: Tags: Conditions Heart Surgery Source Type: blogs

The occupational hazards of being a doctor are frightening
There isn’t any such thing as an ordinary life.  - Lucy Maud Montgomery Heroes are ordinary people who make themselves extraordinary. – Gerard Way My colleague, Dr. Jesse Ehrenfeld, is currently on leave from his academic anesthesia practice as well as from his post as speaker of the house of delegates for the Massachusetts Medical Society to serve as Lt. Commander Jesse Ehrenfeld, combat anesthesiologist in Kandahar, Afghanistan. We all appreciate the sacrifice he is making, putting himself at risk and in harm’s way. Continue reading ... Your patients are rating you on...
Source: Kevin, M.D. - Medical Weblog - February 13, 2015 Category: Journals (General) Authors: Tags: Physician Hospital Surgery Source Type: blogs

Abscess Basics: The Setup and Anesthesia
Part 1 in a Series   We are pleased to bring you our first full-length tutorial on abscess drainage. Part 1 of this series focuses on set up and basics for all beginners.   It is important to note that you should practice on injection techniques and how to properly hold instruments before draining your first abscess. No one likes a shaky, unsure hand. We also believe in the “see one, do one, teach one” mentality. Be sure to check out the stockroom at your facility so you, too, can become familiar with all of the equipment used to drain an abscess properly.   Stay tuned for next month’s blog...
Source: The Procedural Pause - February 12, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Abscess Basics: The Setup and Anesthesia
Part 1 in a Series   We are pleased to bring you our first full-length tutorial on abscess drainage. Part 1 of this series focuses on set up and basics for all beginners.   It is important to note that you should practice on injection techniques and how to properly hold instruments before draining your first abscess. No one likes a shaky, unsure hand. We also believe in the “see one, do one, teach one” mentality. Be sure to check out the stockroom at your facility so you, too, can become familiar with all of the equipment used to drain an abscess properly.   Stay tuned for next month’...
Source: The Procedural Pause - February 12, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Research and Reviews in the Fastlane 070
This study demonstrated a high sensitivity (86%) and very high specificity (97%) when looking for consolidations> 1 cm on US compared to chest X-ray as the standard. The study was done quickly (mean 7 minutes) and by non-experts (1 hour of training) increasing the likelihood that the findings can be generalized to non-study settings.Recommended by: Anand SwaminathanThe Best of the RestResuscitationOlaussen A, et al. Return of consciousness during ongoing Cardiopulmonary Resuscitation: A systematic review, Resuscitation 2014; 86: 44-48. PMID 25447435After introduction of mechanical CPR device CPR induced c...
Source: Life in the Fast Lane - February 11, 2015 Category: Emergency Medicine Authors: Soren Rudolph Tags: Education Emergency Medicine Neurosurgery Pediatrics Resuscitation Trauma critical care examination Intensive Care R&R in the FASTLANE research and reviews Source Type: blogs

Meet Maureen L. Mulvihill
Credit: Actuated Medical, Inc. Maureen L. Mulvihill, Ph.D. Fields: Materials science, logistics Works at: Actuated Medical, Inc., a small company that develops medical devices Second job (volunteer): Bellefonte YMCA Swim Team Parent Boost Club Treasurer Best skill: Listening to people Last thing she does every night: Reads to her 7- and 10-year-old children until “one of us falls asleep” If you’re a fan of the reality TV show Shark Tank, you tune in to watch aspiring entrepreneurs present their ideas and try to get one of the investors to help develop and market the products. Afterward, you might start ...
Source: Biomedical Beat Blog - National Institute of General Medical Sciences - February 9, 2015 Category: Research Authors: Emily Carlson Tags: Pharmacology Profiles Source Type: blogs

A Relatively Narrow Complex Tachycardia at a Rate of 180.
I received a text message with this image: "Cardioversion didn't work.  Any thoughts?" What do you think?  The heart rate is 180.I was viewing this on my phone, but I saw what I thought were P-waves.  I could barely see them in lead II:There are probable P-waves at the arrows, but I wasn't certainI texted back: "Could be very fast sinus."There is also a wide QRS at 113 ms and a large R-wave in aVR, so sodium channel blockade is likely.   Common culprits in this situation are tricyclic overdose and cocaine toxicity (remember cocaine not only increases dopamine in central syn...
Source: Dr. Smith's ECG Blog - February 8, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs

ED Case of Catecholaminergic Polymorphic Ventricular Tachycardia
This article only comments on chronic management, not acute management. (Source: Dr. Smith's ECG Blog)
Source: Dr. Smith's ECG Blog - February 6, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs

How the Advent of Propofol Changed the Meaning of the term “Sedation”
By KAREN SIBERT, MD “Twilight! She has to have twilight,” insisted the adult daughter of my frail, 85-year-old patient. “She can’t have general anesthesia. She hasn’t been cleared for general anesthesia!” We were in the preoperative area of my hospital, where my patient – brightly alert, with a colorful headband and bright red lipstick – […] (Source: The Health Care Blog)
Source: The Health Care Blog - February 5, 2015 Category: Consumer Health News Tags: THCB Anesthesia General anesthesia Propofol Twilight Source Type: blogs

Oculo cardiac reflex : An unique neural link between the eyes and Heart
Heart by development  originates from near  the same spot , where the brain develop (Neuralcrest) .Hence there is no surprise  though a richly a vascular organ, heart  retains many neural connections with brain .Eyeballs with it’s  extensive neural connections  can be considered  direct extension of brain. Occulo cardiac reflex . When the eyeballs or the ocular muscles are manipulated or massaged slowing of heart rate can occur .This is due to  a reflex called  Occulo cardiac reflex mediated by  vagal stimulation .This phenomenon is also referred to as  Aschner p...
Source: Dr.S.Venkatesan MD - February 3, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Neuro cardiology circuits for occulo cardiac reflex diver's reflex eye ball massage trigemianl vagal reflex Source Type: blogs

In the Nalox“ZONE”
A 27-year-old woman with no past medical history presented to the ED by EMS after being found unresponsive at home by her partner. EMS reported that she was unresponsive with a GCS of 3, pinpoint pupils, and sonorous breath sounds. Naloxone 0.4 mg IV was administered, and the patient became responsive. The patient was delirious, agitated, and tachycardic upon arrival to the ED. She was administered lorazepam 2 mg IV without improvement. Her agitation and delirium were so severe that she was intubated, paralyzed with rocuronium, and started on a midazolam infusion.   What is the appropriate dose of IV naloxone? No c...
Source: The Tox Cave - February 2, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

How monitoring low-acuity patients improves health outcomes
The objective was to facilitate early recognition of deterioration and cue rescue interventions at the earliest possible moment. Notifications were sent to a patient's nurse via pager when monitor values were outside established physiologic limits, with an escalation if there was no response. Q: Were you concerned about a possible increase in alarm monitoring? If so, what did you do to minimize such events? A: The possibility of increased alarms was certainly a concern. To proactively address this issue, we lowered thresholds and widened ranges consistent with the work done at Dartmouth. We have found that this decreased...
Source: hospital impact - February 2, 2015 Category: Health Managers Authors: Wendy Johnson Source Type: blogs

How the Advent of Propofol Changed the Meaning of the term “Sedation”
By KAREN SIBERT, MD “Twilight! She has to have twilight,” insisted the adult daughter of my frail, 85-year-old patient. “She can’t have general anesthesia. She hasn’t been cleared for general anesthesia!” We were in the preoperative area of my hospital, where my patient – brightly alert, with a colorful headband and bright red lipstick – […] (Source: The Health Care Blog)
Source: The Health Care Blog - February 1, 2015 Category: Consumer Health News Tags: Physicians Anesthesia General anesthesia Propofol Twilight Source Type: blogs

Cardiac Surgeon Prints 3D Heart to Prep for Challenging Surgery
MRI of patient’s heart used to build the 3D printed model.   Though ventricular septal defects are fairly common and surgically treated, it’s best to plan the approach ahead of time. Since it’s usually done once the patient is opened and on bypass, there’s critical time wasted analyzing the anatomy and deciding on a plan. Richard Kim, a cardiac surgeon at Children’s Hospital Los Angeles (CHLA) , faced with a patient that had an unusual defect in the heart decided to print a 3D model of the actual heart produced from an MRI of the organ. The replica allowed Dr. Kim to work out the best app...
Source: Medgadget - January 30, 2015 Category: Technology Consultants Authors: Editors Tags: in the news... Source Type: blogs

In the Nalox“ZONE”
A 27-year-old woman with no past medical history presented to the ED by EMS after being found unresponsive at home by her partner. EMS reported that she was unresponsive with a GCS of 3, pinpoint pupils, and sonorous breath sounds. Naloxone 0.4 mg IV was administered, and the patient became responsive. The patient was delirious, agitated, and tachycardic upon arrival to the ED. She was administered lorazepam 2 mg IV without improvement. Her agitation and delirium were so severe that she was intubated, paralyzed with rocuronium, and started on a midazolam infusion.   What is the appropriate dose of IV naloxone? No cons...
Source: The Tox Cave - January 30, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Connecticut Transparency Law: Manufacturers Must Only Report Payments to APRNs Practicing Independently
Manufacturers must report quarterly on 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 law allowing APRNs to practice and prescribe independently of physicians.  Proposed Bill No. 257 complicates the reporting obligations in Connecticut by requiring that applicable manufa...
Source: Policy and Medicine - January 30, 2015 Category: American Health Authors: Thomas Sullivan Source Type: blogs