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The LITFL Review 144
The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the best and brightest from the blogosphere, the podcast video/audiosphere and the rest of the Web 2.0 social media jungle to find the most fantastic EM/CC FOAM (Free Open Access Meducation) around. Welcome to the 144th edition, brought to you by: Kane Guthrie [KG] from LITFL Tessa Davis [TRD] from LITFL and Don’t Forget The Bubbles Brent Thoma [BT] from BoringEM,...
Source: Life in the Fast Lane - July 16, 2014 Category: Emergency Medicine Authors: Kane Guthrie Tags: Education eLearning Featured Health Intensive Care LITFL review LITFL R/V Source Type: blogs

Research and Reviews in the Fastlane 039
Welcome to the 39th 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 13 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 project or check out the f...
Source: Life in the Fast Lane - July 14, 2014 Category: Emergency Medicine Authors: Soren Rudolph Tags: Anaesthetics Cardiology Emergency Medicine Emergency Medicine Update Featured Infectious Disease Intensive Care Pre-hospital / Retrieval Resuscitation critical care literature R&R in the FASTLANE recommendations research and revi Source Type: blogs

How to Talk About Pain - NYT
LONDON — IN 1926, Virginia Woolf published an essay on pain, "On Being Ill." Isn't it extraordinary, she observed, that pain does not rank with "love, battle and jealousy" among the most important themes in literature. She lamented the "poverty of the language of pain." Every schoolgirl who falls in love "has Shakespeare, Donne, Keats to speak her mind for her; but let a sufferer try to describe a pain in his head to a doctor and language at once runs dry." Where are the novels or epic poems devoted to typhoid, pneumonia or toothaches, Woolf wondered? Instead, the person in pai...
Source: Psychology of Pain - July 13, 2014 Category: Psychiatrists and Psychologists Source Type: blogs

How To Be A Bad Gastroenterologist
I am a regular reader of patient blogs, and I find myself frequently gasping at the mistreatment they experience at the hands of my peers. Yesterday I had the “pleasure” of being a patient myself, and found that my professional ties did not protect me from outrageously poor bedside manners. I suppose I’m writing this partly to vent, but also to remind healthcare professionals what not to do to patients waking up from anesthesia. I also think my experience may serve as a reminder that it’s ok to fire your doctor when conditions warrant. I chose my gastroenterologist based on his credentials and the q...
Source: Better Health - July 10, 2014 Category: American Health Authors: Dr. Val Jones Tags: Opinion True Stories Bad Bedside Manner Bad Doctors Colonoscopy Compassion Empathy Gastroenterologist Lack Lack of Caring Source Type: blogs

Research and Reviews in the Fastlane 038
Welcome to the 38th 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 Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R project or check o...
Source: Life in the Fast Lane - July 10, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Anaesthetics Cardiology Emergency Medicine Featured Infectious Disease Intensive Care Neurology Palliative care R&R in the FASTLANE Radiology Resuscitation Trauma critical care literature recommendations research and reviews Source Type: blogs

Guest blogger Dr. Sana Johnson-Quijada on Freedom and Self Care
I met Dr. Sana Johnson-Quijada at the APA Annual Meeting this year in New York.   Sana has her own blog Friend to Yourself, and I invited her to do a guest blog on Shrink Rap.  In honor of Independence Day, she sent the following post.  Self-Care is Freedom, is Democracy, is Because We Are Accountableauthenticsociety.comSelf-Care Tip #159 – Be accountable for and to yourself.It was about 100 degrees Fahrenheit, which in my part of the world is considered hot.  But in Washington D.C., I considered that temperature general anesthesia.  I was breathing it in and trying hard to remain a...
Source: Shrink Rap - July 6, 2014 Category: Psychiatrists and Psychologists Authors: Dinah Source Type: blogs

Common Back and Leg Pain Treatment May Not Help Much, Study Says - NYTimes.com
A widely used method of treating a common cause of back and leg pain — steroid injections for spinal stenosis — may provide little benefit for many patients, according to a new study that experts said should make doctors and patients think twice about the treatment.Hundreds of thousands of injections are given for stenosis each year in the United States, experts say, costing hundreds of millions of dollars.But the study, the largest randomized trial evaluating the treatment, found that patients receiving a standard stenosis injection — which combine a steroid and a local anesthetic — had no less pai...
Source: Psychology of Pain - July 3, 2014 Category: Psychiatrists and Psychologists Source Type: blogs

Help wanted
You need to have brain surgery. Wouldn't you want a surgeon who had experience in the field (as opposed to, say, removing ingrown toenails)?Me, too.So, this is an interesting job ad. A hospital is looking for an anesthesiologist. That's the person in charge of making sure you're deeply out when they cut you open, watches your vital signs to make sure you're not dying on the table, and then (hopefully) wakes you up after the surgeon has put you back together.So shouldn't they want someone who'd previously done that a few times?Apparently not:Yes folks, you read that correctly. They want an anesthesiologist, but experience u...
Source: Doctor Grumpy in the House - July 3, 2014 Category: Neurologists Authors: Grumpy, M.D. Source Type: blogs

Healthcare Update Satellite — 07-2-2014
Ve have vays of keeping you qviet. Halt den mund! Government-contracted security force who actually call themselves the “Brown Shirts” … threatens to arrest medical providers if they leak any information to media about all of the medical illnesses that are being seen at an illegal alien refugee camp in Lackland Air Force Base. By the way, this story is from FoxNews, so everyone should just ignore it until you or your family members sit next to one of them on a bus or in a movie theater. Combine these kids on playgrounds with anti-vax kids? What could go wrong? Nothing to worry about. Nothing at all. New ...
Source: WhiteCoat's Call Room - July 2, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

My Difficult Airway
Looks can be deceiving. I was not supposed to have a difficult airway, but we found out the hard way that wasn’t true. I was about to undergo an exploratory laparotomy for suspected appendicitis in 1989, and my wife was adamant that an attending anesthesiologist perform my intubation. The anesthesiology resident at a large Midwest teaching hospital made a claim that I suspect many of us did as we advanced through training and began to feel procedurally invincible. He claimed that the attending anesthesiologist rarely did intubations, and that the residents who performed them daily were more prepared. Unaware of any u...
Source: M2E Too! Mellick's Multimedia EduBlog - July 2, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

My Difficult Airway
Looks can be deceiving. I was not supposed to have a difficult airway, but we found out the hard way that wasn’t true. I was about to undergo an exploratory laparotomy for suspected appendicitis in 1989, and my wife was adamant that an attending anesthesiologist perform my intubation. The anesthesiology resident at a large Midwest teaching hospital made a claim that I suspect many of us did as we advanced through training and began to feel procedurally invincible. He claimed that the attending anesthesiologist rarely did intubations, and that the residents who performed them daily were more prepared. Unaware of any u...
Source: M2E Too! Mellick's Multimedia EduBlog - July 2, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Research and Reviews in the Fastlane 037
Conclusion: Use of an age-adjusted d-dimer threshold reduces imaging among patients age
Source: Life in the Fast Lane - July 2, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Anaesthetics Cardiology Emergency Medicine Featured General Surgery Health Infectious Disease Intensive Care Neurology Neurosurgery Radiology Resuscitation Trauma critical care literature R&R in the FASTLANE recommendations Source Type: blogs

A perfect thank you note to an oncologist
I got a letter the other day from a local urologist requesting clearance for a patient of mine to have surgery.  The doctor wanted to know whether there were any contraindications, from the standpoint of the patient’s cancer, such as bleeding, infection or poor wound healing, which would preclude local anesthesia, bilateral incisions, sharp separation, ligation, and electrocauterization of the vasa deferentia.  In other words, could my patient, a 42-year-old survivor of stage IV Hodgkin’s disease, tolerate a vasectomy? Continue reading ... Your patients are rating you online: How to respond. Manage y...
Source: Kevin, M.D. - Medical Weblog - June 26, 2014 Category: Journals (General) Authors: Tags: Physician Cancer Surgery Source Type: blogs

Research and Reviews in the Fastlane 036
This study found that a high percentage (49%) of patients with serious adverse outcomes after an ED visit for COPD were not initially admitted to the hospital. The authors used logistic regression to derive a decision instrument to aid in determining which patients with COPD exacerbation should be admitted based on risk stratification. The study does not show that admission improves outcomes but the instrument may prove useful for risk stratification if it is prospectively validated. Recommended by: Anand Swaminathan Emergency Medicine, Critical care, Anaesthetics Barends CRM ,Absalom AR. Tied up in science: unknotting ...
Source: Life in the Fast Lane - June 25, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Anaesthetics Emergency Medicine Evidence Based Medicine Featured Health Infectious Disease Intensive Care Respiratory Resuscitation critical care literature R&R in the FASTLANE recommendations research and reviews Source Type: blogs

I don't feel your pain - Ideas - The Boston Globe
IF YOU STOPPED the average person in an emergency room and asked why she's there—not just her guess at the problem, but what really motivated her to show up—the number one answer would be "pain." For all that modern medicine has learned about disease and treatment, it's alleviating pain that still lies at the heart of the profession. And in recent years, the notion of treating "pain" as its own entity has been rising to the forefront in medicine. Pain management now has its own journals, conferences, clinics, and specialists, and pain relief is sometimes referred to as a human right...
Source: Psychology of Pain - June 18, 2014 Category: Psychiatrists and Psychologists Source Type: blogs

Joint Commission’s Speak Up Program™
The Joint Commission along with the Centers for Medicare & Medicaid Services, launched a program in 2002 called Speak Up™.  It encourages patients to take an active role in preventing health care errors by becoming involved and informed participants on their health care team. The Speak Up™ program features brochures, posters, animated videos and now in 2014 infographics, which can be downloaded for free. Their latest release is Speak Up™ Anesthesia. It was developed to raise awareness of the risks of anesthesia or sedation and precautions that should be taken. The infographic includes a descripti...
Source: BHIC - June 18, 2014 Category: Databases & Libraries Authors: Michelle Burda Tags: General Health Information Literacy Source Type: blogs

Research and Reviews in the Fastlane 035
This study suggests that antiemetics are not nearly as potent as widely believed. These drugs have been shown to be effective in preventing nausea (i.e. pretreatment for chemo) but it’s appears that the mechanism for halting nausea is different than that for preventing it. Recommended by: Anand Swaminathan Read More: Nausea? We’ve Got Placebo for That The Best of the Rest Emergency Medicine, Pulmonary 1. Kew KM, Kirtchuk L, Michell C. Intravenous magnesium sulfate for treating adults with acute asthma in the emergency department. Cochrane Database Syst Rev. 2014 May 28;5 PubMed ID: 24865...
Source: Life in the Fast Lane - June 18, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Anaesthetics Cardiology Emergency Medicine Evidence Based Medicine General Surgery Intensive Care Palliative care Pediatrics Respiratory Resuscitation Trauma critical care literature R&R in the FASTLANE recommendations resear Source Type: blogs

Research and Reviews in the Fastlane 035
This study suggests that antiemetics are not nearly as potent as widely believed. These drugs have been shown to be effective in preventing nausea (i.e. pretreatment for chemo) but it’s appears that the mechanism for halting nausea is different than that for preventing it. Recommended by: Anand Swaminathan Read More: Nausea? We’ve Got Placebo for That The Best of the Rest Emergency Medicine, Pulmonary 1. Kew KM, Kirtchuk L, Michell C. Intravenous magnesium sulfate for treating adults with acute asthma in the emergency department. Cochrane Database Syst Rev. 2014 May 28;5 PubMed ID: 24865...
Source: Life in the Fast Lane - June 18, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Anaesthetics Cardiology Emergency Medicine Evidence Based Medicine Featured General Surgery Intensive Care Palliative care Pediatrics Respiratory Resuscitation Trauma critical care literature R&R in the FASTLANE recommendatio Source Type: blogs

The Neuroscience of the Future
Neural prosthetics, brain-computer interfaces (BCI), “closed-loop” deep brain stimulation (DBS) devices, and a world without human brain disorders. The first three of these are already here... is the last one possible?In the utopian world of The Hedonistic Imperative, an ambitious, admirable (and unlikely) 1995 manifesto by philosopher David Pearce, the goal is to “eradicate suffering in all sentient life” through paradise engineering —  which involves sophisticated applications of nanotechnology, genetic engineering, and psychopharmacology. And going beyond the eradication of suffering, &ld...
Source: The Neurocritic - June 16, 2014 Category: Psychiatrists and Psychologists Authors: The Neurocritic Source Type: blogs

Good bye, my love.
Two months ago, Dixie seemed to be feeling under the weather. She wasn't eating well, and seemed to have less energy. I took her to my vet and she was diagnosed with anaplasmosis. (a tick borne illness) She tested a "faint positive" right at the end of the testing window. The vet prescribed antibiotics and said that Dixie should feel better in a few days.A few days later, she wasn't doing any better. I brought her back to the vet and they did an X-ray to "rule out" anything more significant. The vet saw a shadow on her X-ray and sent it to the University of Minnesota vet hospital to have it read by a ra...
Source: Dam Diabetes - June 14, 2014 Category: Diabetes Source Type: blogs

Sham Peer Review Issue Goes Mainstream. WaPo: VA Physicians Fear Sham Peer Review
The paper's words this time, not mine:From the Washington Post, "VA docs concerned about retaliation", June 12, 2014, http://www.washingtonpost.com/blogs/federal-eye/wp/2014/06/12/va-docs-concerned-about-retaliation/:Retaliation from management is a real concern among Department of Veteran Affairs (VA)  employees ...  James Martin, a physician and a representative of the American Federation of Government Employees National VA Council, told the gathering  that sham peer reviews are a problem in the department. In a later interview, he elaborated, saying, “orchestration of facts” related ...
Source: Health Care Renewal - June 13, 2014 Category: Health Management Tags: bad health IT sham peer review Veterans Administration medical scandal Veterans Affairs Source Type: blogs

Pregnancy and the Development of Varicose Veins
Women who are pregnant often develop varicose veins. These are veins that have become enlarged, squiggly, and/or dark in appearance. They develop due to increased pressure in the numerous veins of the body which leads to the damage of vital blood valves. When blood valves are weakened blood can pool, ultimately leading to varicose veins. These veins can be painful and displeasing to look at. While this condition can happen to anyone it is especially common in pregnant women and the general female population. This is due to the increased weight during a pregnancy and the growing fetus applying added pressure to the lower ab...
Source: Cord Blood News - June 12, 2014 Category: Perinatology & Neonatology Authors: joyce at mazelabs.com Tags: Cord Blood Source Type: blogs

Research and Reviews in the Fastlane 034
Welcome to the 34th 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 14 recommended reads. The R&R Editorial Team is Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find out more about the R&R in the FASTLANE project here and check out the team of ...
Source: Life in the Fast Lane - June 12, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Anaesthetics Cardiology Emergency Medicine Featured Health Intensive Care Pediatrics Pre-hospital / Retrieval Renal Resuscitation Trauma critical care literature R&R in the FASTLANE recommendations research and reviews Source Type: blogs

Knee Replacement Surgery: A Race to the Bottom?
A total knee replacement is a very common operation and more than 700,000 of them are performed each year in the United States. With a mean cost of about $16,000 each, in 2011 we spent over eleven billion dollars paying for knee replacements. Projections are that, by 2030, we’ll be doing 3.5 million per year. The operation has great results and patients generally do well during and after their surgery. Anesthetic care has improved dramatically over time. Whereas initially patients who had a knee replaced would be given large doses of narcotic pain medicines (morphine) to deal with their pain, over time anesthesiologi...
Source: Waking Up Costs - June 9, 2014 Category: Anesthesiology Authors: Clark Tags: Health Care Reform Source Type: blogs

Knee Replacement Surgery: A Race to the Bottom?
A total knee replacement is a very common operation and more than 700,000 of them are performed each year in the United States. With a mean cost of about $16,000 each, in 2011 we spent over eleven billion dollars paying for knee replacements. Projections are that, by 2030, we’ll be doing 3.5 million per year. The operation has great results and patients generally do well during and after their surgery. Anesthetic care has improved dramatically over time. Whereas initially patients who had a knee replaced would be given large doses of narcotic pain medicines (morphine) to deal with their pain, over time anesthesiologi...
Source: Waking Up Costs - June 9, 2014 Category: Anesthesiology Authors: Clark Tags: Health Care Reform Source Type: blogs

Three Books to Prep for Change
Changing careers is scary! As I contemplate my move out of the clinical practice of anesthesia into information security consulting I have good days and bad days. And days that are both bad and good. Preparing myself mentally is key. I have had three books recommended to me that are all terrific primers for what’s ahead. I wanted to share them here. Your Job Survival Guide: A Manual for Thriving in Change Switch: How to Change Things When Change Is Hard Leading at The Edge Are there any others you recommend? (Source: Waking Up Costs)
Source: Waking Up Costs - June 7, 2014 Category: Anesthesiology Authors: Clark Tags: Career Change Source Type: blogs

Three Books to Prep for Change
Changing careers is scary! As I contemplate my move out of the clinical practice of anesthesia into information security consulting I have good days and bad days. And days that are both bad and good. Preparing myself mentally is key. I have had three books recommended to me that are all terrific primers for what’s ahead. I wanted to share them here. Your Job Survival Guide: A Manual for Thriving in Change Switch: How to Change Things When Change Is Hard Leading at The Edge Are there any others you recommend? The post Three Books to Prep for Change appeared first on Waking Up Costs. (Source: Waking Up Costs)
Source: Waking Up Costs - June 7, 2014 Category: Anesthesiology Authors: Clark Tags: Career Change Source Type: blogs

A very small shark bit my arm – Part 3
Continued from Part 2 This is typed up stuff from my journal. It took a week of voice dictation bumblings before I remembered… hey, you have one good hand and a selection of PENS! Waiting – Week 2 If you tell people you’re sensitive to the sun they kind of roll their eyes as though you said, my cat can only eat filet mignon. But I promise it’s no exaggeration to say that I burn extremely easily. The sun glares down over Australia with special kind of harshness. That is no country for Fitzpatrick Type 1′s. During the Oz visit last April, each time I stepped o...
Source: The Amazing Adventures of Dietgirl - June 6, 2014 Category: Other Conditions Authors: shauna Tags: Everyday Life Source Type: blogs

Feeling Mighty Unreal: Derealization in Kleine-Levin Syndrome
I went on this trip once, back to my hometown after a long absence. Have you ever felt that your surroundings seem odd and distant, and that you're completely detached from them? That the things and places around you aren't real? This can happen to me, on occasion.It did on this trip, perhaps because I've dreamed about those places so many times that the real places and the dream places are blurred in memory.Of course time marches on. The stores in the strip mall have changed, and you go to Starbucks with your father. But sometimes new and surprising things appear in the landscape.Or maybe old and unexpected things pop up ...
Source: The Neurocritic - June 1, 2014 Category: Psychiatrists and Psychologists Authors: The Neurocritic Source Type: blogs

‘The Empathy Exams,’ by Leslie Jamison - NYTimes.com
Regarding the pain of others requires more than just a pair of eyes. It necessitates an act of the imagination: a willingness to think or feel oneself into the interior of another's experience, to cross between what Susan Sontag once designated as the kingdoms of the sick and of the well. This kind of empathetic border crossing can be both difficult and dangerous, the sort of journey of which one might say: "I get across quickly because I'm headed in the right direction, by which I mean the wrong direction. I'm going where no one wants to stay."This statement, actually describin...
Source: Psychology of Pain - May 27, 2014 Category: Psychiatrists and Psychologists Source Type: blogs

The Magnesium Wars
When you get dxd with diabetes,food goes from being food to being a collection of carbohydrates,proteins,and fats.(the same, I imagine,with any GI related illness) When you have problems with maintaining electrolytes food turns into a collection of potassium,magnesium,etc.The above photo shows four types of magnesium supplement..as with insulins,not all supplements are created equal. Magonate is the rapid-acting,chug it down and in 2-3 hours your acute symptoms with subside,stuff. Slow Mag is the gentler on the stomach stuff(kind of like UltraLente-longgggg curve of action) and Milk of Magnesia is just there to get things ...
Source: The D-Log Cabin - May 21, 2014 Category: Diabetes Authors: HVS Source Type: blogs

Longevity and Long-Term Care: The Medical Crisis of the 21st Century : Part 2
Throughout the 20th century, most Americans saw “longevity” as a goal. If we took care of our bodies, we reasoned, we could “live longer and better.” But in the 21st century, I suspect that some of us will learn to fear “longevity” the way we now fear cancer. This is the second in a series of posts that will explore the anguish that some experience when they live into their late eighties and nineties–and how we, as a society, can address the hardships of “old, old age.”                             &nb...
Source: Health Beat - May 19, 2014 Category: American Health Authors: Maggie Mahar Tags: Knocking on Heaven's Door Alzheimer's Alzheimer's drugs Compassion and Choices fast medicine Long-term care longevity over-treatment pacemakers palliative care senile dementia slow medicine Uncategorized Consumer Reports Katy B Source Type: blogs

A Patient’s Story–How Much Can or Should– Your Doctor Tell You About Potential Risks?
Below a non-fiction story from Pulse: Voices from the Heart of Medicine, “an online magazine of personal experience in health.”  Pulse is both a magazine and an online community that provides a chance for patients, doctors, nurses, social workers to come together, and share their experiences. The magazine’s founders write: “Despite the large numbers of health magazines and medical journals, few openly describe the emotional and practical realties of health care. We at Pulse believe that our stories and poems have the power to bring us together and promote compassionate health care. “...
Source: Health Beat - May 18, 2014 Category: American Health Authors: Maggie Mahar Tags: endometrial cancer malpractice suit Pulse: voices from the heart of medicine shared decision making follow-up surgery lymlymphectomy/omentectomy lymph-vessel blockage lymphedema Source Type: blogs

Valerie Arkoosh, MD – Candidate for Congress (Part 3 of 3)
Valerie Arkoosh, MD, is a former Chair of Anesthesiology, a health policy expert, and a candidate for Congress running in the Democratic primary in the 13th Pennsylvania district. We recently had time to speak to Dr. Arkoosh about her career as a physician and what she hopes to accomplish if elected to Congress. Dr. Valerie Arkoosh What are the most important skills you learned as a Chair that will help you if you are elected to Congress? As an anesthesiologist you learn very early how to always appear calm! But, really, I think the skills of bringing people together who often have very different viewpoints about what need...
Source: Inside Surgery - May 10, 2014 Category: Surgery Authors: Editor Tags: Medical News Wire anesthesiologist candidate congress Pennsylvania Valerie Arkoosh Source Type: blogs

What injured squid can teach us about irritability and pain - LA Times
A new study involving injured squid and hungry sea bass may help explain why we are so grumpy and irritable when we are in pain. For many of us, the unpleasantness of being in pain often goes beyond the agony of the injury. If we are in excruciating discomfort, suddenly it seems everything bothers us -- sounds are too loud, lights are too bright, and even a gentle touch can be uncomfortable. "One of the effects of pain is the peripheral sensory system becomes hyperactive," said Edgar T. Walters, who studies pain and neural plasticity at the University of Texas Medical School at Houston. "People in pain ar...
Source: Psychology of Pain - May 9, 2014 Category: Psychiatrists and Psychologists Source Type: blogs

Battle of the Bulge: Olecranon Bursitis
Olecranon bursitis, also called baker’s or Popeye elbow, can be a painless or an irritating condition involving the bursa located near the proximal end of the ulna in the elbow over the olecranon. Normal bursae sacs generally are filled with a small amount of fluid, which helps the joint remain mobile. The sac can swell under the soft tissue from overuse or when the area sustains an injury from a bump or fall.   Normal bursae are usually small, but they can grow to be quite large, swollen, and occasionally even infected when they become irritated or inflamed. The swelling is obvious because the space in this are...
Source: The Procedural Pause - May 6, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Battle of the Bulge: Olecranon Bursitis
Olecranon bursitis, also called baker’s or Popeye elbow, can be a painless or an irritating condition involving the bursa located near the proximal end of the ulna in the elbow over the olecranon. Normal bursae sacs generally are filled with a small amount of fluid, which helps the joint remain mobile. The sac can swell under the soft tissue from overuse or when the area sustains an injury from a bump or fall.   Normal bursae are usually small, but they can grow to be quite large, swollen, and occasionally even infected when they become irritated or inflamed. The swelling is obvious because the space in this a...
Source: The Procedural Pause - May 6, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

How To Make Inpatient Medical Practice Fun Again: Try Locum Tenens Work
It’s no secret that most physicians are unhappy with the way things are going in healthcare. Surveys report high levels of job dissatisfaction, “burn out” and even suicide. In fact, some believe that up to a third of the US physician work force is planning to leave the profession in the next 3 years – an alarming statistic. Direct primary care practices are touted as the best way to restore patient and provider satisfaction. Those brave enough to cut out the “middle man” (i.e. health insurers, both public and private) find a remarkable reduction in billing paperwork, unrecovered fees, an...
Source: Better Health - May 5, 2014 Category: American Health Authors: Dr. Val Jones Tags: Expert Interviews Health Policy Opinion Anesthesiologists Freedom Hospitalists ICU Intensivists Job satisfaction Locum Tenens Physicians Temp Work Source Type: blogs

I am not a chicken
One of my favorite books is ‘Orbiting the Giant Hairball‘ by Gordon MacKenzie. Subtitled “A Corporate Fool’s Guide to Surviving with Grace,” my favorite chapter is titled ‘A Chicken’s Fate’. In it, the author described his fathers’ discovery that chickens can be mesmerized: The cousin led the way to the ramshackle chicken coop out behind the farmhouse. There he selected a fine white hen. He carried her under his arm to the front of the house, produced a piece of chalk and drew a short line on the porch. He stood the creature over the chalk line and held her beak to it. ...
Source: Waking Up Costs - May 3, 2014 Category: Anesthesiology Authors: Clark Tags: Anesthesia Medicine Source Type: blogs

I am not a chicken
One of my favorite books is ‘Orbiting the Giant Hairball‘ by Gordon MacKenzie. Subtitled “A Corporate Fool’s Guide to Surviving with Grace,” my favorite chapter is titled ‘A Chicken’s Fate’. In it, the author described his fathers’ discovery that chickens can be mesmerized: The cousin led the way to the ramshackle chicken coop out behind the farmhouse. There he selected a fine white hen. He carried her under his arm to the front of the house, produced a piece of chalk and drew a short line on the porch. He stood the creature over the chalk line and held her beak to it....
Source: Waking Up Costs - May 3, 2014 Category: Anesthesiology Authors: Clark Tags: Anesthesia Medicine Source Type: blogs

I am not a chicken
One of my favorite books is ‘Orbiting the Giant Hairball‘ by Gordon MacKenzie. Subtitled “A Corporate Fool’s Guide to Surviving with Grace,” my favorite chapter is titled ‘A Chicken’s Fate’. In it, the author described his fathers’ discovery that chickens can be mesmerized: The cousin led the way to the ramshackle chicken coop out behind the farmhouse. There he selected a fine white hen. He carried her under his arm to the front of the house, produced a piece of chalk and drew a short line on the porch. He stood the creature over the chalk line and held her beak to it....
Source: Waking Up Costs - May 3, 2014 Category: Anesthesiology Authors: Clark Tags: Anesthesia Medicine Source Type: blogs

Can You Avoid Lumbar Puncture in Febrile Neonates?
I don’t have a problem with lumbar punctures in febrile neonates. In fact, my son ended up with three lumbar punctures before aging out of the febrile seizure protocols. I do have a problem, however, with doing unnecessary spinal taps. The emotional stress of a neonatal LP on parents is significant, and the physical stress of the procedure on the infant is also substantial.     The pain of the needle and the unique restraint required for the procedure are also potentially problematic. The pain of the needle can be minimized by EMLA cream (eutectic mixture of local anesthetics [lidocaine and prilocaine]) an...
Source: M2E Too! Mellick's Multimedia EduBlog - May 1, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Can You Avoid Lumbar Puncture in Febrile Neonates?
I don’t have a problem with lumbar punctures in febrile neonates. In fact, my son ended up with three lumbar punctures before aging out of the febrile seizure protocols. I do have a problem, however, with doing unnecessary spinal taps. The emotional stress of a neonatal LP on parents is significant, and the physical stress of the procedure on the infant is also substantial.     The pain of the needle and the unique restraint required for the procedure are also potentially problematic. The pain of the needle can be minimized by EMLA cream (eutectic mixture of local anesthetics [lidocaine and prilocaine]...
Source: M2E Too! Mellick's Multimedia EduBlog - May 1, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Male Scent May Compromise Biomedical Research | Science/AAAS | News
Jeffrey Mogil's students suspected there was something fishy going on with their experiments. They were injecting an irritant into the feet of mice to test their pain response, but the rodents didn't seem to feel anything. "We thought there was something wrong with the injection," says Mogil, a neuroscientist at McGill University in Montreal, Canada. The real culprit was far more surprising: The mice that didn't feel pain had been handled by male students. Mogil's group discovered that this gender distinction alone was enough to throw off their whole experiment—and likely influences the work of ot...
Source: Psychology of Pain - April 29, 2014 Category: Psychiatrists and Psychologists Source Type: blogs

Valerie Arkoosh, MD – Candidate for Congress (Part 2 of 3)
Dr. Val Arkoosh is an Anesthesiologist by training and a current candidate for Congress in the Pennsylvania 13th Congressional District. We recently had the chance to speak to Dr. Val to get her thoughts on being a doctor and being a candidate. Why did you decide to leave full time clinical practice at Jefferson and go to into administration? The position I left Jefferson to take was a pretty exciting one. You might remember that Allegheny opened this hospital for women. It was PCOM’s old hospital on City Ave. And they opened it up and reconfigured I to be a hospital for women. So they moved all the OB GYN, gyn onc ,...
Source: Inside Surgery - April 27, 2014 Category: Surgery Authors: Editor Tags: Interviews 13th candidate congress Hahnemann Pennsylvania Tenet Source Type: blogs