Wine Glass in the Foot: A Case Study
Emergency department providers welcome the weird, the wild, the wonderful, and the unexpected. Routine chest pain workups and negative abdominal CTs occasionally bore us. Last summer we had the pleasure of meeting a man who was a line cook at a local restaurant. He came via ambulance for a foreign body in his foot. What we saw was unanticipated—he arrived with half a wine glass lodged in the sole of his foot. The stemware was lodged in the patient's foot, going through his shoe and sock. Photos by Martha Roberts.The patient was laughing and not in much pain. He said he had a high pain tolerance and could barel...
Source: The Procedural Pause - October 2, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Is the “full course of antibiotics” full of baloney?
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Antibiotic resistance is an emerging threat to public health. If the arsenal of effective antibiotics dwindles, treating infection becomes more difficult. Conventional wisdom has long held that stopping a course of antibiotics early may be a major cause of antibiotic resistance. But is this really supported by the evidence?
According to a new study in the BMJ, the answer is no.
The notion that a longer course of antibiotics prevents resistance started early in the antibiotic era, when doctors found that patients with staphylococcal blood infections and tuberculosis relapsed after short anti...
Source: Harvard Health Blog - August 17, 2017 Category: Consumer Health News Authors: John Ross, MD, FIDSA Tags: Drugs and Supplements Health Infectious diseases Source Type: blogs
What Is The ‘Relative Value’ Of An Infectious Disease Physician?
Infectious diseases (ID) physicians may be disappearing. In the 2016 internal medicine fellowship match, in which residents were matched with sub-specialty training programs, 35 percent of available ID training positions nationwide were left unfilled. By comparison, just 0.9 percent of gastroenterology and cardiology positions were not filled that year (Figure 1). Although trainees’ career choices are influenced by many complex factors, the driving force behind residents’ aversion to ID is likely quite simple: money.
ID specialists are among the lowest paid physicians in the United States. According to the 2016 Medscap...
Source: Health Affairs Blog - February 3, 2017 Category: Health Management Authors: Timothy Sullivan Tags: Costs and Spending Featured Health Professionals Payment Policy Quality Alternative Payment Models infectious disease Physicians RVU targets Source Type: blogs
Cool Image: Inside a Biofilm Build-up
A growing Vibrio cholerae biofilm. Each slightly curved comma shape represents an individual bacterium from assembled confocal microscopy images. Different colors show each bacterium’s position in the biofilm in relation to the surface on which the film is growing. Credit: Jing Yan, Ph.D., and Bonnie Bassler, Ph.D., Department of Molecular Biology, Princeton University, Princeton, NJ.
Bacteria use many methods to overcome threats in their environment. One of these ways is forming colonies called biofilms on surfaces of objects. Often appearing like the bubble-shaped fortress represented in this image, biofilms enable ba...
Source: Biomedical Beat Blog - National Institute of General Medical Sciences - January 31, 2017 Category: Research Authors: Kathryn Calkins Tags: Cell Biology Chemistry and Biochemistry Bacteria Biofilms Cellular Processes Cool Images Source Type: blogs
LITFL Review 264
Welcome to the 264th 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 chunk of FOAM.
The Most Fair Dinkum Ripper Beauts of the Week
Another great set of talks from SMACCDub released this week: John Greenwood discussing assault on the RV and Haney Mallemat on the PEA Paradox. [AS]
The Best of #FOAMed Emergency Medicine
Rob Orman talks to a number of EPs about the prac...
Source: Life in the Fast Lane - January 8, 2017 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs
LITFL Review 263
Welcome to the 263rd 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 chunk of FOAM.
The Most Fair Dinkum Ripper Beauts of the Week
A well-written NY Times essay on how social isolation is killing us made the Internet rounds over the holidays, penned by a medical resident.
The Best of #FOAMed Emergency Medicine
A very interesting and thought provoking post by Josh Fa...
Source: Life in the Fast Lane - January 1, 2017 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs
Duration of antibiotic therapy in community acquired pneumonia
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - December 12, 2016 Category: Internal Medicine Tags: infectious disease pulmonary Source Type: blogs
Age-Friendly Health Systems: How Do We Get There?
As the American population ages, our health care delivery system must embrace significant changes in payment strategies, as well as value-based service provision, to meet the demands of this demographic shift. Health care leaders are clear that without change, the system will suffer destabilizing financial distress, access to needed services will be limited, and the quality of care received by older adults will deteriorate. We will likely experience all of the above unless we continue to shift to new ways of providing and paying for health care.
As a result of the aging demographic doubling and skewing older, the demand fo...
Source: Health Affairs Blog - November 3, 2016 Category: Health Management Authors: Terry Fulmer and Amy Berman Tags: Costs and Spending Featured GrantWatch Health Professionals Hospitals Organization and Delivery Payment Policy Quality ACOs Aging seniors Source Type: blogs
LITFL Review 237
Welcome to the 237th LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chuck of FOAM.
The Most Fair Dinkum Ripper Beauts of the Week
More great reflections on SMACCDub, this time from Bishan Rajapakse and from Celia Bradford. DasSMACC is not to be missed… [SO]
The Best of #FOAMed Emergency Medicine
tPA without a NCHCT first? Insanity you say? Read EM Lit of Note’s post t...
Source: Life in the Fast Lane - June 26, 2016 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs
How Antibiotics Work
Antibiotics work according to the mechanism of action (what the drug “targets” in microbes or how the drug “works” in the microbe) that is driven by the drug’s distinguishing chemical structure.
Chemical structures also define the “classification” of antibiotics. If you hear doctors talk about “macrolides” versus “quinolones”, they are talking about families of drugs (not “one” specific drug) and they are referring to the way each family of drugs targets microbes.
When you hear about “generations” of an antibiotic, this means the chem...
Source: NAKEDMEDICINE.COM - March 16, 2016 Category: Consumer Health News Authors: Jane Tags: Antibiotics Business of Medicine Critical Consumer Source Type: blogs
Research and Reviews in the Fastlane 124
This study, using skin tests, found that 0 out of 211 patients demonstrated cross-reactivity between penicillin and aztreonam. The authors recommend skin testing prior to administration and skin testing isn’t a perfect surrogate for a systemic reaction upon IV administration but the best evidence we have shows that cross-reactivity is highly unlikely.
Recommended by Anand Swaminathan
The Best of the Rest
Emergency medicine
Minneci PC et al. Effectiveness of Patient Choice in Nonoperative vs Surgical Management of Pediatric Uncomplicated Acute Appendicitis. JAMA Surg 2015:1-8. PMID 26676711
Surgeons at a ch...
Source: Life in the Fast Lane - March 3, 2016 Category: Emergency Medicine Authors: Soren Rudolph Tags: Dermatology Education Emergency Medicine Gastroenterology General Surgery Immunology Intensive Care Pediatrics Pharmacology Pre-hospital / Retrieval R&R in the FASTLANE Respiratory Resuscitation Toxicology Toxicology and Toxino Source Type: blogs
FDG-PET CT increases the diagnostic yield in prosthetic valve and intracardiac device related endocarditis
Prosthetic valve endocarditis and intracardiac device related endocarditis are difficult to diagnose and treat. Because of dense acoustic shadowing related to the components of prosthetic valves and cardiac implantable devices, role of echocardiography is often limited in the diagnosis of endocarditis in these situations. Of late Positron Emission Tomography Computed Tomography (PET CT) have been used more often in detecting foci of active inflammation / metabolism in infective endocarditis. Study by María N. Pizzi et al[1] has provided us with documentary evidence for adding PET CT to our diagnostic armamentarium in susp...
Source: Cardiophile MD - September 23, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs
Antibiotics for appendicitis: What does a surgeon think about this?
Like many practicing general surgeons I read with interest the recent Finnish paper published in JAMA that attempted to challenge the long held surgical dogma that the best treatment of acute appendicitis is cold hard steel. The paper itself, in terms of design, was beautiful. This was no retrospective review of a series of case studies. This was a rigorously conducted multi-center randomized controlled trial that assigned 530 patients over the course of 3 years into either surgical or non-surgical treatment arms:
Interventions. Patients randomized to antibiotic therapy received intravenous ertapenem (1 g/d) for 3...
Source: Kevin, M.D. - Medical Weblog - August 7, 2015 Category: Journals (General) Authors: Jeffrey Parks, MD Tags: Conditions Surgery Source Type: blogs
Research and Reviews in the Fastlane 090
This study prospectively looks at 106 patients with either DVT or PE who were identified as low risk based on the Hestia criteria. All of the patients were started on rivaroxaban (a Factor Xa inhibitor) and none had VTE recurrence (while on anticoagulation), major bleeding events or death due to VTE. This study further supports outpatient management for low risk VTE but a randomized controlled trial is needed (keep your eye out for the MERCURY-PE study)
Recommended by Anand Swaminathan
Further reading: SGEM #126: Take me to the Rivaroxaban — Outpatient treatment of VTE (The Skeptics Guide to EM)
Research and critic...
Source: Life in the Fast Lane - July 9, 2015 Category: Emergency Medicine Authors: Jeremy Fried Tags: Airway Clinical Research Emergency Medicine Intensive Care Neurology R&R in the FASTLANE Respiratory Review critical care EBM Education recommendations research and reviews Source Type: blogs
