(Maybe) I Got Bit by a Snake
I saw my hand by the morning light streaming through my blinds and felt like I was looking at something that wasn ’t a part of me. A crimson, half-inch lesion rose above the right side of my right hand like Mary’s Rock. Swelling puffed up the skin like a balloon, leaving me with one apparent knuckle. I flipped my arm over. Red streaks crawled up it like fingers stretching to grasp my heart.My instinct was to call my dermatologist. “Good morning, I’d like to schedule an appointment.”“If this is for body sculpting, I’ll transfer you to that receptionist.”Nope. I rapid-fired my ...
Source: cancerslayerblog - June 7, 2019 Category: Cancer & Oncology Tags: a day in my life animals death Source Type: blogs

Pediatric Conjunctivitis a Simple Diagnosis Until It Isn’t
​Conjunctivitis is a common condition and easy enough to treat, but several uncommon conjunctivitis syndromes require more care and should not be missed.Conjunctivitis is either infectious (viral or bacterial) or noninfectious (allergic or nonallergic). Viral infections are more common in adults, bacterial ones in children, usually caused by Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Adults tend to have more S. aureus infections, while the other pathogens are more common in children. An adenovirus is typically responsible for viral-associated infections in conjunct...
Source: M2E Too! Mellick's Multimedia EduBlog - March 1, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Do you really have a penicillin allergy?
Chances are, you or someone you know is one of the 10% of Americans with a documented penicillin allergy. But just because you were told you had a penicillin allergy, or had one in the past, does not mean you have one now. People with a penicillin allergy history have their allergy disproved with allergy testing more than 90% of the time. Penicillin: a primer Penicillin is part of a larger drug class called beta-lactam antibiotics, which include the common penicillins and cephalosporins. Common penicillins include ampicillin, amoxicillin, and Augmentin. Among other uses, penicillins are often used to treat ear infections, ...
Source: Harvard Health Blog - February 26, 2019 Category: Consumer Health News Authors: Kimberly Blumenthal, MD, MSc Tags: Allergies Health Tests and procedures Source Type: blogs

Distinguishing between Orbital and Preseptal Cellulitis
​Some medical conditions have signs and symptoms that significantly overlap, making a diagnosis a little more difficult. Epididymitis, testicular torsion, and torsion of the testicular appendage are examples, but orbital and preseptal cellulitis are others that can cause significant diagnostic confusion.Both conditions are more common in children than in adults, and preseptal or periorbital cellulitis is more common in children under 5. The preseptal and orbital spaces are separated by only a thin membranous septum that originates in the orbital periosteum and inserts into the tarsal plates. It is only this thin septum t...
Source: M2E Too! Mellick's Multimedia EduBlog - December 31, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

If I were writing sore throat guidelines
Several tweets asked me to answer this question. How would I rewrite sore throat guidelines? Obviously I am biased. So this is my opinion and I am sticking to it! I would not change anything about pre-adolescents. Group A strep is the most important bacterial infection and using rapid tests with backup cultures makes sense.I would change the guidelines for adolescents and young adults. I would treat patients having Centor scores of 3 or 4 with either penicillin or amoxicillin (augmentin would be fine). I would probably treat some 2s if they looked very ill. I would never use macrolides. If the patient is truly penicilli...
Source: DB's Medical Rants - December 29, 2018 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs

Nailed It!
​What do you do for a nail from a nail gun in the hand? This procedure is simple, but you have to worry about the aftermath. Complicated issues may arise post-procedure in the days to weeks after extraction, including retained foreign bodies, infection, fractures, disability, pain, nerve damage, tendon rupture, and cosmetic concerns.​Removing the nail is only half the battle. Proper removal, treatment, and follow-up should be considered with all foreign bodies in the skin, especially the hand. Being prepared for the possible aftershocks will help your patient have a successful recovery.A 23-year-old man with a nail fro...
Source: The Procedural Pause - June 1, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Oldie but Goodie Pediatric Clinical Concepts
​A number of older clinical concepts may be unfamiliar to younger clinicians, but these clinical concepts are useful in pediatric medicine. Some of these concepts showed up in the medical literature for the first time nearly a century ago. Physicians should feel free to question the potential value and validity of older clinical concepts that aren't at the forefront of medical education, but my experience of more than 30 years practicing pediatrics and emergency medicine has repeatedly affirmed to me that these are valuable in emergency medicine.​Parenteral DiarrheaThe concept of parenteral diarrhea has been around for...
Source: M2E Too! Mellick's Multimedia EduBlog - March 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Oldie but Goodie Pediatric Clinical Concepts
​A number of older clinical concepts may be unfamiliar to younger clinicians, but these clinical concepts are useful in pediatric medicine. Some of these concepts showed up in the medical literature for the first time nearly a century ago. Physicians should feel free to question the potential value and validity of older clinical concepts that aren't at the forefront of medical education, but my experience of more than 30 years practicing pediatrics and emergency medicine has repeatedly affirmed to me that these are valuable in emergency medicine.​Parenteral DiarrheaThe concept of parenteral diarrhea has been around for...
Source: M2E Too! Mellick's Multimedia EduBlog - March 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Ultrasound: Foreign Body Removal
Part 2 in a SeriesAre you ready for summer? That means more bare feet, flip-flops, and the potential for foreign bodies of the foot and toe. We will continue to highlight tools and tricks to help you master soft tissue foreign body removal in the emergency department. A refresher on the basics of ultrasound is available in our blog post from last month: http://emn.online/1UGtduz.Foreign bodies of the toe or foot are common presentations in emergency departments, and one way to determine the size and shape of retained superficial foreign bodies is to use ultrasound and the linear probe. This simple technique may help you lo...
Source: The Procedural Pause - April 1, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Beware of predatory journals when it comes to homeopathy studies
An August, 2015 study in Multidisciplinary Respiratory Medicine is being touted as evidence that homeopathy is as effective as antibiotics for respiratory infections in children. It doesn’t show that at all — in fact, it doesn’t show anything, except that crappy studies in crappy journals can nonetheless be used to manipulate opinion. Beware. First, the study itself. Researchers in Italy looked at about 90 children with ordinary colds. All of them were given a homeopathic product that the authors claimed had already been shown to be effective for cough (that’s not actually true, but let’s let ...
Source: Kevin, M.D. - Medical Weblog - November 9, 2015 Category: Journals (General) Authors: Tags: Meds Infectious disease Pediatrics Source Type: blogs

Dabbling in Dentistry
Most people will experience dental pain or a dental complication at some point in their lives. Dental pain is an incredibly common complaint by people of all ages, especially those who lack dental insurance and suitable hygiene habits. Sometimes, though, poor dentition or injury is simply a result of bad luck. Patients often present to the ED hoping to find a dentist and an answer to their problems.   Your first thought? “I am not a dentist. What am I going to do?” You’re right to an extent. We are not dentists, and often feel we have little to offer patients for acute issues that require equipment...
Source: The Procedural Pause - July 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Dabbling in Dentistry
Most people will experience dental pain or a dental complication at some point in their lives. Dental pain is an incredibly common complaint by people of all ages, especially those who lack dental insurance and suitable hygiene habits. Sometimes, though, poor dentition or injury is simply a result of bad luck. Patients often present to the ED hoping to find a dentist and an answer to their problems.   Your first thought? “I am not a dentist. What am I going to do?” You’re right to an extent. We are not dentists, and often feel we have little to offer patients for acute issues that require equipment w...
Source: The Procedural Pause - July 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Tips to avoid medical errors in the emergency department
Emergency medicine physicians: Could these be your cases? A 35-year-old presents with shortness of breath and numbness to the legs. CXR and EKG are normal. She is discharged to see her doctor in two days, but is found dead at home. Autopsy reveals a dissecting aortic aneurysm. A 15-month-old is triaged to fast track and seen by a physician assistant for fever, lethargy, and ear pain. Treatment includes Augmentin. The next day the patient is admitted with pneumococcal sepsis and meningitis with severe brain damage. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A ...
Source: Kevin, M.D. - Medical Weblog - May 12, 2015 Category: Journals (General) Authors: Tags: Physician Emergency Malpractice 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

Research and Reviews in the Fastlane 040
In this study the role of a “1/2 dose” thrombolysis was evaluated for the reduction of pulmonary artery pressure in moderate PE. A total of 121 patients with moderate PE received either tissue plasminogen activator plus anticoagulation or anticoagulation alone with the primary end points of pulmonary hypertension and the composite end point of pulmonary hypertension and recurrent PE at 28 months. The results suggested that the ½ dose or “safe dose” thrombolysis was safe and effective in the treatment of moderate PE, with a significant immediate reduction in the pulmonary artery pressure that ...
Source: Life in the Fast Lane - July 22, 2014 Category: Emergency Medicine Authors: Soren Rudolph Tags: Anaesthetics Emergency Medicine Evidence Based Medicine Featured Gastroenterology Haematology Health Infectious Disease Intensive Care Neurology Pre-hospital / Retrieval Respiratory critical care literature R&R in the FASTLANE 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

Twitter and the dissemination of research evidence
Trip aggregates some wonderful content.  The main route for people finding this evidence is via search or by registering with Trip and indicating what topic areas they're interested (in which case we email the user with the latest research that matches their interests).Towards Christmas I started to experiment with using Twitter as a dissemination route.  Basically, I created two topic areas (Primary care and Cancer) and starting tweeting simply the title of the article and the URL of relevant articles that were recently added to Trip.  The Trip techie (Phil) suggested I use some tracking to see if people ar...
Source: Liberating the literature - January 17, 2014 Category: Technology Consultants Source Type: blogs

Medical Mispronunciations and Misspelled Words: The Definitive List.
Hearing medical mispronunciations and seeing misspelled words are an under appreciated  joy of working in healthcare.  Physicians often forget just how alien the language of medicine is to people who don't live it everyday.  The best part about being a physician is not helping people recover from critical illness. The best part is not  about  listening and understanding with compassion and empathy.  Nope, the best part about being a physician is hearing patients and other healthcare providers butcher the language of medicine and experiencing great entertainment in the process.   Doctors c...
Source: The Happy Hospitalist - October 2, 2013 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs

Paul Krugman: China’s economy has hit its Great Wall
China has a drug problem. While most Western countries spend 10-12% of their healthcare budget on medicines, in China it is well over 40%, a disparity that goes to the heart of Beijing’s crackdown on the industry.All economic data are best viewed as a peculiarly boring genre of science fiction, but Chinese data are even more fictional than most. Add a secretive government, a controlled press and the sheer size of the country, and it’s harder to figure out what’s really happening in China than it is in any other major economy.Yet the signs are now unmistakable: China is in big trouble. Read more.A pro...
Source: PharmaGossip - July 27, 2013 Category: Pharma Commentators Authors: insider Source Type: blogs

Healthcare Update Satellite — 07-09-2013
More updates available tomorrow on my other blog at DrWhitecoat.com Why does an $11,596 emergency department visit cost $1,100? A spokesperson for the California Hospital Association says that it is because of government regulation. I want to know what doctor ever gets paid $4,242 for a Level 4 emergency department visit. California attorneys are trying to raise the cap on damages under California’s Medical Injury Compensation Reform Act. Caps are currently $250,000 and haven’t been raised in more than 35 years. The article says that many attorneys won’t take medical malpractice cases in California becaus...
Source: WhiteCoat's Call Room - July 9, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

DOJ Probing International Pharmaceutical Manufacturing
Earlier this year, we noted that a new enforcement focus for the U.S. Department of Justice (DOJ) will be increased oversight to ensure compliance with the Food and Drug Administration's (FDA) current good manufacturing practices (cGMPs) regulations. Specifically, Maame Ewusi-Mensah Frimpong, Deputy Assistant Attorney General (DAAG) for DOJ's Consumer Protection Branch (CPB), noted her division has long worked closely with FDA to promote the safety of pharmaceutical products.    Several months later, it appears that DOJ is acting on this promise in two recent cases. As reported by the Washington Post, Reu...
Source: Policy and Medicine - July 5, 2013 Category: Health Medicine and Bioethics Commentators Authors: Thomas Sullivan Source Type: blogs

The Last Doctor is Always the Smartest
Twice recently, I’ve been privy to patient complaints about emergency department “misdiagnoses” when patients have gone to follow up appointments with their physicians. One case involved a young girl who had a rash. The rash was preceded by a low grade fever in the days prior, began on the chest and spread outward, and had the classic appearance of a viral exanthem. The girl’s parents weren’t happy with that diagnosis. They believed that the girl was suffering from an allergic reaction and that she needed antihistamines and steroids. The doctor explained that the rash was not an allergic-type ...
Source: WhiteCoat's Call Room - June 17, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs

Please Poke My Paronychium!
THE BASICSWhat is more satisfying than draining a pus-filled paronychium? Seeing the look of relief on the face of your patient when his painful, pulsating digit is relieved of all that tension! This rather elementary procedure could be perceived as stale and uneventful for some of you. The more thorough and astute clinicians, however, realize these tiny infections around the nail root may open the door to a mixed bag of insidious and harmful bacterial infections including MRSA, chronic reoccurrences, cellulitis, subungual abscesses, osteomyelitis, herpetic whitlow, or even the dreaded felon.   Whatever your pleasure,...
Source: The Procedural Pause - May 1, 2013 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Lyme Disease
Pathophysiology of Lyme Disease Lyme disease is an 1) infection with Borrelia burgdorferi via tick bite 2) previous thinking held tick vector was Ixodes but transmission is now thought by some experts to be possible with additional tick species 3) occurs in stage I and stage II days to weeks after infection and in stage III months to years after infection (usually with preceding latency period Signs and Symptoms Stage I 1) characteristic expanding annular rash with central clearing (“bull’s eye or “target” rash) that occurs in only 40% of infections Stage II 2) multiple secondary annular skin lesio...
Source: Inside Surgery - March 19, 2013 Category: Surgeons Authors: Editor Tags: Infectious Disease babesia bulls eye rash coinfections deer tick erythema migrans hyperbaric ixodes target rash Source Type: blogs

In Which We Finally Get All the Medications
Nolan was prescribed Augmentin (a really common antibiotic) and Flonase compounded with Bactroban. Our ENT sent the prescriptions to Rite Aid, the pharmacy we've been using. They've been notoriously horrible at filling Nolan's prescriptions, and I keep... (Source: Deaf Village)
Source: Deaf Village - February 28, 2013 Category: Other Conditions Authors: Say What? Tags: AVT Hard-of-Hearing vm Source Type: blogs