The Unintended Consequences of Public Reporting
ProPublica Surgeon Scorecard Ad
A major concern surrounding ProPublica’s recently released “Surgeon Scorecard” is that rating physicians in a public database solely on complication rates may discourage surgeons from operating on high-risk patients. The fear, it turns out, is a legitimate one. A study published this month in the Journal of the American College of Cardiology examined the effect that public reporting of procedural outcomes has on heart attack patients. The authors looked at two states, Massachusetts and New York, which mandate the public reporting of hospital outcomes of per...
Source: Policy and Medicine - August 12, 2015 Category: American Health Authors: Thomas Sullivan Source Type: blogs
Tips in femoral artery access : Rapid Fluroscopic puncture in cardiogenic shock !
Femoral artery puncture is still the default technique for cardiac catheterization even as the radial access has gained huge popularity in recent years.Though patient comfort and access site complications are clearly low in radial approach, complex procedures still demand femoral access. The true draw-back of the obsessive adaptation of radial access could be the gradual loss of expertise in the fine art of femoral artery puncture.
It’s true femoral artery puncture can be troublesome at times by palpatory method .How to get into a difficult femoral artery with a poor pulse either due to anatomical reasons, ex...
Source: Dr.S.Venkatesan MD - July 24, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs
LITFL Review 187
Welcome to the 187th 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
Incredible talk on vulnerability from SMACC Chicago given by Tim Leeuwenburg. This is a must watch for any physician. [AS]
Did you miss SMACC Chicago? Great podcasts released by St. Emlyn’s and FOAMCast highlighting pearls from the workshops an...
Source: Life in the Fast Lane - July 5, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs
Emergency Physicians Must Make the Tough Decisions
This recent case, which occurred within the past year, was sent to me by an unnamed 2nd year EM resident. She says she is a believer in all things FOAM!As this case could have been managed better, she will remain anonymous. But rather than being critical of the management, just try to learn from it.Case presentation:A middle-aged woman with a history of vascular disease presented to a community Emergency Department after an episode of syncope. She complained of 24 hours of severe chest pain radiating to her back, and epigastric abdominal pain. Initial vital signs were BP 128/85, HR 122, RR 22 and O2 saturation ...
Source: Dr. Smith's ECG Blog - June 12, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
Mechanisms of aortic regurgitation in aortic dissection
Aortic regurgitation is second most common cause of death in acute aortic dissection, most common cause being aortic rupture. It may occur in up to three fourths of cases of Stanford Type A aortic dissection. There are several mechanisms for aortic regurgitation in aortic dissection:
Dilatation of the aortic root and annulus
Tearing of aortic annulus or cusps of the aortic valve
Displacement of aortic cusps in relation to each other, interfering with closure
Loss of support for aortic cusps
Intimal flap interfering with closure of aortic cusps
Those with severe aortic regurgitation secondary to acute aortic dissection pr...
Source: Cardiophile MD - June 9, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs
Circle of Life
Life is all about beginnings and endings. One of the biggest draws of Obstetrics as a medical specialty is the fascination with the birth process as the beginning of life. The other extreme…well, let’s say in this particular place and time in history, it’s still something that catches people unawares. Too often filled with dread and loathing, we approach the death of patients as a foreshadowing of our own. Why else have we as doctors developed the reputation of squaring off with Death? Beating Him off with tubes and drugs and electricity, “No!” we shriek. “You can’t have this one ...
Source: Musings of a Dinosaur - May 18, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Acute chest pain, bradycardia, and hypotension
A middle-aged male complained of acute onset of chest pain. He was diaphoretic, weak, lightheaded, but alert. Blood pressure was 60/palp with a pulse of 40. was given aspirin and a 500 ml normal saline bolus.Here is the prehospital 12-lead:There is bradycardia and some kind of AV block. P-waves are difficult to discern, so the exact nature of the block is unclear There is obvious inferior STE. Reciprocal ST depression in aVL confirms inferior STEMI, and ST depression in lead I is a good indicator that this is an RCA occlusion.In inferior MI due to RCA occlusion, one should always look ...
Source: Dr. Smith's ECG Blog - April 21, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
A History of General Refrigeration
Ancient societies figured out that hypothermia was useful for hemorrhage control, but it was Hippocrates who realized that body heat could be a diagnostic tool. He caked his patients in mud, deducing that warmer areas dried first.
Typhoid fever, the plague of Athens in 400 BC and the demise of the Jamestown Colony in the early 1600s, led Robert Boyle to attempt to cure it around 1650 by dunking patients in ice-cold brine. This is likely the first application of therapeutic hypothermia, but it failed to lower the 30 to 40 percent mortality rate. One hundred years later, James Currie tried to treat fevers by applying hot,...
Source: Spontaneous Circulation - March 31, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
A History of General Refrigeration
Ancient societies figured out that hypothermia was useful for hemorrhage control, but it was Hippocrates who realized that body heat could be a diagnostic tool. He caked his patients in mud, deducing that warmer areas dried first.
Typhoid fever, the plague of Athens in 400 BC and the demise of the Jamestown Colony in the early 1600s, led Robert Boyle to attempt to cure it around 1650 by dunking patients in ice-cold brine. This is likely the first application of therapeutic hypothermia, but it failed to lower the 30 to 40 percent mortality rate. One hundred years later, James Currie tried to treat fevers by applying ho...
Source: Spontaneous Circulation - March 31, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Cardiac arrest, severe acidosis, and a bizarre ECG
A middle aged male had an unwitnessed PEA arrest associated with cocaine use. Whether there was a shockable rhythm prior to PEA is unknown, but he was never defibrillated. He received chest compressions with LUCAS and 3 doses of epinephrine, and was intubated by prehospital providers. He had intermittent pulses. Here is his initial ECG, with a pH of 6.50:The rhythm is uncertain: probably an accelerated junctional rhythm with RBBB and PVCs, but it could be an accelerated rhythm initiated in the left bundle, mimicking RBBB. It is important to ascertain the end of the QRS, which I attempt to do b...
Source: Dr. Smith's ECG Blog - January 14, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
ECMO – Extracorporeal membrane oxygenation
ECMO (extracorporeal membrane oxygenation)
Extracorporeal membrane oxygenation (ECMO) has been in use for the past four decades to support persons who are unlikely to survive with mechanical ventilation. ECMO is used in both adult and pediatric practice, though in the initial years, use of ECMO was restricted to pediatric intensive care. The enthusiasm for use of ECMO in adults have been triggered by the beneficial effect noted during the last H1N1 influenza pandemic [Australia and New Zealand Extracorporeal Membrane Oxygenation (ANZ ECMO) Influenza Investigators. Extracorporeal Membrane Oxygenation for 2009 Influenza A(H1...
Source: Cardiophile MD - December 7, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiac Surgery Source Type: blogs
AVOID Study: Harm with oxygen in MI?
Air Versus Oxygen In ST-elevation MyocarDial Infarction (AVOID Study)
Air Versus Oxygen In ST-elevation MyocarDial Infarction (AVOID Study) presented at the AHA Scientific Sessions, 2014, checked whether there is any harmful effect for supplemental oxygen given to patients with ST elevation myocardial infarction (STEMI) in the absence of hypoxemia. Patients with STEMI undergoing primary angioplasty and having oxygen saturation of 94% or more were randomized to receive supplemental oxygen at 8 liters/ minute or air.
Of about four hundred and forty patients, half each were randomized to either receive oxygen or no oxygen. At...
Source: Cardiophile MD - November 30, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs
Techniques that May Actually Save Your V-Fib Patient
Winning teams have depth, and games are often won from the bench or deep in the batting order. That is certainly true when competing against ventricular fibrillation, and a few tools you might not know can help these patients.
A 55-year-old man with severe coronary heart disease and previous four-vessel coronary artery bypass surgery collapsed at a mall. He also had an unprotected left main atherosclerotic plaque. Bystanders immediately began chest compressions, and the available AED, unfortunately, advised no shock.
Paramedics started bag-valve-mask ventilation and high-quality mechanical compressions with a Lucas devi...
Source: Spontaneous Circulation - October 1, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Techniques that May Actually Save Your V-Fib Patient
Winning teams have depth, and games are often won from the bench or deep in the batting order. That is certainly true when competing against ventricular fibrillation, and a few tools you might not know can help these patients.
A 55-year-old man with severe coronary heart disease and previous four-vessel coronary artery bypass surgery collapsed at a mall. He also had an unprotected left main atherosclerotic plaque. Bystanders immediately began chest compressions, and the available AED, unfortunately, advised no shock.
Paramedics started bag-valve-mask ventilation and high-quality mechanical compressions with a Lucas d...
Source: Spontaneous Circulation - October 1, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
