A Nefarious Character with an Agenda
Every new advanced nurse practitioner, physician assistant, or resident gets his fair share of complex emergency department procedures during training. Seasoned providers, however, are just as excited to place a central line in a septic patient, LP a "rule-out meningitis," or swiftly fix a nursemaid's elbow.This month we hope to remind you of a few sweet and satisfying procedures that take only moments to do. Your skill in completing these procedures is imperative. Not only will you amaze your patient, but you'll shorten your door to dispo-time.The StyeThe stye is a nefarious character with an agenda. It starts o...
Source: The Procedural Pause - February 1, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Funtabulously Frivolous Friday Five 133
Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old fashioned medical trivia…introducing Funtabulously Frivolous Friday Five 133
Question 1
Why do onions make you cry?
+ Reveal the Funtabulous Answer
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Propanethiol S-oxide
When you cut an onion, separate enzymes start mixing and produce propanethiol S-oxide, which is a volatile sulphur compound. The gas that is emitted reacts with the water of your eyes and forms sulphuric acid. The sulphu...
Source: Life in the Fast Lane - January 29, 2016 Category: Emergency Medicine Authors: Neil Long Tags: Frivolous Friday Five erysipelas FFFF fish sperm Hamptons hump heparin onions propanethiol S-oxide protamine pulmonary embolism St Anthony's Fire Source Type: blogs
LITFL Review 214
Welcome to the 214th 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
Should we be doing ultrasound-assisted catheter directed therapy (CDT) in submassive PE? Josh Farkas reviews the evidence and physiological explanation against the utility of this modality. [AS]
The Best of #FOAMed Emergency Medicine
Two excelle...
Source: Life in the Fast Lane - January 10, 2016 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs
Misunderstanding ProPublica
By ASHISH JHA, MD
In July the investigative journalists at ProPublica released an analysis of 17,000 surgeons and their complication rates. Known as the “Surgeon Scorecard,” it set off a firestorm. In the months following, the primary objections to the scorecard have become clearer and were best distilled in a terrific piece by Lisa Rosenbaum. As anyone who follows me on Twitter knows, I am a big fan of Lisa –she reliably takes on health policy group think and incisively reveals that it’s often driven by simplistic answers to complex problems.
So when Lisa wrote a piece eviscerating the ProPublica effort, I...
Source: The Health Care Blog - October 8, 2015 Category: Consumer Health News Authors: Simon Nath Tags: THCB Ashish Jha Source Type: blogs
The Medicaid Expansion Experience In Michigan
As of July 2015, 30 states and the District of Columbia have expanded or planned to expand Medicaid under the Affordable Care Act (ACA). Michigan is one of only six states with a fully Republican-led state government to expand the program. The Healthy Michigan Plan (Michigan’s version of the Medicaid expansion) went into effect on April 1, 2014. One year into this expansion, Michigan’s experience has confirmed some expectations but vastly exceeded others.
Michigan’s Path To Expansion
In late 2012, Republican Governor Rick Snyder expressed initial concerns that the state would not have enough health care providers to ...
Source: Health Affairs Blog - August 28, 2015 Category: Health Management Authors: Marianne Udow-Phillips, Kersten Burns Lausch, Erin Shigekawa, Richard Hirth and John Ayanian Tags: Equity and Disparities Following the ACA Medicaid and CHIP Population Health Public Health CMS Healthy Michigan Plan Republican Rick Snyder Source Type: blogs
A Procedure’s Impact on Patient Comfort, Care, and Outcome
This blog teaches procedures, with its case studies and videos intended to help you perfect your technique and strengthen your confidence. This month we explore issues related to procedural patient impact. How will your intervention positively or negatively affect patient outcome? What happens when we decide to step in and complete a procedure?
A risk is always inherent when a provider undertakes a procedure, no matter how insignificant. Carefully, we weigh the pros and cons of the potential procedure with our patients. Will our intervention cause a positive effect or outcome? Our goals are to repair, resolve, or rest...
Source: The Procedural Pause - August 3, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
A Procedure’s Impact on Patient Comfort, Care, and Outcome
This blog teaches procedures, with its case studies and videos intended to help you perfect your technique and strengthen your confidence. This month we explore issues related to procedural patient impact. How will your intervention positively or negatively affect patient outcome? What happens when we decide to step in and complete a procedure?
A risk is always inherent when a provider undertakes a procedure, no matter how insignificant. Carefully, we weigh the pros and cons of the potential procedure with our patients. Will our intervention cause a positive effect or outcome? Our goals are to repair, resolve, or restor...
Source: The Procedural Pause - August 3, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
The Hugest of the Huge Hematomas
Welcome to our new series, “Guts and Gore.” That title should serve as a warning that some of the videos we will use as teaching tools may be controversial and not for weak stomachs. We hope, however, that part of why you became an emergency provider was to handle sticky situations like the ones we will present. People like us have the ability to ignore blood and copious discharge, and instead focus on saving and improving the lives of our patients. Rarely are you thanked for this ability, and we hope this series on guts and gore will improve your technique, even when the going gets tough.
The Approach
n Proper i...
Source: The Procedural Pause - June 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
The Hugest of the Huge Hematomas
Welcome to our new series, “Guts and Gore.” That title should serve as a warning that some of the videos we will use as teaching tools may be controversial and not for weak stomachs. We hope, however, that part of why you became an emergency provider was to handle sticky situations like the ones we will present. People like us have the ability to ignore blood and copious discharge, and instead focus on saving and improving the lives of our patients. Rarely are you thanked for this ability, and we hope this series on guts and gore will improve your technique, even when the going gets tough.
The Approach
n Proper iden...
Source: The Procedural Pause - June 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Why Physicians Must Not Skimp On The Physical Exam
Like most physicians, I feel extremely rushed during the course of my work day. And every day I am tempted to cut corners to get my documentation done. The “if you didn’t document it, it didn’t happen” mantra has been beaten into us, and we have become enslaved to the quantitative. It’s tempting to rush through physical exams, assuming that if there’s anything “really bad” going on with the patient, some lab test or imaging study will eventually uncover it. Just swoop in, listen to the anterior chest wall, ask if there’s any new pain, and dash off to the next hospital b...
Source: Better Health - May 20, 2015 Category: American Health Authors: Dr. Val Jones Tags: Health Tips True Stories Diagnosis Don't Skimp Patient Satisfaction Physical Exam quality healthcare Respect Winning Confidence Source Type: blogs
Research and Reviews in the Fastlane 077
This article sheds some light on the issue. In this study of ICU patients in Australia and New Zealand, the standard SIRS criteria missed 1 in 8 patients who went on to severe sepsis. These results call into question the reliability of the SIRS criteria.Recommended by: Anand SwaminathanThe 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 Landmark paper A paper that made a differenceR&R Game Changer? Might change your clinical practiceR&R Eureka! Revolutionary i...
Source: Life in the Fast Lane - April 2, 2015 Category: Emergency Medicine Authors: Jeremy Fried Tags: Cardiology Emergency Medicine Haematology Immunology Infectious Disease Intensive Care R&R in the FASTLANE critical care Education literature recommendations research and reviews 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
· If unsure, use ultrasound guide...
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 fo...
Source: The Procedural Pause - March 31, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
