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
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
A Forty-Year Struggle for Openness
In 1977, while I was busy with Star Wars and action figures, Andreas Gruentzig was using his kitchen-made balloon catheter to dilate and open a highly stenotic LAD coronary artery. Fixing atherosclerotic disease of the coronary arteries had previously required open heart bypass surgery, a procedure only 10 years old at the time. He had taken coronary catheterization, which until then had only been used for diagnostics and surgical planning, and became the first to perform transluminal interventional therapy. Unfortunately, it turned out that the coronary artery would often close either immediately or over the following day...
Source: Spontaneous Circulation - June 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Research and Reviews in the Fastlane 084
This study demonstrated that using a simulation program, EM residents could be brought up to speed on proper sterile technique and that these lessons could be applied clinically. The authors of this study found identical CRBI rates between ED and MICU placed central lines after this educational intervention.
Recommended by: Anand Swaminathan
Trauma
Hildebrand DR et al. Modern management of splenic trauma. BMJ. 2014; 348. PMID: 24696170
Pediatric patients with abdominal trauma can be a challenge to assess. Naturally, we often are concerned for potential splenic injury. What is the most current approach to managing splen...
Source: Life in the Fast Lane - May 21, 2015 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Airway Anaesthetics Education Emergency Medicine Intensive Care R&R in the FASTLANE Toxicology and Toxinology Trauma critical care examination research and reviews Source Type: blogs
Cardiology MCQ: INR value for prosthetic mitral valve
Recommended INR value for mechanical prosthesis at mitral position:
a) 1-2
b) 1.5-2.5
c) 2-3
d) 2.5-3.5
Correct answer: d) 2.5-3.5
Mechanical prosthesis at mitral position has higher chance of thrombosis than one at aortic position due to the lower pressure gradient across it. Hence the recommended value of INR for a mitral prosthesis is 2.5-3.5 while it is only 2-3 for an aortic prosthesis. Low dose aspirin is also often added along with warfarin in case of metallic mitral prosthesis, to reduce the chance of thromboembolic complications. Read more on prosthetic valve thrombosis… (Source: Cardiophile MD)
Source: Cardiophile MD - April 20, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Update: Social justice of AF care, NOAC monitoring, population health and two new podcasts
Hi All,
Here is a short update of the past week.
The first thing to say is the Atrial Fibrillation Care: Put the Catheter (and Rx Pad) Down post has gotten a lot of attention. It stayed on the most popular list all week. It has over a 130 comments, and I have received many emails on it. It is a big moment in AF care.
I would also point you to an interview I did with Dr. Prash Sanders from Adelaide. Prash is the senior researcher on the LEGACY trial. His team’s work has been most responsible for the change in thinking of AF care. The title of the post: LEGACY PI Throws Down the Gauntlet to US Physicians
Is AF care fai...
Source: Dr John M - April 20, 2015 Category: Cardiology Authors: Dr John Source Type: blogs
Writing update: Lown Institute Conference and ACC2015
Hi all,
I have been busy in the last few weeks. Here is an update of my happenings and posts.
From March 8-11, I attended and presented at the third annual Lown Institute Conference in San Diego. I have never felt more at home in a conference than I did at the Lown conference. Take a look at the About Us page of the Lown Institute and you will see why.
Lown Institute Core Values
No matter how things turn out for me in Medicine–today or tomorrow–I am happy and proud to be on the same side as Dr. Bernard Lown and his Institute. The motto of the conference was RightCare. That is perfect. Here is a link to a front ...
Source: Dr John M - March 23, 2015 Category: Cardiology Authors: Dr John Source Type: blogs
LITFL Review 172
Welcome to the 172nd 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 WeekDi McMath writes a touching post reminding us all to build and maintain our resilience in “caring for the invisible wounds”. Thanks to Minh Le Cong for the tip! [SO]The Best of #FOAMed Emergency MedicineNice review of core content on skin and sof...
Source: Life in the Fast Lane - March 8, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs
Why don’t some parents believe the safety of vaccines?
As a medical student, I strongly support vaccination. It works, it’s safe, and it doesn’t cause autism. But I also understand why many parents don’t believe me and the medical community when we beg them to vaccinate their kids.
Medicine has come a long way from “do no harm.” Now we talk about risks and benefits: and none of our tests, medicines, or procedures are without risks. Increasingly, pharmaceutical companies have been caught concealing those risks from doctors and the public.
Around 2000, Merck (the manufacturer with a monopoly on the MMR vaccine that protects against measles) ...
Source: Kevin, M.D. - Medical Weblog - February 28, 2015 Category: Journals (General) Authors: Vamsi Aribindi Tags: Meds Pediatrics Source Type: blogs
The medical decision as a gamble
The medical decision–to have a screening mammogram, to take warfarin, to undergo a catheter ablation–is, at its core, a gamble. We pit the treasure of the win (benefit) against the pain of the loss (harm).
In times past, medical gambles were easier. You took the antibiotic or you lost your leg. Most medical decisions today are hardly that clear. We say they are preference-sensitive.
Many factors determine these preferences.
The digital revolution notwithstanding, what a patient prefers turns substantially on how the decision is framed. (Wear this vest or you could die.) How the decision is framed depends on the...
Source: Dr John M - February 2, 2015 Category: Cardiology Authors: Dr John Source Type: blogs
Medications After a Heart Attack
From: www.secondscount.orgYour heart attack recovery will include medications. Taking these medications exactly as prescribed is one of the best tools at your disposal for avoiding death in the months following a heart attack. According to an article published in Circulation, the journal of the American Heart Association, heart attack patients who had not filled any of their prescriptions within 120 days of being discharged from the hospital had 80 percent greater odds of death than those who filled all of their prescriptions.Medications you are likely to be prescribed after a heart attack fall int...
Source: Dr Portnay - January 23, 2015 Category: Cardiology Authors: Dr Portnay Source Type: blogs
Changing over from Heparin to Warfarin
Changing over from Heparin to Warfarin
Short Notes
Abstract: Heparin should be overlapped with warfarin till the INR is within therapeutic range, with a minimum of four days after initiation of warfarin therapy.
It is usual practice to start heparin initially and then switch over to warfarin in many situations like peripheral embolism and pulmonary embolism. Sometimes warfarin is not initiated along with heparin when potential for a surgical intervention is considered in the near future because of the longer wane out period of warfarin effect. When such a possibility does not exist, warfarin can be initiated along with ...
Source: Cardiophile MD - January 13, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs
Candidates for tissue valve replacement
Candidates for tissue valve (bioprosthetic) replacement
Brief Review
Bioprosthetic valves have the advantage of doing away with anticoagulation after the initial period of about 3 months during which the valve gets endothelialized. This is because of their lower thrombogenicity compared to mechanical prosthetic valves which require lifelong anticoagulation.
Elderly patients
In elderly patients avoiding anticoagulation by implanting bioprosthetic valves is beneficial because they are more prone for bleeding complications with anticoagulation. Moreover they are more prone for thrombotic episodes with mechanical prostheses be...
Source: Cardiophile MD - January 4, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiac Surgery Bioprosthetic valves Candidates for tissue valve replacement Source Type: blogs
Factor Xa inhibitors
This study involving about seven thousand four hundred patients, was terminated prematurely due to higher bleeding risks at a dose of 5 mg twice daily and there was no siginificant reduction of ischemic events. It may be noted that the drug was added over and above standard antiplatelet therapy in the setting of acute coronary syndrome.
AVERROES (Apixaban Versus Acetylsalicylic Acid [ASA] to Prevent Stroke in Atrial Fibrillation Patients Who Have Failed or Are Unsuitable for Vitamin K Antagonist Treatment) study on the other hand compared the use of same dose of apixaban with varying doses of aspirin (81 to 325 mg).5 In th...
Source: Cardiophile MD - December 21, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs
The year in Cardiology 2014 — a top-10 list
When the editors at Medscape asked me to put together an essay on the Top 10 stories in cardiology in 2014, I thought it would be an easy project. I was wrong. It turns out there was a lot to say about the happenings in cardiology this year. In the end, the final essay had 37 references–a bunch for a blogger.
The link to the piece is at the end of this post. What follows is a regular-language breakdown of the ten topics. The first five deal with specifics; the second five touch on trends.
Here we go:
1. Renal denervation is the medical name given to a procedure in which a doctor uses a catheter to ablate (burn) n...
Source: Dr John M - December 21, 2014 Category: Cardiology Authors: Dr John Source Type: blogs
