Funtabulously Frivolous Friday Five 155
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 FFFF…introducing Funtabulously Frivolous Friday Five 155
Question 1
Takotsubo syndrome from the Japanese word for an octopus trap has entered our common vernacular but what is moyamoya disease and what does it mean in Japanese?
+ Reveal the Funtabulous Answer
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Puff of smoke.
Moyamoya is a rare type of stroke. Arteries become blocked via constriction and thrombosis whi...
Source: Life in the Fast Lane - July 22, 2016 Category: Emergency Medicine Authors: Neil Long Tags: Frivolous Friday Five EYD French gauge joseph benoit charriere masque ecchymotic moyamoya moyamoya disease penis captivus warfarin william osler Wisconsin Alumni Research Foundation Source Type: blogs
Prescribing opioids is a dilemma for every doctor
Once a month, she waits patiently in my exam room, despite the fact that I’m almost always running an hour late in my hectic community health center practice. She is 86 and suffers from mild dementia, diabetes, arthritis and an arrhythmia for which she takes warfarin, a powerful blood thinner. At every visit, she comes to me with some sort of homemade gift — a scarf, a tin of cookies, a beaded keychain — and also with a request for a refill of her opioid painkiller prescription.
My patient’s request makes me enormously uncomfortable. She is old and frail, and if she were to stumble and fall from the sedatin...
Source: Kevin, M.D. - Medical Weblog - July 16, 2016 Category: Journals (General) Authors: Alison Block, MD Tags: Physician Pain management Primary care Source Type: blogs
DM / DNB Cardiology Entrance New Test Series 4
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Source: Cardiophile MD - July 16, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs
Alere Withdraws Anticoagulation Monitoring System At Heart Of ROCKET AF Controversy
–FDA says the manufacturer has not demonstrated that it has fixed the problem. The Alere INRatio® and INRatio®2 PT/INR Monitoring System are being pulled from the market. Alere, the manufacturer of the devices, which are used by people taking warfarin to monitor their INR, said that the action follows a “collaborative process” with the FDA. The...Click here to continue reading... (Source: CardioBrief)
Source: CardioBrief - July 13, 2016 Category: Cardiology Authors: Larry Husten Tags: People, Places & Events Policy & Ethics Alere anticoagulation FDA INR monitoring system ROCKET-AF Source Type: blogs
ROCKET AF Investigators Say New Analysis Supports Original Trial Results
–Test of stored blood may help answer troubling questions about the trial. A new analysis of stored blood by the ROCKET AF trial investigators may help resolve lingering questions about the trial. The questions about ROCKET AF, which compared rivaroxaban (Xarelto, Johnson & Johnson) to warfarin in patients with atrial fibrillation, emerged last November, when...Click here to continue reading... (Source: CardioBrief)
Source: CardioBrief - July 6, 2016 Category: Cardiology Authors: Larry Husten Tags: Heart Rhythms People, Places & Events Policy & Ethics anticoagulants INR rivaroxaban Xarelto Source Type: blogs
DM / DNB Cardiology Entrance New Test Series 1
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Source: Cardiophile MD - June 28, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs
Research and Reviews in the Fastlane 139
This study is a reanalysis of the data, attempting to identify the threshold where the benefit in functionality is produced, using ranges of <160, 160–169, 170–179, 180–189, and ≥190 mm Hg. The outcome was Rankin Scale at 90 days. Although the ranges proposed by the authors only include a <160 as the lowest, the linear analysis of SBP and Rankin Score shows a direct correlation going as low as 130-139mmHg, therefore the authors conclude that 130-139mmHg for SBP is the optimal range for management of patients with ICH.
The study is a post-hoc analysis of a previous large study (open and unblinded) making no ...
Source: Life in the Fast Lane - June 23, 2016 Category: Emergency Medicine Authors: Soren Rudolph Tags: Clinical Research Education Emergency Medicine R&R in the FASTLANE Resuscitation Trauma Clinical Case critical care research and reviews Source Type: blogs
Heparin induced thrombocytopenia – Cardiology MCQ
Alternative anticoagulation for a patient with HIT (Heparin induced thrombocytopenia) should not include:
a) Low molecular weight heparin
b) Warfarin
c) Argatroban
d) a and b
Correct answer: d) a and b
Both LMWH (low molecular weight heparin) and warfarin can worsen the thrombin generation and risk for thrombosis. LWMH can cross react with HIT antibodies in up to 90%.
Argatroban is a direct thrombin inhibitor which has been approved by U.S. Food and Drug Administration for treatment of thrombosis in HIT [1].
Reference:
Salter BS et al. Heparin-Induced Thrombocytopenia – A Comprehensive Clinical Review. J Am Coll ...
Source: Cardiophile MD - May 27, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
LITFL Review 227
Welcome to the 227th 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
The old and new titans of critical care Paul Marik and Rob MacSweeney throw down over the futility of predicting fluid responsiveness in resuscitation. [JS]
Natalie May provides a thought-provoking post looking at our polarised perspectives in th...
Source: Life in the Fast Lane - April 17, 2016 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs
All drugs are poisons, and that’s OK
There are a number of aphorisms that one imbibes over many years of medical education, especially in medical school. Some are useful; some are not; but some stick with you for reasons that even you can’t figure out. For example, I still remember my first day of medical school over 30 (!) years ago. It… (Source: Respectful Insolence)
Source: Respectful Insolence - April 7, 2016 Category: Surgery Authors: Orac Tags: Complementary and alternative medicine Pseudoscience Quackery Skepticism/critical thinking anticoagulant coumadin drugs medical school pharmaceuticals poison warfarin Source Type: blogs
MKSAP: 32-year-old woman is evaluated for anticoagulation management
A 32-year-old woman is evaluated for anticoagulation management after an uncomplicated vaginal delivery of a healthy newborn. She was diagnosed with a bilateral pulmonary embolism at 25 weeks’ gestation and was treated with therapeutic low-molecular-weight heparin (LMWH). The LMWH was discontinued at the onset of labor and was restarted 6 hours after delivery. Medical history is otherwise unremarkable, and her only medication is full-dose LMWH.
Anticoagulation for 3 months is planned. The patient wishes to breastfeed her newborn.
Which of the following is the most appropriate anticoagulation option for this patient?
...
Source: Kevin, M.D. - Medical Weblog - April 2, 2016 Category: Journals (General) Authors: mksap Tags: Conditions Medications OB/GYN Source Type: blogs
DM / DNB Cardiology Entrance Mock Test 24
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Source: Cardiophile MD - March 26, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
One reason we get ECGs in stroke patients
This patient presented with a sudden right sided weakness and ophthalmoplegia that was resolving upon presentation to the ED.Here is his ED ECG:What do you see?There are anterior Q-waves, and even some ST elevation. This is suggestive of LV aneurysm. CT and CT angiogram were normal. As all symptoms were resolved, no intervention was undertaken.MRI confirmed small strokes and some atherosclerotic cerebrovascular disease, which could have been the source of the stroke. However, because of the ECG findings, an echocardiogram was done which confirmed LV aneurysm and showed:1. Decreased left ventricula...
Source: Dr. Smith's ECG Blog - March 13, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
Research and Reviews in the Fastlane 125
Welcome to the 125th 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 6 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R project or check ou...
Source: Life in the Fast Lane - March 10, 2016 Category: Emergency Medicine Authors: Jeremy Fried Tags: Cardiology ECG Emergency Medicine Gastroenterology Intensive Care R&R in the FASTLANE critical care EBM Education literature recommendations research and reviews Source Type: blogs
MKSAP: 53-year-old woman with a skin lesion
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 53-year-old woman is evaluated for a slowly enlarging, telangiectatic, pearly, ulcerated 1-cm plaque on the left temple. It bleeds periodically when traumatized. Medical history is significant for atrial fibrillation. She takes warfarin daily. She is otherwise in good health.
On physical examination, vital signs are normal. Cardiac examination shows an irregular heart rate but is otherwise normal. The remainder of the examination is unremarkable.
Biopsy of the lesion reveals a basal cell carcinoma with microno...
Source: Kevin, M.D. - Medical Weblog - March 5, 2016 Category: Journals (General) Authors: mksap Tags: Conditions Dermatology Source Type: blogs
