Coming clean: Your anesthesiologist needs to know about marijuana use before surgery
Given the increasing prevalence and legalization of marijuana, many patients have come to think that marijuana use is not worth mentioning to their physicians. After all, they reason, I would not necessarily tell my doctor that I had a glass of wine last night, so why should I disclose that I smoked marijuana yesterday? Unfortunately, this reasoning is flawed. Because marijuana has a variety of effects on the body and on anesthesia medicines, it is crucial that anyone undergoing a preoperative evaluation disclose their marijuana use. Don’t worry that your anesthesiologist is judging you. That’s not our job! Our...
Source: Harvard Health Blog - January 15, 2020 Category: Consumer Health News Authors: David Hepner, MD, MPH Tags: Health care Marijuana Prevention Safety Surgery Source Type: blogs

Concerning Findings About Cannabis Use
While recreational marijuana is legal in 11 states as of November 2019, more states gravitating toward legalizing the recreational use of the substance, and 33 states allowing medical marijuana, there’s apparently no stopping this trend. Cannabis, in the form of marijuana, hemp, and cannabidiol (CBD)  is being used for pain relief, to alleviate stress, cope with anxiety, and a number of other mental health disorders and addictions. Yet, there’s a dearth of clinical studies that have been conducted on the overall effects on a user’s health. Clearly, as Crain’s Detroit Business points out, more ...
Source: World of Psychology - November 16, 2019 Category: Psychiatry & Psychology Authors: Suzanne Kane Tags: Medications Substance Abuse Cannabis Marijuana Source Type: blogs

An Overdose that Happens Hours Later
​A 15-year-old girl was brought to the emergency department by EMS after a seizure witnessed by her mother. She admitted that she had ingested "a handful of pills" in a suicide attempt five hours earlier. The mother said her daughter had a history of cutting but no prior suicide attempts.Her past medical history was significant for depression, for which she took bupropion XL, and she reported past alcohol and marijuana use. Her initial vital signs were a temperature of 97.9°F, a pulse of 162 bpm, a blood pressure of 127/65 mm Hg, a respiratory rate of 14 bpm, and a pulse ox of 100% on room air. Her exam was...
Source: The Tox Cave - November 1, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

5 hidden symptoms of physician burnout
As I lay there awaiting my shock, the doctors milled in and out of my room over the course of several hours. It was a normal but hectic morning in the emergency department with ambulances and code blues pulling my doctor away. Before pushing the Propofol and completing my cardioversion, the doctor flatly stated something […]Find jobs at  Careers by KevinMD.com.  Search thousands of physician, PA, NP, and CRNA jobs now.  Learn more. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - October 17, 2019 Category: General Medicine Authors: < span itemprop="author" > < a href="https://www.kevinmd.com/blog/post-author/mitchel-schwindt" rel="tag" > Mitchel Schwindt, MD < /a > < /span > Tags: Physician Practice Management Source Type: blogs

An image that reminds us what  life versus death looks like
This is what  life versus death looks like. This is what medicine verses mortality looks like. This is what science verses humanity looks like. After a thoracotomy, a fellow ER doctor Dr. Mitch Li snapped this picture of the spilled blood and Propofol on the trauma bay floor. Blood courses through every on e of our veins to sustain life. Propofol courses through […]Find jobs at  Careers by KevinMD.com.  Search thousands of physician, PA, NP, and CRNA jobs now.  Learn more. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - March 24, 2019 Category: General Medicine Authors: < span itemprop="author" > < a href="https://www.kevinmd.com/blog/post-author/amy-ho" rel="tag" > Amy Faith Ho, MD < /a > < /span > Tags: Physician Emergency Medicine Source Type: blogs

IV Acetaminophen prevents post op delirium
Intravenous acetaminophen (paracetamol) when added to a sedative has been found to reduce the risk of postoperative delirium in patients after cardiac surgery [1]. Post operative delirium is common after surgery in elderly persons. It often increases the length of hospital stay and naturally the expenses and has adverse effects on final outcome. The DEXACET Randomized Clinical Trial randomized 120 elderly patients undergoing coronary artery bypass surgery (CABG) or combine CABG/valve surgery. Four groups received either intravenous acetaminophen or placebo and sedative IV propofol vs dexmedetomidine. Primary outcome measu...
Source: Cardiophile MD - February 24, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

The Anoscope for Foreign Bodies in the Rectum
​Rectal exams are difficult for the patient and require true expertise. You cannot expect to complete a good rectal exam or remove a rectal foreign body without the correct information, good bedside relationship, and the right equipment.Ensuring your patient has confidence in your ability is vital. Take the time to get to know what equipment is available in your ED. It's important to know what to do before a patient comes to your department with a rectal complaint.Most departments have a box dedicated to the anoscope. It typically will have two handles for light sources and two sizes of obturators with casing. The items ...
Source: The Procedural Pause - December 31, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Q & A with Dr. Daniel Rukstalis on prostatic urethral lift for enlarged prostates
A new procedure that relieves symptoms without causing sexual side effects As men get older, their prostates often get bigger and block the flow of urine out of the bladder. This condition, which is called benign prostatic hyperplasia, causes bothersome symptoms. Since men can’t fully empty their bladders, they experience sudden and frequent urges to urinate. Treatments can relieve these symptoms, but not without troubling side effects: pharmaceutical BPH treatments cause dizziness, fatigue, and retrograde ejaculation, meaning that semen gets diverted to the bladder during orgasm instead of being ejected from the bod...
Source: Harvard Health Blog - October 25, 2018 Category: Consumer Health News Authors: Charlie Schmidt Tags: BPH Prostate Knowledge Q & A HPK Source Type: blogs

Double Trouble: Both-Bone Fractures
​Both-bone forearm fractures may make you feel a little nervous. A completely crooked forearm is definitely a disturbing sight. Both-bone forearm fractures (especially of the midshaft) typically require surgical intervention, but relocation of bony injuries, regardless of site or complexity, is an important and necessary skill you need to know. Plus, you will be required to assist with sedation, reduction, and splinting when the orthopedic team is involved.​Correcting and stabilizing two bones (instead of one) may seem tricky, but we are going to help you do it right. This complex procedure should be done with orthoped...
Source: The Procedural Pause - August 31, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Bupropion Overdose Followed by Cardiac Arrest and, Later, ST Elevation. Is it STEMI?
A young woman presented with status seizures and apparent overdose of bupropion.  There was a question of cocaine use too (with later suspicion of possible ingestion or body stuffing).She had status seizures for which she was intubated and medically treated (successfully) with propofol and benzos.An ECG was recorded:Sinus tach, with a slightly widened QRS (113 ms) and slightly long QTThere is a slightly abnormally large R-wave in aVR.So there might be some sodium channel blockade here, which is expected with cocaine.Bicarbonate was given.This was recorded 8 hours later:QRS = 148 ms and large R-wave in aVR (very danger...
Source: Dr. Smith's ECG Blog - July 20, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs

Learning the health care ecosystem is an uphill battle
The short white coat, breast pocket full of colorful pens, side pockets bulging with gauze pads and suture kits, a simultaneous look of bewilderment, excitement and fear. Pathognomonic signs of the third-year medical student on wards. Third year of medical school is a period of learning how to diagnose disease, treat patients and understand what it means to be a doctor in this health care landscape. There is not enough time in the mere weeks you will be rotating through a clerkship to master all the literature, so you utilize the necessary resources for success, while hoping the rest diffuses into your consciousness. The s...
Source: Kevin, M.D. - Medical Weblog - March 30, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mohammed-ahmed" rel="tag" > Mohammed Ahmed < /a > Tags: Education Public Health & Policy Washington Watch Source Type: blogs

The problem of drug shortages in the emergency department
I first experienced the impact of drug shortages in the U.S. in my first month of my residency training in emergency medicine. The most common drug used to sedate patients for intubation, etomidate, was on national shortage. I learned to use the second most common drug, Propofol, until it went on shortage too. We use it as the first line medication for sedation for painful procedures like re-aligning broken bones, draining painful abscesses and intubating. We resorted to using older combinations of medications that just didn’t work as well. That was over six years ago. And now, we have even more shortages all the tim...
Source: Kevin, M.D. - Medical Weblog - March 26, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/susan-derry" rel="tag" > Susan Derry, MD < /a > Tags: Physician Emergency Medicine Infectious Disease Source Type: blogs

Here ’s what you learn when a young patient dies
“This is a 17-year-old boy who came in as a category 1 trauma yesterday for a rollover MVC with bilateral uncal herniation, epidural hematoma and subdural hematoma currently intubated and sedated with propofol and fentanyl.” As the overnight resident presented this patient on PICU, we could see everyone’s early morning smiles fading slowly and beginning to understand the grave consequences anticipated in this severe traumatic brain injury. We could see the wheels churning in the doctors’ brains, emotions churning in parents’ minds and tears turning in the rest of the family. The family underst...
Source: Kevin, M.D. - Medical Weblog - January 4, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/shubham-bakshi" rel="tag" > Shubham Bakshi, MD < /a > Tags: Physician Critical Care Pediatrics Source Type: blogs

Conversations with our Fathers
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog This is a guest post by Dr Ben Symon (@symon_ben). Ben is a paediatric emergency physician in Queensland and one of the creators of Simulcast. When I was thirteen years old, my father told me about the Milgram Shock Experiment. I vividly remember sitting at our kitchen table as he told me that study participants willingly dialled up the voltage of an electric shock on another person and that despite believing the shock might kill the confederate, the majority complete...
Source: Life in the Fast Lane - December 19, 2017 Category: Emergency Medicine Authors: Chris Nickson Tags: Education acceptance active listening ben symon leadership openness patient safety rejection Speaking up Source Type: blogs

When your doctor ’s computer crashes
Earlier this week, as I write this, our office lost a skirmish against technology. It was my procedure day, where lucky patients file in awaiting the pleasures of scope examinations of their alimentary canals. A few will swallow the scope (under anesthesia), but most will have back-end work done. We are a small private practice equipped with an outstanding staff. We do our best every day to provide them with the close personal attention they deserve. The first patient of the day is on the table surrounded by the medical team. The nurse anesthetist and I have already briefed the patient on what is about to transpire. Propof...
Source: Kevin, M.D. - Medical Weblog - July 7, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/michael-kirsch" rel="tag" > Michael Kirsch, MD < /a > Tags: Tech Health IT Source Type: blogs

Alzheimer's and Anesthesia
Alzheimer's and anesthesia don't mix well. Some physicians are advising their patients that are already diagnosed with Alzheimer ’s to avoid surgery unless absolutely necessary.By Sydney S. Farrier, LCSWHow often have you heard the comment about an older person who recently underwent a major surgery, "She was fine until she had that (hip surgery, knee replacement, cardiac surgery, etc) but now she seems confused."Learn More -What is the Difference Between Alzheimer ’s and DementiaThis week I was visiting with an attractive woman in her 80's who had a knee surgery under a general anesthesia a couple of...
Source: Alzheimer's Reading Room, The - June 26, 2017 Category: Neurology Tags: alzheimer's alzheimer's anesthesia Alzheimers Dementia anesthesia dementia care of dementia patients dementia care dementia made worse by anesthesia dementia news health Source Type: blogs

Ultrasound Helps Release Drugs from Nanoparticles Into Brain
Researchers at Johns Hopkins University have come up with a simple way of using ultrasound to release drugs from special nanoparticles delivered into the brain. The technology would allow for targeted drug delivery, making sure the medication is delivered where the ultrasound beam is focused while preventing its from influencing the rest of the body. The biodegradable plastic nanoparticles are made of a hydrophilic exterior, to travel through the body, and a hydrophobic interior, to contain propofol, a commonly used small molecule anesthetic tried in this study. They are too large to move through the blood-brain barri...
Source: Medgadget - January 23, 2017 Category: Medical Equipment Authors: Editors Tags: Nanomedicine Neurology Neurosurgery Oncology Source Type: blogs

David Newman betrayed patients and emergency medicine
I remember that morning in January 2016 very well.  I opened up my twitter feed to find many people linking to an article that made me stop dead in my tracks.  The New York Post was reporting that Dr. David Newman had been accused of sexually assaulting a patient in his emergency department.  He was accused of giving the patient a dose of propofol and then sexually assaulting her. My initial reaction was denial and anger.  It wasn’t denial and anger that this happened but that it ever took place and that the media was reporting it before charges were filed.  I will admit my initial reaction w...
Source: Kevin, M.D. - Medical Weblog - December 31, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/steve-carroll" rel="tag" > Steve Carroll, DO < /a > Tags: Physician Emergency Source Type: blogs

Research and Reviews in the Fastlane 163
Welcome to the 163rd 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 5 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Justin Morgenstern and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&a...
Source: Life in the Fast Lane - December 7, 2016 Category: Emergency Medicine Authors: Justin Morgenstern Tags: Education Emergency Medicine Pediatrics R&R in the FASTLANE Resuscitation EBM literature recommendations research and reviews Source Type: blogs

LITFL Review 259
Welcome to the 259th 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 chunk of FOAM. The Most Fair Dinkum Ripper Beauts of the Week ‘The speaker wasted my time.’  So how do you deal with negative feedback on your presentation?  Our own Swami talks us through using negativity to spur us on to excellence. [CC] The Best of #FOAMed Emergency Medicine &...
Source: Life in the Fast Lane - November 27, 2016 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

Fight Aging! Newsletter, September 26th 2016
This study included 647 patients 80 to 106 years of age who had audiometric evaluations at an academic medical center (141 had multiple audiograms). The degree of hearing loss was compared across the following age brackets: 80 to 84 years, 85 to 89 years, 90 to 94 years, and 95 years and older. From an individual perspective, the rate of hearing decrease between 2 audiograms was compared with age. The researchers found that changes in hearing among age brackets were higher during the 10th decade of life than the 9th decade at all frequencies for all the patients (average age, 90 years). Correspondingly, the annual rate of ...
Source: Fight Aging! - September 25, 2016 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs

A Selection of Views on Cryonics from the Cryonics Community
Here I'll point out a good article on cryonics and its nuances in the online press; it includes thoughts from people working at cryonics providers, people signed up for cryopreservation, and advocates with various viewpoints. Like any community there are a range of opinions on what constitutes progress and the best strategy for moving ahead, and just as many motivations as there are individuals involved. What is cryonics? It is the low-temperature preservation of at least the brain as closely following death as possible. Early preservations in the 1960s and 1970s were a matter of straight freezing, and thus the preserved i...
Source: Fight Aging! - September 24, 2016 Category: Research Authors: Reason Tags: Healthy Life Extension Community Source Type: blogs

LITFL Review 248
Welcome to the 248th 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 Susan Wilcox drops some serious knowledge on pulmonary hypertension and clapped-out right ventricles on EMCrit Podcast. Brilliant guest with excellent clinical applications. [JS] Anatomy is back, Andy Neill returns with more of the superb Emergen...
Source: Life in the Fast Lane - September 11, 2016 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

Research and Reviews in the Fastlane 149
Welcome to the 149th 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, Justin Morgenstern and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&a...
Source: Life in the Fast Lane - August 31, 2016 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Emergency Medicine Infectious Disease Intensive Care Neurology Palliative care Pre-hospital / Retrieval R&R in the FASTLANE Radiology Respiratory critical care recommendations research and reviews Resuscitation Source Type: blogs

LITFL Review 243
Welcome to the 243rd 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 EM Nerd Rory Spiegel gives us statistical non-nerds an excellent and important education in descriptive statistic in a case of central tendencies. [SO]   The Best of #FOAMed Emergency Medicine Ketofol or Propofol for procedural sedation i...
Source: Life in the Fast Lane - August 7, 2016 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: LITFL review LITFL R/V Source Type: blogs

Research and Reviews in the Fastlane 145
Welcome to the 145th 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 5 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Justin Morgenstern, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more...
Source: Life in the Fast Lane - August 4, 2016 Category: Emergency Medicine Authors: Justin Morgenstern Tags: Education Emergency Medicine Pediatrics R&R in the FASTLANE Resuscitation EBM literature recommendations research and reviews Source Type: blogs

The widespread use of fentanyl escalates the risk of overdose
A fentanyl overdose led to the recent death of musician and singer Prince, according to the medical examiner’s report released June 2. The drug seems likely to become as notorious as propofol did after the death of Michael Jackson in 2009. For all of us in anesthesiology who’ve been using fentanyl as a perfectly respectable anesthetic medication and pain reliever for as long as we can remember, it’s startling to see it become the cause of rising numbers of deaths from overdose.  Fentanyl is a potent medication, useful in the operating room to cover the intense but short-lived stimulation of...
Source: Kevin, M.D. - Medical Weblog - June 30, 2016 Category: Journals (General) Authors: Tags: Physician Medications Pain management Source Type: blogs

Demystifying General Anesthetics
When Margaret Sedensky, now of Seattle Children’s Research Institute, started as an anesthesiology resident, she wasn’t entirely clear on how anesthetics worked. “I didn’t know, but I figured someone did,” she says. “I asked the senior resident. I asked the attending. I asked the chair. Nobody knew.” For many years, doctors called general anesthetics a “modern mystery.” Even though they safely administered anesthetics to millions of Americans every year, they didn’t know exactly how the drugs produced the different states of general anesthesia. These states includ...
Source: Biomedical Beat Blog - National Institute of General Medical Sciences - June 22, 2016 Category: Research Authors: Carolyn Beans Tags: Pharmacology Anesthesiology Big Questions Source Type: blogs

Fame and Fetanyl
By KAREN SIBERT, MD A fentanyl overdose led to the recent death of musician and singer Prince, according to the medical examiner’s report released June 2. The drug seems likely to become as notorious as propofol did after the death of Michael Jackson in 2009. For all of us in anesthesiology who’ve been using fentanyl as a perfectly respectable anesthetic medication and pain reliever for as long as we can remember, it’s startling to see it become the cause of rising numbers of deaths from overdose.  Fentanyl is a potent medication, useful in the operating room to cover the intense but short-...
Source: The Health Care Blog - June 7, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Fetanyl Source Type: blogs

Fame and Fentanyl
By KAREN SIBERT, MD A fentanyl overdose led to the recent death of musician and singer Prince, according to the medical examiner’s report released June 2. The drug seems likely to become as notorious as propofol did after the death of Michael Jackson in 2009. For all of us in anesthesiology who’ve been using fentanyl as a perfectly respectable anesthetic medication and pain reliever for as long as we can remember, it’s startling to see it become the cause of rising numbers of deaths from overdose.  Fentanyl is a potent medication, useful in the operating room to cover the intense but short-...
Source: The Health Care Blog - June 7, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Fetanyl Source Type: blogs

An unusual wrist injury
A 30 year old man attends the Emergency Department after injuring his right wrist. He was playing rugby and landed awkwardly during a tackle with his hand trapped underneath another player. On arrival he is complaining of significant pain in his right wrist with reduced movement in all directions. Clinical Case Report Examination: Examination of the wrist reveals reduced movement in flexion and extension and significant pain on pronation and supination. You notice a hollow where his ulna styloid normally sits on the dorsum of his wrist. + Show Clinical Image of wrist on arrival expand(document.getElementB...
Source: Life in the Fast Lane - May 6, 2016 Category: Emergency Medicine Authors: Dan Stevens Tags: Clinical Case Education Orthopedics dislocation DRUJ relocation Trauma Volar Distal Ulnar Dislocation wrist injury Source Type: blogs

LITFL Review 222
Welcome to the 222nd 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 Josh Farkas explains his top 10 issues/problems with the new Sepsis-3 definitions. [SR] The Best of #FOAMed Emergency Medicine First 10 EM drops their articles of the month as February comes to a close. [AS] Cameron Berg discusses another way ...
Source: Life in the Fast Lane - March 6, 2016 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

Briefly without pulse, has pulmonary edema and LBBB with 10 mm of ST Elevation
A middle-aged male was found down.  EMS was able to get the patient to climb onto the ambulance by himself, then during transport he became less responsive.  They briefly could not find pulses, and gave a short period of CPR with ROSC, but he did not require a shock. They gave Narcan without improvement.  An oral airway was placed and BVM oxygenation provided.  The patient arrived unable to provide any further history.BP was 180/100, HR 130, Oxygen saturations 84%.He was intubated.  A bedside ultrasound showed poor global function and B-lines of pulmonary edema.Here was the first ECG:There is sinus...
Source: Dr. Smith's ECG Blog - December 13, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs

Funtabulously Frivolous Friday Five 127
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 127 Question 1 Which two life threatening diseases can bats transmit? + Reveal the Funtabulous Answer expand(document.getElementById('ddet1031217351'));expand(document.getElementById('ddetlink1031217351')) Histoplasmosis and rabies (technically bat lyssavirus) Question 2 What parenteral drug commonly used in Emergency Medicine practice is known to generate green urine? + Reveal the Funtabulous Answer expand(documen...
Source: Life in the Fast Lane - November 27, 2015 Category: Emergency Medicine Authors: Neil Long Tags: Frivolous Friday Five asparagus asparagusic acid bat lyssavirus Green urine Histoplasmosis Malaria normal saline propofol rabies Source Type: blogs

Rise of the Machines
By SHIRIE LENG, MD “We are convinced the machine can do better than human anesthesiologists.” This statement was made by a doctor. Not only a doctor but an anesthesiologist. Not just an anesthesiologist but a pediatric anesthesiologist. Not just any old pediatric anesthesiologist but one in charge of pediatric anesthesia research at the University of British Columbia medical school in Vancouver. One can only assume that this guy has a pretty low estimation of what his colleagues can do. Must make for great break room conversation. The doctor making this statement, one JM Ansermino, is co-creator of a new automa...
Source: The Health Care Blog - July 31, 2015 Category: Consumer Health News Authors: suchandan roy Tags: THCB Shirie Leng Source Type: blogs

Long QT Syndrome with Continuously Recurrent Polymorphic VT: Management
A young woman presented with intermittent shocks from her implantable defibrillator.  She was intermittently unconscious and unable to give history.   The monitor showed intermittent polymorphic ventricular tachycardia.    The physician was presented with this ECG at the same moment he was observing the repeated syncope:Time zeroIt is a bigeminal rhythm with a very bizarre PVC.  The PVC has an incredibly long QT, but the intervening native rhythms do not.  However, when I saw this (it was texted to me), it immediately reminded me of this case, so I knew by sheer recognition that it was lo...
Source: Dr. Smith's ECG Blog - July 8, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs

LITFL Review 177
Welcome to the 177th 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 WeekMichelle Johnston manages to capture, in her superbly eloquent style, the heartbreak of the Wrong type of Swiss Cheese. Errors must be prevented, yes. But not at the cost of our humanity. [SO] The Best of #FOAMed Emergency MedicineThe April issu...
Source: Life in the Fast Lane - April 12, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

How the advent of propofol changed the meaning of the term ”sedation”
“Twilight! She has to have twilight,” insisted the adult daughter of my frail, 85-year-old patient. “She can’t have general anesthesia. She hasn’t been cleared for general anesthesia!” We were in the preoperative area of my hospital, where my patient — brightly alert, with a colorful headband and bright red lipstick — was about to undergo surgery. Her skin had broken down on both legs due to poor circulation in her veins, and she needed skin grafts to cover the open wounds. She had a long list of cardiac and other health problems. Continue reading ... Your patients are ratin...
Source: Kevin, M.D. - Medical Weblog - February 19, 2015 Category: Journals (General) Authors: Tags: Meds Surgery Source Type: blogs

How the advent of propofol changed the meaning of the term “sedation”
“Twilight! She has to have twilight,” insisted the adult daughter of my frail, 85-year-old patient. “She can’t have general anesthesia. She hasn’t been cleared for general anesthesia!” We were in the preoperative area of my hospital, where my patient — brightly alert, with a colorful headband and bright red lipstick — was about to undergo surgery. Her skin had broken down on both legs due to poor circulation in her veins, and she needed skin grafts to cover the open wounds. She had a long list of cardiac and other health problems. Continue reading ... Your patients are ratin...
Source: Kevin, M.D. - Medical Weblog - February 19, 2015 Category: Journals (General) Authors: Tags: Meds Surgery Source Type: blogs

Wide Complex Tachycardia in a 20 something.
This was sent by a former resident.  He will remain anonymous because his identity could compromise patient confidentiality.CaseA 20-something female presented with palpitations and lightheadedness.  She had no previous medical history except for some "in utero tachycardia" which was treated until a very early age.  She has had no problems since and takes no medications.  She has no specific conduction abnormality diagnosis. Her mother states she is not thinking clearly ("acting as if she is intoxicated").  The patient reports exertional syncope and was syncopal on the way to th...
Source: Dr. Smith's ECG Blog - February 16, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs

A Relatively Narrow Complex Tachycardia at a Rate of 180.
I received a text message with this image: "Cardioversion didn't work.  Any thoughts?" What do you think?  The heart rate is 180.I was viewing this on my phone, but I saw what I thought were P-waves.  I could barely see them in lead II:There are probable P-waves at the arrows, but I wasn't certainI texted back: "Could be very fast sinus."There is also a wide QRS at 113 ms and a large R-wave in aVR, so sodium channel blockade is likely.   Common culprits in this situation are tricyclic overdose and cocaine toxicity (remember cocaine not only increases dopamine in central syn...
Source: Dr. Smith's ECG Blog - February 8, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs

ED Case of Catecholaminergic Polymorphic Ventricular Tachycardia
This article only comments on chronic management, not acute management. (Source: Dr. Smith's ECG Blog)
Source: Dr. Smith's ECG Blog - February 6, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs

How the Advent of Propofol Changed the Meaning of the term “Sedation”
By KAREN SIBERT, MD “Twilight! She has to have twilight,” insisted the adult daughter of my frail, 85-year-old patient. “She can’t have general anesthesia. She hasn’t been cleared for general anesthesia!” We were in the preoperative area of my hospital, where my patient – brightly alert, with a colorful headband and bright red lipstick – […] (Source: The Health Care Blog)
Source: The Health Care Blog - February 5, 2015 Category: Consumer Health News Tags: THCB Anesthesia General anesthesia Propofol Twilight Source Type: blogs

LITFL Review 167
Welcome to the 167th 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 Janu-airway continues over at EMcrit with things Scott Weingart learned at the NYC airway course. [MG]The Best of #FOAMed Emergency MedicineShould men and women have different cutoff values to define a positive troponin? EM Lit of Note discusses a r...
Source: Life in the Fast Lane - February 1, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

How the Advent of Propofol Changed the Meaning of the term “Sedation”
By KAREN SIBERT, MD “Twilight! She has to have twilight,” insisted the adult daughter of my frail, 85-year-old patient. “She can’t have general anesthesia. She hasn’t been cleared for general anesthesia!” We were in the preoperative area of my hospital, where my patient – brightly alert, with a colorful headband and bright red lipstick – […] (Source: The Health Care Blog)
Source: The Health Care Blog - February 1, 2015 Category: Consumer Health News Tags: Physicians Anesthesia General anesthesia Propofol Twilight Source Type: blogs

Research and Reviews in the Fastlane 068
Welcome to the 68th 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 ...
Source: Life in the Fast Lane - January 29, 2015 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Cardiology Education Emergency Medicine Infectious Disease Intensive Care LITFL Microbiology Psychiatry and Mental Health critical care examination LITFL R/V R&R in the FASTLANE recommendations Review Source Type: blogs

The Anesthesiologist’s Story: New Details Emerge In the Joan Rivers Case
By KAREN SIBERT, MD New York Post reporter Susan Edelman revealed on January 4 the name of the unfortunate anesthesiologist allegedly present on August 28 at Yorkville Endoscopy, during the throat procedure that led to the death of comedian Joan Rivers. She is reported to be Renuka Reddy Bankulla, MD, 47, a board-certified anesthesiologist from New Rochelle, NY. Having […] (Source: The Health Care Blog)
Source: The Health Care Blog - January 4, 2015 Category: Consumer Health News Tags: THCB anesthesiology Joan Rivers Case Oxygen Saturation Propofol Yorkville Endoscopy Source Type: blogs

The Shadow Boxer
Conclusion The patient was admitted to a monitored setting with a diagnosis of GHB withdrawal. He had multiple episodes of agitation and combativeness during his admission. He was administered escalating doses of diazepam, a total of 480 mg of diazepam IV during his eight-day hospital stay. The patient recovered in eight days, and was referred to drug rehabilitation.   References 1. Dyer JE, Roth B, Hyma BA. Gamma-hydroxybutyrate withdrawal syndrome. Ann Emerg Med 2001;37(2):147. 2. Tarabar AF, Nelson LS. The gamma-hydroxybutyrate withdrawal syndrome. Toxicol Rev 2004;23(1):45. 3. Craig K, Gomez HF, et al. Severe gam...
Source: The Tox Cave - October 2, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

The Shadow Boxer
Conclusion The patient was admitted to a monitored setting with a diagnosis of GHB withdrawal. He had multiple episodes of agitation and combativeness during his admission. He was administered escalating doses of diazepam, a total of 480 mg of diazepam IV during his eight-day hospital stay. The patient recovered in eight days, and was referred to drug rehabilitation.   References 1. Dyer JE, Roth B, Hyma BA. Gamma-hydroxybutyrate withdrawal syndrome. Ann Emerg Med 2001;37(2):147. 2. Tarabar AF, Nelson LS. The gamma-hydroxybutyrate withdrawal syndrome. Toxicol Rev 2004;23(1):45. 3. Craig K, Gomez HF, et al. Seve...
Source: The Tox Cave - October 2, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs