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.
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Source: Kevin, M.D. - Medical Weblog - February 19, 2015 Category: Journals (General) Authors: Karen S. Sibert, MD 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 rating you online: How to res...
Source: Kevin, M.D. - Medical Weblog - February 19, 2015 Category: Journals (General) Authors: Karen S. Sibert, MD 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 the triage desk.Exam: ...
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 synapses, but is also a...
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 or check out the...
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 g...
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. Severe gamma-h...
Source: The Tox Cave - October 2, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
What Happened at Yorkville Endoscopy?
KAREN SIBERT, MD The ear, nose and throat specialist who treated comedian Joan Rivers on August 28 has been identified as Dr. Gwen Korovin, a prominent New York physician who is known as a voice doctor to many entertainers and Broadway stars including Hugh Jackman and Julie Andrews. With a physician who is an expert in airway anatomy at her […] (Source: The Health Care Blog)
Source: The Health Care Blog - September 23, 2014 Category: Consumer Health News Tags: THCB Accreditation Association For Ambulatory Health Care Ambulatory Surgery Center Class A Joan Rivers Laryngospam Office Based Surgery Law Propofol Succinycholine VIP Syndrome Yorkville Endoscopy Source Type: blogs
Anesthesiologist’s Review of the Facts in the Joan Rivers Case
By KAREN SIBERT, MD Since the death of comedian and talk-show host Joan Rivers, more information has surfaced about the events on the morning of August 28 at Yorkville Endoscopy. But key questions remain unanswered. News accounts agree that Ms. Rivers sought medical advice because her famous voice was becoming increasingly raspy. This could be caused […] (Source: The Health Care Blog)
Source: The Health Care Blog - September 15, 2014 Category: Consumer Health News Tags: THCB Airway Laryngospasm Larynx Polyp Propofol Tumor Yorkville Endoscopy Source Type: blogs
What Killed Joan Rivers? Piecing Together a Medical Mystery
KAREN SIBERT, MD There are minor operations and procedures, but there are no minor anesthetics. This could turn out to be the one lesson learned from the ongoing investigation into the death of comedian Joan Rivers. Ms. Rivers’ funeral was held yesterday, September 7. Like so many of her fans, I appreciated her quick wit as […] (Source: The Health Care Blog)
Source: The Health Care Blog - September 8, 2014 Category: Consumer Health News Tags: THCB Demerol Hypotension Joan Rivers Midazolam outpatient care Propofol Wellness Yorkville Endoscopy Source Type: blogs
