Massive ST Elevation After V Fib Arrest, Discordant Bedside Echo Results
A woman in her 40's was brought the ED (not by ambulance) for what is believed to be a seizure. She was reportedly very anxious and there was a question of benzodiazepine withdrawal. Events are uncertain (perhaps there was another seizure?), but soon thereafter, the patient was found limp and pulseless, and was found to be in ventricular fibrillation. She underwent immediate resuscitation with chest compressions (LUCAS and ResQPod). She was given a total of 3-4 shocks, vasopressin, bicarb x 2 and Epinephrine and, after 10 minutes on LUCAS she had ROSC and was noted to be moving on the cart. An ECG w...
Source: Dr. Smith's ECG Blog - August 6, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
Research and Reviews in the Fastlane 042
This article challenges the notion that lacerations need to be closed within a specific “golden period” lest they become infected. The authors find that diabetes, wound contamination, length greater than 5 cm and location on the lower extremity are important risk factors for wound infection. Time from injury to wound closure is not as important as previously thought.
Recommended by: Anand Swaminathan
Read More: Goldfinger (More Dogma of Wound Care) (SGEM)
Emergency Medicine, Procedural Sedation
Green SM, Andolfatto G. Managing Propofol-Induced Hypoventilation. Ann Emerg Med. 2014 Jul 11. pii: S0196-0644...
Source: Life in the Fast Lane - August 4, 2014 Category: Emergency Medicine Authors: Jeremy Fried Tags: R&R in the FASTLANE critical care Emergency Medicine Intensive Care literature recommendations research and reviews Source Type: blogs
How To Be A Bad Gastroenterologist
I am a regular reader of patient blogs, and I find myself frequently gasping at the mistreatment they experience at the hands of my peers. Yesterday I had the “pleasure” of being a patient myself, and found that my professional ties did not protect me from outrageously poor bedside manners. I suppose I’m writing this partly to vent, but also to remind healthcare professionals what not to do to patients waking up from anesthesia. I also think my experience may serve as a reminder that it’s ok to fire your doctor when conditions warrant.
I chose my gastroenterologist based on his credentials and the q...
Source: Better Health - July 10, 2014 Category: American Health Authors: Dr. Val Jones Tags: Opinion True Stories Bad Bedside Manner Bad Doctors Colonoscopy Compassion Empathy Gastroenterologist Lack Lack of Caring Source Type: blogs
Research and Reviews in the Fastlane 038
This study, however, has major flaws and biases that question the validity of their conclusions. Only 19% of centers that were contacted agreed to contribute data to the Consortium. Additionally, the researchers do not assess the quality of the studies included in their meta-analysis. Regardless, observational data should not be used to trump the RCT data included in the recent, Cochrane review. Finally, Roche pharmaceuticals was a major sponsor of this research team. The accompanying editorial is a must-read.
Recommended by: Anand Swaminathan
Infection Control, Hand hygiene
D’Egidio G et al. A study of the ...
Source: Life in the Fast Lane - July 10, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Anaesthetics Cardiology Emergency Medicine Featured Infectious Disease Intensive Care Neurology Palliative care R&R in the FASTLANE Radiology Resuscitation Trauma critical care literature recommendations research and reviews Source Type: blogs
Unconventional Sign Language
The patient coming through the door was having trouble breathing. No doubt. You could hear the hiss of the nebulizer as the cart whisked by the nurse’s station into a room.
Most people knew the patient from prior emergency department visits.
Bad asthma
Steroid dependent
Several previous intubations
Last ED visit a couple of months ago
Unfortunately, being in the middle of doing a central line on a septic octagenarian with a systolic blood pressure less than her age makes it difficult to go evaluate a new patient.
I asked the nurse to go get me one of the PAs.
“Do me a favor,” I said to the PA, “Go t...
Source: WhiteCoat's Call Room - December 31, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs
Why IPAB is a good idea
IPAB – the independent payment advisory board is a key feature of the ACA. This board will do what many countries already do – have an independent expert panel to assess the effectiveness of procedures, imaging studies, pharmaceuticals, etc.
Why do we need this board? We need careful assessments of new trends in medicine. Let me suggest two situations.
We have read much about increasing colonoscopy costs. We have a controversy about anesthesia – conscious sedation versus a more standard anesthesia with propofol. The former only requires the gastroenterologist; the latter adds an anesthesiologist, a...
Source: DB's Medical Rants - November 29, 2013 Category: Health Medicine and Bioethics Commentators Authors: rcentor Tags: Medical Rants Source Type: blogs
Pharmalot... Pharmalittle... The Weekend Nears
And so, another working week will soon draw to a close. This is, as you know, our treasured signal to daydream about weekend plans. Today, however, the daydreaming begins early because we are officially off today, although we have obviously stopped for a few moments to conduct some business here. In any event, our agenda is filled with excitement, such as celebrating a birthday with one of the Pharmalot ancestors and taking Mrs. Pharmalot to yet another installment in our 'Let's-See-Them-Before-They-Die' concert series. But what about you? Anything interesting planned? How about catching up with someone special or reading ...
Source: Pharmalot - October 11, 2013 Category: Pharma Commentators Authors: esilverman Source Type: blogs
Medical Mispronunciations and Misspelled Words: The Definitive List.
Hearing medical mispronunciations and seeing misspelled words are an under appreciated joy of working in healthcare. Physicians often forget just how alien the language of medicine is to people who don't live it everyday. The best part about being a physician is not helping people recover from critical illness. The best part is not about listening and understanding with compassion and empathy. Nope, the best part about being a physician is hearing patients and other healthcare providers butcher the language of medicine and experiencing great entertainment in the process. Doctors c...
Source: The Happy Hospitalist - October 2, 2013 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs
sartorius
Blogging has changed a lot in the almost 13 years (!) since I started writing online, and I often think--particularly during this most recent long hiatus, when I was too busy to perform anything but the most basic of life tasks (see: job, performance of; family, keeping alive of)--why do I still do it? What is it, aside from perhaps the compulsive need for me to document the minutiae of my life, that makes me continue to write online?It's not a business decision, certainly. It probably speaks to the direction that online media is moving these days that this blog is such an aberration--a more than decade-old blog that is al...
Source: the underwear drawer - September 25, 2013 Category: Anesthetists Authors: Michelle Au Source Type: blogs
Modern medicine has made me a salesman
I am a physician. But modern medicine, with all its complexity and top-down control, has made me a salesman. It’s an odd turn of events, because I remember when we tried to repudiate business and its effects on our practices. We railed against corporate influence in medicine. We were shocked, shocked I say, at the power that drug companies and drug reps wielded. We took a dim view of gifts, knowing as we did that sandwiches and refrigerator magnets were nothing less than powerful talismans that led us down the primrose path. We turned a blind eye to industry sponsored studies. We were, at least in the ER, sud...
Source: Kevin, M.D. - Medical Weblog - September 24, 2013 Category: Family Physicians Tags: Physician Emergency Source Type: blogs
Physicians Against Drug Shortages Challenge the Controlled Drug Market for Hospital
We have written previously about the shortage of lifesaving drugs in the United States. This crucial topic is addressed in a recent New York Times editorial by Margaret Clapp, former chief pharmacy officer at Massachusetts General Hospital, Michael A. Rie, associate professor of anesthesiology at the University of Kentucky College of Medicine and co-chairman of Physicians Against Drug Shortages, and Phillip L. Zweig, executive director of Physicians Against Drug Shortages. They note 302 drugs were in short supply as of July 31, up from 211 a year earlier.
The editorial asks: "Policy makers apparently failed to ask th...
Source: Policy and Medicine - September 11, 2013 Category: Health Medicine and Bioethics Commentators Authors: Thomas Sullivan Source Type: blogs
Transcranial Magnetic Stimulation for Assessment of Consciousness in Brain Injury Patients
Assessing the level of consciousness in severely injured patients is a difficult task both technically and emotionally. A person might be locked-in and incapable of communicating in any way while the brain is aware of what’s going on around. A team of researchers in Europe have developed a promising way of using transcranial magnetic stimulation (TMS) to assess consciousness and tested it on healthy subjects as well as those that emerged from vegetative state, minimally conscious state, and locked-in syndrome.
The system calculates a perturbational complexity index (PCI) by directing a magnetic field at the cortex to...
Source: Medgadget - August 16, 2013 Category: Technology Consultants Authors: Editors Tags: Critical Care Neurology Source Type: blogs
SEDASYS Propofol Sedation System Gets FDA Nod
Ethicon Endo-Surgery, a Johnson & Johnson company, announced that the FDA granted PMA approval for its SEDASYS device, the first computer-assisted personalized sedation (CAPS) system for use by clinicians in the endoscopy suites.In other words, the system aims to replace anesthesiologists and CRNAs with computerized technology to administer propofol and to monitor minimal-to-moderate sedation in patients undergoing upper and lower endoscopies. According to the company, only ASA class I and II patients are eligible to receive propofol via SEDASYS.Read More (Source: Medgadget)
Source: Medgadget - May 10, 2013 Category: Technology Consultants Authors: Editors Tags: Anesthesiology GI Source Type: blogs
UnitedHealth CEO Continues to Prosper While His Company's Behavior Appears to Contradict its Mission Statement
Tis spring, the season in the US for legal settlements, government findings, and proxy statements revealing executive compensation. Therefore, maybe there should be no surprise that we are seeing a series of cases in which health care corporate leaders continue to enrich themselves while their organizations' behavior raises ethical questions.Following on the Amgen example, we now present the latest UnitedHealth example (in a post organized similarly.)The CEO Gets RicherLast week, the Associated Press (via the Washington Post) summarized UnitedHealth CEO Stephen J Hemsley's growing pile of money:UnitedHealth Grou...
Source: Health Care Renewal - May 3, 2013 Category: Health Medicine and Bioethics Commentators Tags: UnitedHealth quality executive compensation managed care organizations mission-hostile management legal settlements Source Type: blogs
Feeding tubes and weird ideas
My favorie BADD post: Tube-ageddon.
I haven't had much time to write anything here about the hell I went through getting my GJ tube. I had every indication for a GJ tube. I had gastroparesis so bad it was starting to affect my breathing, in a way that doctors said was likely to result in infection after infection until I died. From the emergency room onward, doctors were saying my best hope was to get a feeding tube.
Yet the pressure I got from doctors, while in the hospital for one of those infections, was to just keep getting infections, go home, wait to die. Most of them wouldn't say that outright. But so...
Source: Ballastexistenz - May 2, 2013 Category: Autism Authors: Amanda Tags: Abuse Autism Bullying Cognitive disability Degradation Developmental disability Disability Rights Discrimination Ethics Ethics, justice, etc. Food Hatred Medical Medical stuff Outside Perceptions Physical disability Power Source Type: blogs
