Plus-Minus: Finding the Unmeasured All-Stars in Medicine
We’ve seen sports teams full of All-Stars who don’t win games. These teams have the highest scorers in the league, and the best defensive players. And yet they lose, repeatedly. We have the same thing in medicine.
Who is the best physician?
The answer: You cannot tell from this data which physician is the best.
Look at any physician scorecard and you may think you can quantify contribution and effectiveness succinctly. In fact, you may choose your next physician or manage your next colleague from similar data. However, the data is incomplete and neglects to understand the impact of each physician individually ...
Source: richard[WINTERS]md - July 24, 2016 Category: Universities & Medical Training Authors: Richard Winters MD Tags: Uncategorized Source Type: blogs
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?
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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
JellyBean 042 Liam Yore and MovinMeat
It is official; Donald Trump is the Republican Candidate for the Presidency on the United States of America. What does that mean? What does that mean for Healthcare in the USA? (Or world peace?) I don’t know so I asked someone who might. It’s Liam Yore. a.k.a. @MovinMeat
Liam Yore is a man that has stuff to say. He has been saying stuff for years on All bleeding stops and he is still saying stuff.
“So Liam; healthcare in the USA whats up with that?”
Dr Yore says; “It feels irredeemably broken.”
Turns out there is stuff to be said. Liam has managed to marry his interest in progressive politics with his full...
Source: Life in the Fast Lane - July 21, 2016 Category: Emergency Medicine Authors: Doug Lynch Tags: JellyBean Liam Yore movinmeat Source Type: blogs
Research and Reviews in the Fastlane 143
Welcome to the 143rd 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, 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 ...
Source: Life in the Fast Lane - July 21, 2016 Category: Emergency Medicine Authors: Jeremy Fried Tags: Clinical Research Education Emergency Medicine Neurology R&R in the FASTLANE Trauma EBM literature recommendations research and reviews Source Type: blogs
Critical Care Collaborative Conference, Melbourne 2016
The Critical Care Collaborative: Transitions of Change is an exciting interprofessional continuing education symposium, now in its second year. A joint ACCCN/ANZICS event, it will be held at Rydges Carlton in Melbourne on Friday 26th August 2016.
With a stellar, multi-disciplinary and diverse line-up of speakers, it promises to bring the latest research and best practice for all critical care clinicians through high-quality presentations and interactive sessions. Aimed at promoting our local ICU talent and fostering collegiality, there will be plenty of time for networking – post-conference drinks are even included!
...
Source: Life in the Fast Lane - July 20, 2016 Category: Emergency Medicine Authors: Sarah Yong Tags: Conference critical care collaborative Source Type: blogs
LITFL Review 240
Welcome to the 240th 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
TheResusRoom site just launched with great new podcasts on sepsis, CXR in trauma, PCI following ROSC and many more. For those more textually inclined there are paper summaries and guidelines to whet your appetite. [CC]
Iain Beardsell’s “Throm...
Source: Life in the Fast Lane - July 17, 2016 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs
Food allergy amplification all the RAGE
We recently wrote about the amplification of food anaphylaxis in Australia, where the rate of fatalities has increased 3-fold in the last 15 years. Smith and colleagues (Gold Coast, Australia and New York) have just published a paper reviewing the epidemiology, in-vitro and in-vivo studies and hypothesize a “false alarmin” method via which food allergies may develop in susceptible individuals 1. Current food allergy hypotheses (hygiene, microbiome, vitamin D, timing of introduction of solids) do not adequately or totally explain the rise of food allergies and the subsequent allergic march.
Alarmins are compou...
Source: Life in the Fast Lane - July 16, 2016 Category: Emergency Medicine Authors: Mike Cadogan Tags: Immunology Advanced Glycation End Product AGE Alarmin allergy Anaphylaxis false alarmin RAGE receptor Source Type: blogs
JellyBean 041 Tracheostomy Nightmare and Latent Risk
Tracheostomy; Friend or Foe? Properly Interesting or Deathly Dull? Have you been bored to death or worse by one of these things?
It’s been a little while since I spoke to Jon Gatward: Intensivist, Simulationalist, Fashion Guru and Lycraffecionado.
He has a scary story to share. (It is not about the lycra.) You will discover why he has become synonymous with Risk, Planning for Disaster and indeed Guerrilla Simulation. This Jellybean was put on hold to await the Intensive Care Network (ICN) Podcast of the talk Jon gave at a previous Bedside Critical Care.
Unfortunately the folks at ICN have got a giant depository of great...
Source: Life in the Fast Lane - July 16, 2016 Category: Emergency Medicine Authors: Doug Lynch Tags: JellyBean jon gatward Tracheostomy Source Type: blogs
Funtabulously Frivolous Friday Five 154
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 154
Question 1
What is the Somogyi effect?
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Hyperglycaemia after prolonged hypoglycaemia.
The effect is counter-intuitive to insulin users who experience high blood sugars in the morning as a result of too much insulin during the night. [Reference]
https://en.wikipedia.org/wiki/Chronic...
Source: Life in the Fast Lane - July 15, 2016 Category: Emergency Medicine Authors: Neil Long Tags: Frivolous Friday Five Boerhaave's Cower diabetes FFFF gout Mackler's triad Nun urine Pergonal Somogyi Somogyi effect William the Conqueror Source Type: blogs
Research and Reviews in the Fastlane 142
This study demonstrated that very early administration (pre-hospital) did not change outcomes in terms of infarct size. There was also no reduction in ventricular dysrhythmias. Once again we see that earlier is not always better.
Recommended by Anand Swaminathan
The R&R iconoclastic sneak peek icon key
The list of contributors
The R&R ARCHIVE
R&R Hall of famer You simply MUST READ this!
R&R Hot stuff! Everyone’s going to be talking about this
R&R Landmark paper A paper that made a difference
R&R Game Changer? Might change your clinical practice
R&R Eureka! Revolut...
Source: Life in the Fast Lane - July 13, 2016 Category: Emergency Medicine Authors: Jeremy Fried Tags: Cardiology Clinical Research Education Emergency Medicine Pediatrics R&R in the FASTLANE critical care EBM literature recommendations research and reviews Source Type: blogs
LITFL Review 239
Welcome to the 239th 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 weaves an elegant web around the NINDS Trial, not debating the therapy, but explaining Fragility Index and introducing the Instability Index. This is truly critical appraisal 2.0. [JS, AS, SO]
The Best of #FOAMed Emergency Medicine
...
Source: Life in the Fast Lane - July 10, 2016 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Education LITFL review Source Type: blogs
Funtabulously Frivolous Friday Five 153
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 153
Question 1
What part of your body could be considered callipygian?
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Your buttocks
The Callipygian Venus, literally meaning “Venus (or Aphrodite) of the beautiful buttocks is a roman statue, housed in Naples. [Reference]
Question 2
Why do you hands and feet wrinkle in ...
Source: Life in the Fast Lane - July 8, 2016 Category: Emergency Medicine Authors: Neil Long Tags: Frivolous Friday Five callipygian cardiac tamponade electrical alternans Q-fever Stethoscope total alternans Source Type: blogs
Research and Reviews in the Fastlane 141
This study showed that while it’s feasible to acutely lower systolic blood pressure < 140 mm Hg, there’s no benefit to death or disability. Additionally, patients in the aggressive blood pressure treatment arm were more likely to have adverse renal events at 7 days. These results mirror those seen in the INTERACT-2 trial (prior to the statistical shenanigans used to spin the results positively). Based on the best available evidence, we can confidently say that it should not be standard care to aggressively drop blood pressure in these patients.
Recommended by Anand Swaminathan
Further reading The case of ...
Source: Life in the Fast Lane - July 7, 2016 Category: Emergency Medicine Authors: Jeremy Fried Tags: Airway Clinical Research Emergency Medicine Neurology Neurosurgery Pediatrics R&R in the FASTLANE Resuscitation critical care EBM Education literature recommendations research and reviews Source Type: blogs
JellyBean 040 with a man called Rusty
Sometimes Jellybeans are very bloody serious. I am a big supporter of paramedics. BIG. They do a difficult job in an unpredictable environment. Bad things can happen. Bad things do happen. Let me introduce Rusty; a brave paramedic that has something important to say. It is relevant to us all.
Expect the unexpected in this Brave Jellybean recorded at SMACC in Dublin. There are so many different types of bravery. Big and obvious or small and subtle. Different flavours. Different arenas.
This is one for the Paramedics, the EMS Providers and everyone else in critical care too.
Rusty and I talk about that curious and sometimes...
Source: Life in the Fast Lane - July 6, 2016 Category: Emergency Medicine Authors: Doug Lynch Tags: JellyBean Kate Granger Paramedic PTSD Rusty Source Type: blogs
Beta-Blockers for Cocaine and other Stimulant Toxicity
Dogma: “a belief or set of beliefs that is accepted by the members of a group without being questioned or doubted; a point of view or tenet put forth as authoritative without adequate grounds.”
Years ago I treated a university student who presented to the emergency department (ED) after drinking several cans of a popular caffeinated energy drink to “pull an all-nighter” during final exam week. He was tremulous, agitated, and pale, with sinus tachycardia ranging from 140 to 160 bpm and normal blood pressure (BP). The house officer (registrar) working with me that night proposed treating him with a benzodiazepine, bu...
Source: Life in the Fast Lane - July 4, 2016 Category: Emergency Medicine Authors: John Richards Tags: Toxicology and Toxinology alpha stimulation amphetamines Beta Blockers cocaine dogma John Richards Stimulant Toxicity Stimulants Source Type: blogs
