Research and Reviews in the Fastlane 034
This study was hoping to show that NAC will keep all those contrast CTs from giving our patients contrast induced nephropathy (CIN). It did not. It looks like the real answer is fluids (and that maybe we are not killing off so many kidneys anyway).
Recommended by: Zack Repanshek
Pediatrics
9. Wang J, Xu E, Xiao Y. Isotonic versus hypotonic maintenance IV fluids in hospitalized children: a meta-analysis. Pediatrics. 2014 Jan;133(1):105-13 PubMed PMID: 24379232
Meta-analysis of 10 RCTs looking at maintenance IV fluids in hospitalized pediatric patients. The study found a RR = 2.24 for hyponatremia in comparing hypo...
Source: Life in the Fast Lane - June 12, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Anaesthetics Cardiology Emergency Medicine Featured Health Intensive Care Pediatrics Pre-hospital / Retrieval Renal Resuscitation Trauma critical care literature R&R in the FASTLANE recommendations research and reviews Source Type: blogs
Michael Kirsch, MD Redux
For the past 30 minutes, my cell phone has buzzed repeatedly, urging me not to climb out of this rabbit hole. “Come back,” it beckons, “we’re not finished yet.”
When KevinMD deleted my first comment about Dr. Kirsch, I decided to keep further comments on my own blogs so they don’t mysteriously disappear again. Now I’ve learned that I’ve been demoted: Instead of my comments on KevinMD posting immediately, I must receive prior approval before my comments can be viewed by anyone else on Kevin’s blog. All because I pull aside the curtain so people could see the real “insider.”
Next will be th...
Source: WhiteCoat's Call Room - June 9, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Random Thoughts Source Type: blogs
Michael Kirsch, MD – An Emergency Physician Basher Without A Clue
The nice thing about the internet, about having a blog, and about having a Twitter account is that even us peons have the ability to combat censorship.
Here’s a good example.
Self-described “insider” and “whistleblower” Michael Kirsch, MD, who blogs at “MD Whistleblower,” has a penchant for bashing emergency physicians even though his commentary shows that his “inside knowledge” is full of misinformation. You can be the judge of Dr. Kirsch’s veracity, but my opinion is that he is unethically spewing his inside misinformation as fact.
So I called him out on it.
Kev...
Source: WhiteCoat's Call Room - June 7, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Medical Topics Source Type: blogs
Esophageal cancer: How far should we screen?
The incidence of esophageal adenocarcinoma has increased more than five-fold over the past four decades in the U.S. While the rate of rise in incidence of esophageal cancer has slowed somewhat in recent years, this malignancy is still associated with a dismal prognosis. Barrett’s esophagus, the precursor lesion to esophageal cancer, is easily identifiable on routine upper endoscopy and can be monitored for the development of precancerous changes. We generally assume that by performing endoscopic surveillance in our Barrett’s patients, we can detect high-grade dysplasia and esophageal cancer at early stages when it is s...
Source: Kevin, M.D. - Medical Weblog - June 1, 2014 Category: Journals (General) Authors: Julian A. Abrams, MD Tags: Conditions Cancer GI Source Type: blogs
The Magnesium Wars
When you get dxd with diabetes,food goes from being food to being a collection of carbohydrates,proteins,and fats.(the same, I imagine,with any GI related illness) When you have problems with maintaining electrolytes food turns into a collection of potassium,magnesium,etc.The above photo shows four types of magnesium supplement..as with insulins,not all supplements are created equal. Magonate is the rapid-acting,chug it down and in 2-3 hours your acute symptoms with subside,stuff. Slow Mag is the gentler on the stomach stuff(kind of like UltraLente-longgggg curve of action) and Milk of Magnesia is just there to get things ...
Source: The D-Log Cabin - May 21, 2014 Category: Diabetes Authors: HVS Source Type: blogs
Cockroach in the Ear
I took a surprisingly enjoyable course in medical entomology as an undergrad at Ohio State University. Admittedly, decades later, the only things I remember from that course are that only four of the 4500 species of cockroaches are classified as pests: the German, Asian, American, and Oriental cockroaches.
The majority of cockroach species live in their natural habitats in woods, tropical forests, or deserts, but these four have taken up residence with humans and have become serious pests. They may have distinctly cosmopolitan names, but it is believed that they all started in Africa. Their mouths can chomp through ca...
Source: M2E Too! Mellick's Multimedia EduBlog - April 2, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Cockroach in the Ear
I took a surprisingly enjoyable course in medical entomology as an undergrad at Ohio State University. Admittedly, decades later, the only things I remember from that course are that only four of the 4500 species of cockroaches are classified as pests: the German, Asian, American, and Oriental cockroaches.
The majority of cockroach species live in their natural habitats in woods, tropical forests, or deserts, but these four have taken up residence with humans and have become serious pests. They may have distinctly cosmopolitan names, but it is believed that they all started in Africa. Their mouths can chomp through card...
Source: M2E Too! Mellick's Multimedia EduBlog - April 2, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Telelap ALF-X Endoscopic Robotic Surgical System
Intuitive Surgical is the dominant player in robotic surgery, having developed the now famous da Vinci System that turned traditional endoscopy into a futuristic endeavor. Now we learn of a system being developed by SOFAR, an Italian pharmaceutical firm, that looks set to compete with the da Vinci.
The Telelap ALF-X features haptic feedback, allowing the surgeon to indirectly “feel” the tissues that are being manipulated. This can lead to improved safety and allow certain maneuvers to be performed with greater confidence. The system also tracks the surgeon’s eye movements, positioning the camera so the f...
Source: Medgadget - March 21, 2014 Category: Technology Consultants Authors: Editors Tags: ENT Ob/Gyn Surgery Thoracic Surgery Urology Vascular Surgery Source Type: blogs
Medrobotics’ New Flex System for Snake-Like Surgical Endoscopy Cleared in Europe
Surgical endoscopy has been hailed as the route to an end to open surgical procedures, but many relatively simple operations still have to be done with a scalpel. Enter the Flex System from Medrobotics (Raynham, Massachusetts), the first surgical endoscopy device with snake-like abilities that allow it to reach places that straight instruments simply can’t.
The technology behind the Flex was originally developed at the Carnegie Mellon Robotics Lab and developed further by Farm, a medical device product development firm. It involves flexible concentric components that can be made to be stiff or go limp as necessary,...
Source: Medgadget - March 20, 2014 Category: Technology Consultants Authors: Editors Tags: Cardiac Surgery Ob/Gyn Thoracic Surgery Urology Vascular Surgery Source Type: blogs
Fuse Wide Angle Endoscope Detects Significantly More Polyps Than Standard Colonoscopy
Last May EndoChoice (Alpharetta, GA) received FDA clearance for its novel Fuse endoscopy system that provides a 330° field of view compared to traditional scopes that do up to 170°. A new study just published in The Lancet has confirmed a significant advantage to having such a wide field of view when detecting adenomas during colonoscopies.
The Fuse has multiple cameras and LED lights illuminate the scene, providing an integrated view on tablet-like touchscreen panel. In the study 88 patients had adenomas detected using traditional colonoscopy, but there was a 41% miss rate of further adenomas that were detected only us...
Source: Medgadget - March 19, 2014 Category: Technology Consultants Authors: Editors Tags: GI Source Type: blogs
Residual fear after a cancer diagnosis
I went to see my oncologist for my six-month checkup yesterday. All was routine, other than my blood pressure being 131 over something when it’s usually in the 115 range, even when I see my family doctor. No anxiety there.
When he asked what had changed in the last six months, I told him about the endoscopy I had in December, which turned out to be normal. But what prompted it is something anyone who’s had cancer faces whether you want to admit it or not (and I usually don’t) — fear. I was having stomach discomfort that went beyond what over-the-counter drugs could handle. I finally got worried eno...
Source: Kevin, M.D. - Medical Weblog - March 14, 2014 Category: Family Physicians Tags: Patient Cancer Source Type: blogs
The “Olden Days” and the (o)esophagus
aka American ER Doc Gone Walkabout… 027
I got another “Pathway” to be used in our ED today – for the management of esophageal obstruction. It ought to be pretty useful, as it defines what the various departmental roles and responsibilities are if medical management fails – i.e. who manages sedation while GI disimpacts via endoscope and what happens next if endoscopy under procedural sedation only fails.
But, I was surprised that the only recommended medical management was IV glucagon. I gave up on that decades ago – it’s never worked for me (except when the patient vomits from the glucagon, and b...
Source: Life in the Fast Lane - March 6, 2014 Category: Emergency Medicine Doctors Authors: Rick Abbott Tags: American ER Doc Gone Walkabout Emergency Medicine ENT and Maxillofacial Featured Gastroenterology esophageal obstruction flood bolus oesophagus rick abbott Source Type: blogs
J.
The path that brought J to a gluten-free, LCHF diet is interesting to learn about. The fact that he is a fellow medical practitioner makes it even more so. – Dr. Perlmutter.
I am a physician who has had intermittent diarrhea my entire life as did most of the members of my family. I simply lived with it. However, in my mid-forties, I started developing other symptoms, including inflammatory arthritis of my PIP joints of the hand (negative rheumatologic workup), odd fatigue, and three year’s worth of microscopic hematuria (negative urological workup). I was serum negative for the standard gluten markers and endoscop...
Source: Renegade Neurologist - A Blog by David Perlmutter, MD, FACN - February 28, 2014 Category: Neurologists Authors: gbadmin Tags: Success blood diabetes diarrhea Fatigue gluten free joint pain LCHF physician Taubes urine Source Type: blogs
HIMSS, Continua launch Personal Connected Health Alliance
ORLANDO, Fla.—As HIMSS President and CEO hinted at yesterday in his podcast with me, HIMSS today announced the formation of the Personal Connected Health Alliance, in conjunction with the Continua Health Alliance and the HIMSS-owned mHealth Summit.
This short video from HIMSS explains:
Also, Lieber mentioned that HIMSS has not signed on to a letter from 48 organizations—led by CHIME—to HHS Secretary Kathleen Sebelius, calling for more time and flexibility in meeting Meaningful Use Stage 2 requirements., Lieber said HIMSS declined to sign because the requests were, in his opinion, “very vague.”
Today, the...
Source: Neil Versel's Healthcare IT Blog - February 24, 2014 Category: Technology Consultants Authors: Neil Versel Tags: CIOs CMS consumerism EMR/EHR health IT health reform Healthcare IT HHS HIMSS Innovation meaningful use mobile ONC regulations remote monitoring video CHIME Continua Health Alliance Kathleen Sebelius mHealth Summit P Source Type: blogs
Should you eat kamut?
In conclusion, significant improvements in both IBS symptoms and the inflammatory profile were reported after the ingestion of ancient wheat products.
It’s a modest experience, but a persuasive one. IBS has become nearly synonymous with “non-celiac gluten intolerance” (NCGI), i.e., celiac disease-like symptoms but without the accompanying small intestinal destructive changes. (In a recent consensus document, for instance, it was suggested that IBS and NCGI were one and the same.) But, as the assessment of inflammatory markers in this study and others suggest, it does not mean that IBS/NCGI are benign nor ...
Source: Wheat Belly Blog - February 19, 2014 Category: Cardiology Authors: Dr. Davis Tags: Ancient forms Source Type: blogs
