A game of broken telephone in the hospital
Sometimes an interesting thing happens on patient rounds. Rounds are a traditional exercise in hospitals going back at least a century. In the old days, this meant the physician going from patient to patient. He (it was nearly always he back then) went over the patient’s progress with the bedside nurse, examined the patient, reviewed pertinent test results, made an assessment, decided on a plan for the day, and gave orders to implement the plan. He also explained things to the patient. That traditional system worked fine when there was only one physician running things. These days there are many caregivers involved, and...
Source: Kevin, M.D. - Medical Weblog - October 30, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/christopher-johnson" rel="tag" > Christopher Johnson, MD < /a > Tags: Physician Hospital Source Type: blogs
The Future of Work Part I
Have you ever taken some time to think about what work will look like 5, 10 or even 20 years from now? If you haven’t, it is probably worth the effort because a changing work environment may have dramatic implications for how you are employed in the future. In these two posts, I want to talk about some of the trends I’m seeing and how they may play out in the coming years.
Outsourcing
Companies are getting better and better at spinning off specific business functions and letting them be handled by others. For example, many businesses can’t justify running payroll in-house. It is cheaper to hire a company...
Source: Productivity501 - September 20, 2016 Category: Psychiatry & Psychology Authors: Mark Shead Tags: Misc Source Type: blogs
Dyspnea and Convex ST elevation, Marked LVH, with Bedside Echos
Case 1.Chief complaint: A 60-something African American male with 5 days of increasing SOB with dyspnea on exertion.This male in his 60's has a PMH of CAD with MI and CABG, HTN with LVH, hyperlipidemia, and mild HF with only moderately reduced ejection fraction (and some diastolic dysfunction as well).He presents with 5 days of worsening shortness of breath with orthopnea as well as chest pain. His BP is 191/90. He also has a history of venous thromboembolism and has not been taking his anticoagulants. He was also off of his BP meds (lisinopril, amlodipine and carvedilol).Here is his ED ECG (ECG #1):...
Source: Dr. Smith's ECG Blog - July 13, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
The importance of listening to the patient before we develop our plans
Around 30 years ago, LRZ taught me a most important lesson. LRZ, one of my most fondly remembered patients, was a classic blue collar guy. He had a wonderful, gregarious personality. He had significant systolic dysfunction, yet still worked hard for the city. Amongst other things he did, he shoveled the salt into trucks on snow and ice days. He functioned well most days.
One day he came to see me. In those days, prior to ACE inhibitors or the use of beta blockers, we focused on digoxin and diuretics. As I picked up his chart I noted that he had gained 3 pounds. From past experience, I knew that he would soo...
Source: Kevin, M.D. - Medical Weblog - July 13, 2016 Category: Journals (General) Authors: Robert Centor, MD Tags: Conditions Nephrology Source Type: blogs
Funtabulously Frivolous Friday Five 151
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 151
Question 1
Your house surgeon, having just reversed a patient on unfractionated heparin with haematemasis is agitated because the patient has “sulphur drugs – anaphylaxis” as an allergy alert and you’ve just given them protamine sulphate! Is it time to grab the adrenaline? Is this allergy relevent for protamine sulphate? What about furosemide – which is derived from the sulf...
Source: Life in the Fast Lane - June 24, 2016 Category: Emergency Medicine Authors: Niall Hamilton Tags: Frivolous Friday Five apocrine chromohidrosis eccrine chromohidrosis optic neuritis pseudochromhidrosis Sulphur allergy tattoo associated uveitis tomomania Source Type: blogs
Listening to our patients
Around 30 years ago, LRZ taught me a most important lesson. LRZ, one of my most fondly remembered patients, was a classic blue collar guy. He had a wonderful gregarious personality. He had significant systolic dysfunction, yet still worked hard for the city. Amongst other things he did, he shoveled the salt into trucks on snow and ice days. He functioned well most days.
One day he came to see me. In those days, prior to ACE inhibitors or the use of beta blockers, we focused on digoxin and diuretics. As I picked up his chart I noted that he had gained 3 pounds. From past experience, I knew that he would soon...
Source: DB's Medical Rants - June 21, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
STEMI with Life-Threatening Hypokalemia and Incessant Torsades de Pointes
Conclusions: In the select group of hypokalemic patients studied, potassium infusions of 20 to 40 mmol delivered over 1 hr were safe to administer and effectively increased serum potassium levels in a dosedependent and predictable fashion. Furthermore, these results were independent of the patient's underlying renal function or associated diuretic administration. (Crit Care Med 1991; 19:694)Concentrated Potassium Chloride Infusions in Critically Ill Patients with HypokalemiaThe Journal of Clinical Pharmacology. Volume 34, Issue 11, pages 1077–1082, November 1994Although concentrated infusions of pota...
Source: Dr. Smith's ECG Blog - April 7, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
Multitasking and not taking time to think
How could a blog post titled Learn how to think avoid my praise? This post made the Farnam Street Blog top 10 for 2015. The post refers to a wonderful essay – Solitude and Leadership By William Deresiewicz. On first reading (and this essay deserves several reads) two concepts resonated strongly.
Multitasking, in short, is not only not thinking, it impairs your ability to think. Thinking means concentrating on one thing long enough to develop an idea about it.
We know that multitasking does not really work. This concept has great importance in medicine. We have added so many tasks to the patient interacti...
Source: DB's Medical Rants - December 31, 2015 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Pulmonary edema after device closure of ASD
Brief Review
Device closure of atrial septal defect (ASD) is almost replacing surgical ASD closure in all cases with suitable morphology. Percutaneous ASD closure is usually well tolerated. One of the rarest complications in literature following device closure of atrial septal defect is the occurrence of pulmonary edema after ASD device closure. Acute pulmonary edema is well reported after surgical closure of ASD, especially in the elderly, when a sudden increase in the preload to a poorly compliant and small left ventricle leads to diastolic heart failure.
One of the earliest reports of left heart failure after device cl...
Source: Cardiophile MD - December 4, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Structural Heart Disease Interventions left ventricular conditioning for ASD device closure pulmonary edema after ASD closure pulmonary edema after closure of atrial septal defect Source Type: blogs
LITFL Review 175
Welcome to the 175th 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 If you are trained in transcutaneously pacing then you absolutely must read part 1 and part 2 of Transcutaneous Pacing Success, over at the EMS 12-Lead Blog. [MG] The Best of #FOAMed Emergency MedicineEM Didactic offers a great primer to the c...
Source: Life in the Fast Lane - March 29, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs
Why do we still use oral furosemide?
Most physicians do not understand pharmacology and pharmacokinetics. We use Lasix (furosemide) because we have always used furosemide. As an academic hospitalist, we often have patients admitted with heart failure (either right sided or left sided) who have gained significant fluid weight despite taking significant oral doses of furosemide. When they get admitted we start with IV furosemide and amazingly they pee like racehorses.
How many of us remember that oral furosemide is variably absorbed, with a general range of 20%-80%? You may not remember that, or you might just be in the habit of using Lasix. Lasix has a gr...
Source: DB's Medical Rants - March 11, 2015 Category: Internal Medicine Authors: rcentor Tags: Attending Rounds Source Type: blogs
National Drug Facts Week with Pharmacy Professor Mary Lynn McPherson!
by Mary Lynn McPherson, PharmD, MA, BCPSThis week is National Drug Facts Week! Why do we tell patients to take furosemide on an empty stomach? Ok, it’s not quite “why did the chicken cross the road” but it’s still an important drug fact! The answer is that taking furosemide on an empty stomach doubles the bioavailability and clinical response! If you want to learn about additional awesome drug facts – tune in this Wednesday evening, January 28, 2015 at 6 pm PST/9 pm EST for the #hpm tweet chat! We’ll also be talking about the utility/futility of medications as patients approach the end of life. What s...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 28, 2015 Category: Palliative Carer Workers Tags: mcpherson opioids pharmacy Source Type: blogs
MKSAP: 59-year-old woman with pain of the right foot
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 59-year-old woman is evaluated for a 1-week history of increasing pain of the right foot. She recalls stepping on a nail about 1 month before her symptoms began. The patient has a 5-year history of heart failure secondary to idiopathic dilated cardiomyopathy. She has an implantable cardioverter-defibrillator, and her current medications are carvedilol, lisinopril, furosemide, and spironolactone.
On physical examination, vital signs are normal. Examination of the foot reveals tenderness and warmth directly belo...
Source: Kevin, M.D. - Medical Weblog - October 4, 2014 Category: Journals (General) Authors: mksap Tags: Conditions Infectious disease Radiology Source Type: blogs
Pacemaker Panic #2
ECG Exigency 016
A 68-year old woman presents by ambulance to the Emergency Department. Per the ambulance crew, she was brought from home after experiencing 7 out of 10 chest discomfort and weakness. She has a history of hypertension that is well controlled with furosemide, and has a pacemaker because her “heart used to go funny.” The ambulance crew are basic life support only, so the patient has received 324mg of aspirin, and oxygen by nasal cannula. Upon arrival she is seated upright on the stretcher breathing rapidly, with the following vitals: heart rate 107, blood pressure 180/110, respirations 20 and slightly lab...
Source: Life in the Fast Lane - September 19, 2014 Category: Emergency Medicine Authors: Mat Goebel Tags: Cardiology Clinical Case ECG Education Emergency Medicine EKG failure hyperkalaemia hyperkalemia pacemaker pacer pacing ppm Source Type: blogs
Research and Reviews in the Fastlane 047
In this study, the research team collected pooled urine (read many people used the urinal they collected from) from a popular nightclub area in London and analyzed the specimens for the presence of illicit drug compounds. The goal was to determine whether this method could be used to track patterns and monitor trends in recreational drug use.
Recommended by: Anand Swaminathan
Emergency Medicine, Critical Care, Anaesthetics
Hindman BJ et al. Intubation Biomechanics: Laryngoscope Force and Cervical Spine Motion during Intubation with Macintosh and Airtraq Laryngoscopes. Anesthesiology. 2014; 121(2):260-71. PMID...
Source: Life in the Fast Lane - September 9, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Clinical Research Education Emergency Medicine R&R in the FASTLANE critical care Intensive Care literature recommendations Research and Review Source Type: blogs
