A History of General Refrigeration
Ancient societies figured out that hypothermia was useful for hemorrhage control, but it was Hippocrates who realized that body heat could be a diagnostic tool. He caked his patients in mud, deducing that warmer areas dried first.
Typhoid fever, the plague of Athens in 400 BC and the demise of the Jamestown Colony in the early 1600s, led Robert Boyle to attempt to cure it around 1650 by dunking patients in ice-cold brine. This is likely the first application of therapeutic hypothermia, but it failed to lower the 30 to 40 percent mortality rate. One hundred years later, James Currie tried to treat fevers by applying hot,...
Source: Spontaneous Circulation - March 31, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Theorizing that the Brain is Destroyed by the Pulse
It is uncontroversial that the age-related deterioration of the vascular system leads to damage to the brain, causing cognitive decline and then dementia. Progressive stiffening due to cross-links and calcification and inflammation-driven remodeling of blood vessel walls reduces structural integrity at the same time as it causes hypertension, raised blood pressure that puts more stress on those same blood vessel walls. This paper presents a novel way of looking at this contribution to the aging process:
The brain and its blood vessels are very different tissues. The nerve and glial cells of the brain (its processing machi...
Source: Fight Aging! - March 23, 2015 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
Research and Reviews in the Fastlane 067
This study looks into the question and finds that medical students randomized to having their simulated patient die report increased cognitive load and had poorer learning outcomes. The authors caution that this doesn’t mean we shouldn’t have simulated patients die but that we need to plan for this outcome intelligently.Recommended by: Anand SwaminathanPediatricsMaffei FA et al. Duration of mechanical ventilation in life-threatening pediatric asthma: description of an acute asphyxial subgroup. Pediatrics 2004; 114(3):762-7. PMID: 15342851Interestingly, while we often preach to not intubate the asthmatic…...
Source: Life in the Fast Lane - January 21, 2015 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Anaesthetics Cardiology Education Emergency Medicine Intensive Care Pediatrics R&R in the FASTLANE Resuscitation critical care examination recommendations Review Source Type: blogs
Research and Reviews in the Fastlane 064
This study showed a poor specificity (48%) for two tools in identifying stroke patients in the field speaking to the need for better tools and/or better training. A low specificity means lots of patients without disease may be treated.Recommended by: Anand SwaminathanEmergency Medicine, Neurology Hamaekers AE, Henderson JJ. Equipment and strategies for emergency tracheal access in the adult patient. Anaesthesia. 2011 Dec;66 Suppl 2:65-80. PMID: 22074081How to access the cricothyroid membrane….or not! – a great review of the literature for different ways of gaining emergency airway access via the cricothyroid...
Source: Life in the Fast Lane - December 31, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Cardiology Education Emergency Medicine Gastroenterology Intensive Care Neurology Ophthalmology Pediatrics Pre-hospital / Retrieval Resuscitation critical care Press Ganey R&R in the FASTLANE recommendations Review Source Type: blogs
Factor Xa inhibitors
This study involving about seven thousand four hundred patients, was terminated prematurely due to higher bleeding risks at a dose of 5 mg twice daily and there was no siginificant reduction of ischemic events. It may be noted that the drug was added over and above standard antiplatelet therapy in the setting of acute coronary syndrome.
AVERROES (Apixaban Versus Acetylsalicylic Acid [ASA] to Prevent Stroke in Atrial Fibrillation Patients Who Have Failed or Are Unsuitable for Vitamin K Antagonist Treatment) study on the other hand compared the use of same dose of apixaban with varying doses of aspirin (81 to 325 mg).5 In th...
Source: Cardiophile MD - December 21, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs
Research and Reviews in the Fastlane 062
This study is a meta-analysis looking at whether tamsulosin increases the rate of spontaneous stone passage in patients with renal colic. The authors report a benefit to the drug with a RR for passage of 1.50. However, this meta-analysis is significantly flawed as the studies entered into it had significant bias mainly due to issues with randomization as well as a high level of heterogeneity. This meta-analysis typifies the issue of garbage in equals garbage out and does not change the fact that tamsulosin has little good evidence to defend its use in these patients.Recommended by: Anand SwaminathanEmergency Medicine, Res...
Source: Life in the Fast Lane - December 17, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Education critical care emergency Emergency Medicine Intensive Care Press Ganey R&R in the FASTLANE recommendations Review Source Type: blogs
EHRs and Ebola in the Texas Health Presbyterian Hospital ED: the ED physician finally speaks out
At my Oct. 2, 2014 post "Did Electronic Medical Record-mediated problems contribute to or cause the current Dallas Ebola scare?" (http://hcrenewal.blogspot.com/2014/10/did-electronic-medical-record-mediated.html) I had written:While I have no evidence as to any role of EHRs in this seemingly strange, cavalier and incomprehensible medical decision to send this man home, resulting in potential exposure of numerous other individuals to Ebola (and I am certainly not in a position to have such evidence), I believe this possibility [that is, an EHR-related information snafu - ed.] needs to be investigated fully. I then ...
Source: Health Care Renewal - December 15, 2014 Category: Health Management Tags: AHRQ Ebola virus EPIC healthcare IT risk Joseph Howard Meier Silverstein EHR principle Texas Health Presbyterian Hospital Source Type: blogs
Vorapaxar: thrombin receptor antagonist for prevention of stent thrombosis
Vorapaxar is a new thrombin receptor antagonist which has been shown to reduce cardiovascular deaths and recurrent thrombotic events in patients with stable atherosclerotic vascular disease. This effect has been documented when added to standard anti platelet therapy.
Vorapaxar is an orally active protease-activated-receptor-1 (PAR-1) antagonist capable of inhibiting thrombin induced platelet activation. Thrombin activates platelets through PAR-1 and PAR-4. PAR-1 is more important in the sense that it is activated by lower concentrations of thrombin than PAR-4 and mediates a more rapid response. TRACER trial [Tricoci P et...
Source: Cardiophile MD - December 2, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Coronary Interventions Source Type: blogs
Pulmonary Embolus pondering
A 52 y.o. bricklayer is transferred from another hospital with an acute episode of dizziness, palpitations and tachycardia. 2 days ago he had bilateral total knee replacements for osteoarthritis.Observations on arrival: P 120, BP 130/75, RR 22, SpO2 88% room air, 98% 4 litres via nasal prongs.ECG CTPA Bedside echo in EmergencyNormal LV, dilated RV with moderate impairment, septal paradox (bowing RA septum towards left).Troponin I (high sensitivity) 4410 ng/LThis man has acute Pulmonary Embolus (PE)His ECG demonstrates a normal axis, tachycardia and SI QIII TIII (see also ECG changes in PE).His CTPA demonstrates an extens...
Source: Life in the Fast Lane - November 26, 2014 Category: Emergency Medicine Authors: Fraser Brims Tags: Respiratory PE PEITHO PTE Pumonary Embolus tenecteplase thrombolysis Source Type: blogs
Research and Reviews in the Fastlane 059
This study looked at national survey data from 2009-2010 of patients >18 y/o presenting to the ED (n=44,448 visits) and found that cardiac enzyme testing was performed in 16.9% of visits, including in 8.2% of visits lacking ACS-related symptoms (which includes things like nausea, vomiting, abdominal pain, dyspnea, etc). This begs the question, why then, was a troponin (or ck-mb) ordered? It’s probably not changing management. In an era in which we’re discovering that there are harms to downstream testing, this study calls out just how trigger happy we may be. As more sensitive cardiac assays are used, this m...
Source: Life in the Fast Lane - November 26, 2014 Category: Emergency Medicine Authors: Jeremy Fried Tags: R&R in the FASTLANE airway brain failure critical care Emergency Medicine General Surgery hypothermia Intensive Care prehospital recommendations Review Trauma Source Type: blogs
We Still Don’t Know What’s Wrong
A few years ago, I was talking with a medical student who had just finished a shift in the ED. He was an excellent student, but today he had a string of patients who left him frustrated. The 40 year-old woman who presented with abdominal pain left the ED with a diagnosis of “abdominal pain.” We discharged the 35 year-old man who presented with a severe headache with a diagnosis of “possible tension headache.” A five year-old girl with a fever left with “fever of probable viral etiology.” We had gotten blood tests and a CT scan on the woman with abdominal pain, the results of which were normal. We had treated th...
Source: Academic Medicine Blog - November 17, 2014 Category: Universities & Medical Training Authors: David P. Sklar, M.D. Tags: Featured From the Editor ambiguity specialty choice tolerance for ambiguity Source Type: blogs
Lumbar Puncture Made Simple
Part 2 of a Three-Part Mini-Series on Lumbar Puncture
This month we are back (no pun intended) with the second part of our mini-series focused on perfect patient positioning and lumbar puncture (LP). Part one can be found at http://bit.ly/ProceduralPause.
Now that you have the proper skills to position your patient for an LP, the procedure should be pretty simple, right? The answer is yes! We want you all to be experts. We know that you can and will master an LP after reading these short and sweet LP guidelines and clinical pearls.
Lumbar puncture in the emergency department.
Manual of Clinical Anesthesiology;...
Source: The Procedural Pause - November 3, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Lumbar Puncture Made Simple
Part 2 of a Three-Part Mini-Series on Lumbar Puncture
This month we are back (no pun intended) with the second part of our mini-series focused on perfect patient positioning and lumbar puncture (LP). Part one can be found at http://bit.ly/ProceduralPause.
Now that you have the proper skills to position your patient for an LP, the procedure should be pretty simple, right? The answer is yes! We want you all to be experts. We know that you can and will master an LP after reading these short and sweet LP guidelines and clinical pearls.
Lumbar puncture in the emergency department.
Manual of Clinical Anesth...
Source: The Procedural Pause - November 3, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
October Man of the Month: John D. Phillips, Ph.D.
As part of our celebration of World Stroke Day (October 29) we are pleased to announce that John D. Phillips, Ph.D. is Disruptive Women in Health Care’s October Man of the Month. John, co-founder of the Stroke Comeback Center, is a visionary who saw an unmet need, and helped to create an innovative solution.
John was one of those well-connected Washington insiders, who had served as a deputy commissioner for higher education in the Ford Administration, then served as founding president of the National Association of Independent Colleges and Universities, and then ran an executive search practice specializing in recruitin...
Source: Disruptive Women in Health Care - October 30, 2014 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Man of the Month Source Type: blogs
Research and Reviews in the Fastlane 055
This study demonstrates a higher success rate (100% vs. 88%) and lower pneumothorax rate (0% vs. 5%) in comparing ultrasound guided versus landmark technique for placement. Although the ultrasound guided method may be technically difficult to learn and take some time investment, that time is repayed in the shorter time to accessing the vessel and lower complication rate.
Recommended by: Anand Swaminathan
Emergency medicineRosen P. The biology of emergency medicine. JACEP. 1979 Jul;8(7):280-3. PubMed PMID 449164
Peter Rosen has called this ‘the only good article I have ever written’. This is Rosen’s rati...
Source: Life in the Fast Lane - October 28, 2014 Category: Emergency Medicine Authors: Soren Rudolph Tags: Anaesthetics Clinical Research Emergency Medicine Intensive Care Neurology Resuscitation Trauma critical care Education literature R&R in the FASTLANE recommendations Research and Review Source Type: blogs
