Research and Reviews in the Fastlane 164
Welcome to the 164th 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 and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R project or check o...
Source: Life in the Fast Lane - December 14, 2016 Category: Emergency Medicine Authors: Justin Morgenstern Tags: Emergency Medicine Intensive Care R&R in the FASTLANE Resuscitation EBM literature recommendations research and reviews Source Type: blogs
Are these prescription drugs preventing your weight loss?
A number of drugs prescribed to treat common conditions, such as hypertension, allergies, depression, inflammation, and diabetes, block your ability to lose weight. Several of these drugs actually cause weight gain, and most doctors fail to inform their patients of such side effects. Among the drugs that block weight loss are:
Beta-blockers: metoprolol, atenolol, carvedilol, and propranolol
Antidepressants: amitriptyline (Elavil), nortriptyline (Pamelor), doxepin, paroxetine (Paxil), trazodone, and others
Steroids: prednisone and hydrocortisone (but not inhaled or nasal steroids for allergies)
Antihistamines: diphenhydr...
Source: Wheat Belly Blog - September 13, 2016 Category: Cardiology Authors: Dr. Davis Tags: Depression Dr. Davis Drugs and wheat Nutritional supplements Weight loss Wheat Belly Wheat Belly Lifestyle Wheat Belly Total Health Wheat-Free Lifestyle anxiety Source Type: blogs
Anorectal Procedures: Thrombosed Hemorrhoids
We are going to get up close and personal this month to talk about hemorrhoids. You should be familiar with these painful offenders because half to two-thirds of people between 45 and 65 will suffer from their cruelty. (Am Surg 2009;75[8]:635.) Patients may seek emergency department care if they experience bleeding or severe pain from hemorrhoids.Hemorrhoids are highly vascular structures that are round or oval in shape. They arise from the rectal and anal canal, and sometimes appear around the anus itself. It is important to note that hemorrhoids do not have arteries and veins but special blood vessels called sinusoid...
Source: The Procedural Pause - August 1, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Funtabulously Frivolous Friday Five 122
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…introducing Funtabulously Frivolous Friday Five 122
Question 1
What is a Clay-shoveler’s fracture and how do you get one?
+ Reveal the Funtabulous Answer
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Fracture through the spinous process of a vertebra occurring at any of the lower cervical or upper thoracic vertebrae, classically at C6 or C7.
Originally described in Australia associated with (no prizes for...
Source: Life in the Fast Lane - October 23, 2015 Category: Emergency Medicine Authors: Neil Long Tags: Frivolous Friday Five adrenal crisis adrenal insufficiency botulism clay shoveler's fracture erythema multiforme rhabdomyolysis Source Type: blogs
Hyponatremia, he fell, the answer
To recap:
78-year-old man admitted after a fall – no fractures.
His labs on admission
125
89
33
128
5.2
22
2.1
He has a history of B-cell lymphoma.
His serum osm are 273 and urine osm 263.
Clinically he is euvolemic (i.e., not orthostatic). He is bradycardic (we stopped his beta blocker given for previous CABG).
He is new to our hospital, we do not know his previous renal function.
Your question – what further tests do you want? Can you speculate on his diagnosis?
Cory had the proper instincts. The patient had a random cortisol of ~4 (normal 8 or greater). His stimulation test had a peak cortis...
Source: DB's Medical Rants - October 13, 2015 Category: Internal Medicine Authors: rcentor Tags: Acid-Base & Lytes Source Type: blogs
Test your medicine knowledge: 27-year-old woman with an intensely pruritic rash
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 27-year-old woman is evaluated for a 1-week history of an intensely pruritic rash on her eyelids. She applied a new brand of eye makeup just prior to the onset of the rash. She immediately discontinued its use and has been applying a moisturizing lotion to both eyelids since then without improvement in her symptoms. She notes no other areas of rash and generally feels well. The patient has no significant medical history and takes no medications.
On physical examination, vital signs are normal. There is erythem...
Source: Kevin, M.D. - Medical Weblog - September 26, 2015 Category: Journals (General) Authors: mksap Tags: Conditions Dermatology Source Type: blogs
MKSAP: 72-year-old man with community-acquired pneumonia
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 72-year-old man is hospitalized for treatment of community-acquired pneumonia. Despite 4 days of treatment with intravenous fluids and antibiotics appropriate for the bacteria cultured from sputum and blood, he remains febrile with mild tachycardia. The patient subsequently develops mild hypotension and is transferred to the intensive care unit. Results of two subsequent blood cultures are negative for bacteria. Medical history is significant for hypertension treated with amlodipine and recurrent osteoarthriti...
Source: Kevin, M.D. - Medical Weblog - August 9, 2014 Category: Journals (General) Authors: mksap Tags: Conditions Endocrinology Hospital Source Type: blogs
Notes to myself – 2
Pentobarb coma – BIS should be 10-20 and SR (suppression ratio) should be 70-80
Consider lev albuterol
Should give vaccines after coiling of spleen or before if possible
No calcium channel blockers post MI definitely and post op in general
Toradol inhibits spine healing
Don’t do endoscopes with patients in supine position
don’t ambulate patients with known dvt’s. wait 2-3 days until clots get stuck.
dvt’s even with filter get heparin as much as possible for post phlebitic syndrome and to retard new clot formation
diffuse alveolar hemorrhage – secondary to chemo, goodpasture’s, wege...
Source: Inside Surgery - December 31, 2013 Category: Surgeons Authors: Editor Tags: General Source Type: blogs
MKSAP: 38-year-old woman with increasing fatigue and weight gain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 38-year-old woman reports a 3-month history of increasing fatigue and weight gain. She underwent transsphenoidal surgery 4 years ago to remove a nonfunctioning pituitary macroadenoma, followed 4 months later by radiation therapy because of residual tumor. She started taking hydrocortisone 14 months ago after adrenal insufficiency was diagnosed. The patient developed amenorrhea 1 year ago and began taking an oral contraceptive. Medications are hydrocortisone, norethindrone with ethinyl estradiol, and a multivita...
Source: Kevin, M.D. - Medical Weblog - November 2, 2013 Category: Family Physicians Tags: Conditions Endocrinology Source Type: blogs
Preventing and Treating Severe Mosquito Bites
Dr. Greene’s Answer:
Many kids (including my daughter Claire) develop large local reactions to mosquito bites – charmingly called Skeeter Syndrome. It’s a reaction to proteins in mosquitos saliva. There’s usually some reaction within hours of the bite, they progress over 8 to 12 hours or more, and have disappeared within 3 to 10 days. They can be quite dramatic, and occasionally even blister or bruise.
It’s rare to get any whole-body symptoms from this.
The most common age for it to start is somewhere between age 2 and age 4, and (good news!) once it develops, most kids only have this for several ...
Source: Conversations with Dr Greene - September 22, 2013 Category: Pediatricians Authors: Dr. Alan Greene Tags: Q&A Insect Bites & Stings Source Type: blogs
Acute otitis externa
What is Acute otitis externa?
Acute otitis externa is a common condition involving inflammation of the ear canal. It is caused by bacteria such as Pseudomonas aeruginosa and Staphylococcus aureus. Acute otitis externa often occurs following swimming or minor trauma from inappropriate cleaning.
What are the symptoms of Acute otitis externa?
The rapid onset of ear canal inflammation leads to otalgia (earache), itching, canal edema, erythema, and otorrhea. Tenderness with movement of the tragus or pinna is a classic finding.
What is the treatment for Acute otitis externa?
For uncomplicated cases, use topical antimicrob...
Source: Clinical Cases and Images - Blog - March 21, 2013 Category: Professors and Educators Tags: Infectious Disease AFP ENT Source Type: blogs
October 2011: How is Your Crohn’s Today?
Hello everyone! I hope that you are doing well today! It is time for us to have another edition of ‘How is your Crohn’s today?’.
For those who are new to the blog, every now and then I like to check in with everyone to hear how you are doing and how your Crohn’s is holding up.
Here’s how I’ve been doing: I started the Stem Cell Clinical Trial and had the first infusion on the 12th of October. I was really nervous about the first one since I don’t have good success with medications (I always seem to get those rare side effects!), so I asked my husband to take me. It was good that I brought him because they...
Source: Life with Crohn's - October 24, 2011 Category: Other Conditions Authors: Kelly R Tags: Crohn's disease Crohn's community crohns How is your Crohn's today medication Source Type: blogs
