Right Way and Wrong Way: Making an Immediate Ethical/Legal Medical Decision
Discussion Blog)
Source: Bioethics Discussion Blog - October 30, 2015 Category: Medical Ethics Source Type: blogs
Extracorporeal CPR
Conventional cardiopulmonary resuscitation (CPR) involves chest compressions and respiratory support with either mouth to mouth respiration or bag and mask ventilation. Extracorporeal CPR (ECPR) means supporting the heart and lung function using extracorporeal method of venoarterial perfusion during cardiac arrest [1]. Extracorporeal membrane oxygenator (ECMO) circuits are used in extracorporeal CPR. The recently published 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care [2] discusses the use of ECPR for cardiac arrest and also the potential ethical i...
Source: Cardiophile MD - October 27, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology CPR ECPR ROSC Source Type: blogs
First phase of VF – Cardiology MCQ
First phase of VF (ventricular fibrillation) is known as:
a) Electrical phase
b) Hemodynamic phase
c) Metabolic phase
d) None of the above
Correct answer: a) Electrical phase
Electrical phase: Initial 4 minutes of VF.
Hemodynamic phase: 4 minutes to 10 minutes after the onset of VF.
Metabolic phase: Beyond 10 minutes after the onset of VF.
If EMS (Emergency medical service) arrives within 4 min (electrical phase) – defibrillation first – It is likely to be coarse VF and responds better to defibrillation.
If after 4 min, but before 10 min, cardiopulmonary resuscitation (CPR) followed by defibrillation.
If beyond 10 min...
Source: Cardiophile MD - October 17, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance ECG / Electrophysiology Source Type: blogs
5 Year Old New Jersey Girl Died from the MMR Vaccine, Holly’s Law Created
Conclusion
We leave you with words from Robin:
“My family and I hope that Holly’s story will make a difference and help you realize that you must be aware of the risks of vaccinations, just as you make yourself aware of the risks of any medical procedure.
We hope to make change, and one very important improvement must be that the pediatricians acknowledge that there are vaccine reactions, that moderate to serious and even fatal vaccine reactions do exist and occur at least 100 times more than is reported to the Vaccine Adverse Event Reporting System (VAERS).
We are still very disappointed and disgusted with the actio...
Source: vactruth.com - September 24, 2015 Category: Allergy & Immunology Authors: Augustina Ursino Tags: Top Stories Augustina Ursino Human MMR vaccine VAERS Vaccine Death National Vaccine Injury Compensation Program (NVICP) adverse reactions truth about vaccines Holly's Law Robin Stavola Holly Marie Stavola Source Type: blogs
LITFL Review 196
Welcome to the 196th 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
The Best Case Ever series features Rich Levitan this week discussing the benefits of slowing down how we think, move and perform in order to perform like an expert. [AS]
The Best of #FOAMed Emergency Medicine
Young people can have MIs too. Think...
Source: Life in the Fast Lane - September 6, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs
Research and Reviews in the Fastlane 098
This study compared appropriate doses for PCC (bebulin) vs. FFP (10ml/kg) vs. FFP+PCC. All patients received Vit K. There were no differences between PCC and FFP related to time to correct INR or vascular complications. Interestingly there was a significantly lower rate of death and re-bleed on the PCC group. The expected difference on speed of correction was not seen by the outcomes were significantly better with PCC, is it time to adopt it as standard of care?
Recommended by: Daniel Cabrera
Emergency Medicine
Beam DM et al. Immediate Discharge and Home Treatment With Rivaroxaban of Low-risk Venous Thromboembolism Diagno...
Source: Life in the Fast Lane - September 2, 2015 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Education Emergency Medicine Emergency Medicine Update Haematology Intensive Care Laboratory R&R in the FASTLANE Renal Toxicology and Toxinology Urology EBM literature research and reviews Source Type: blogs
LITFL Review 195
Welcome to the 195th 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
The Australia and New Zealand Intensive Care Society (ANZICS) have a superb YouTube page with lots of great lectures from their 2014 ASM being uploaded. Why not get started with the oration lecture from the legendary Simon Finfer? [SO]
The Best o...
Source: Life in the Fast Lane - August 30, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs
Research and Reviews in the Fastlane 094
This article has significant implications for clinicians translating evidence into practice.
7 decreasing mortality
Noninvasive ventilation (NIV) for specific population with acute respiratory failure
Mild hypothermia after cardiac arrest
Prone positioning
Low tidal volume ventilation in acute respiratory distress syndrome (ARDS)
Tranexamic acid in patients with or at high risk of traumatic hemorrhagic shock
Daily interruption of sedatives in critically ill patients
Albumin administration in cirrhotic patients with spontaneous bacterial peritonitis
And 8 shown to increase mortality including hydroxyethy...
Source: Life in the Fast Lane - August 5, 2015 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Education Emergency Medicine Infectious Disease Intensive Care Orthopedics Pediatrics Pre-hospital / Retrieval Resuscitation Trauma critical care EBM literature R&R in the FASTLANE recommendations research and reviews Source Type: blogs
Emergency Transvenous Cardiac Pacing
This case was provided by one of our fine 5th year EM/IM residents, Rachael Krob MD. The description of the method for inserting a pacing wire is by one of our fine 3rd year EM residents, Mark Sandefur MD.CaseAn elderly male was found on the floor with altered mental status. When EMS arrived, he was obtunded but occasionally able to answer yes/no questions. He was found to be bradycardic in the 20's-30’s. Glucose was normal. A prehospital 12-lead was recorded; unfortunately, only half of it made it into the chart:There is a slow indeterminate rhythm with a right bundle branch block morphology. The medics r...
Source: Dr. Smith's ECG Blog - July 21, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
Circle of Life
Life is all about beginnings and endings. One of the biggest draws of Obstetrics as a medical specialty is the fascination with the birth process as the beginning of life. The other extreme…well, let’s say in this particular place and time in history, it’s still something that catches people unawares. Too often filled with dread and loathing, we approach the death of patients as a foreshadowing of our own. Why else have we as doctors developed the reputation of squaring off with Death? Beating Him off with tubes and drugs and electricity, “No!” we shriek. “You can’t have this one ...
Source: Musings of a Dinosaur - May 18, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Pulmonary thromboendarterectomy – Cardiology MCQ
Pulmonary thromboendarterectomy is the treatment of choice for:
a) Primary pulmonary hypertension
b) Eisenmenger syndrome
c) Chronic thromboembolic pulmonary hypertension (CTEPH)
d) Massive pulmonary embolism
Correct answer: c) Chronic thromboembolic pulmonary hypertension (CTEPH)
Majority of patients with CTEPH have good relief of symptoms with pulmonary endarterectomy and surgical mortality is around five percent in expert centres. Responders to surgery have near normalization of hemodynamics. Non responsiveness could be due to the presence of pulmonary microvascular disease. The procedure is done under deep hypothermi...
Source: Cardiophile MD - May 16, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiac Surgery Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Research and Reviews in the Fastlane 083
This study looks at intra-arrest cooling in the prehospital setting. No benefit was found for either the surrogate markers or the most important patient centered outcome of survival. Interestingly, the median temperature upon hospital presentationin the group that did not get intra-arrest cooling was 35 degrees (below the 36 degrees recommended in the TTM trial conclusions). Intra-arrest cooling may simply be a lot of money and effort spent without noticeable differences in outcomes.Recommended by: Anand SwaminathanRead More: JC: Getting Chilly Quickly 3. Hypothermia at St.Emlyn’s (St Emlyn’s)Critical CareWalkey...
Source: Life in the Fast Lane - May 14, 2015 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Anaesthetics Education Emergency Medicine Intensive Care Pediatrics R&R in the FASTLANE Resuscitation Trauma Wilderness Medicine critical care examination literature recommendations research and reviews Source Type: blogs
JellyBean 021 with Michael Parr
Michael Parr has had the kind of career that most of us can only dream of. Co-Editor of Resuscitation. Australian Rep on ILCOR. Director of ICU in one of the biggest hospitals in Sydney. It’s a great story starting in Liverpool, via Yorkshire, London, Baltimore and ending in, well, Liverpool. I wouldn’t even dream of looking back on something similar at the end of my career. And he is far from done yet. He has a very interesting story and he credits his mentor, Peter Baskett, for so much of it. I think there’s at least a little credit due to Michael himself but he is rather humble about it. (Lucky he wasn’t...
Source: Life in the Fast Lane - May 12, 2015 Category: Emergency Medicine Authors: Doug Lynch Tags: JellyBean Podcast Web Culture Michael Parr Source Type: blogs
The No-Sugar Daddy
A 40-year-old man presented with hypoglycemia following an intentional overdose with Humalog Mix 75/25 (75% insulin lispro protamine suspension and 25% insulin lispro injection). He reported injecting 900 units into his abdomen one hour prior to ED presentation. He complained of lightheadedness and nausea. His initial vital signs were heart rate 110 bpm, blood pressure 112/70 mm Hg, respiratory rate 14 breaths per minute, and oxygen saturation 99% on room air. His physical exam is remarkable for a visible injection site on the abdomen. Blood glucose is 50, potassium is 3.1, and creatinine is 0.8. The patient reports a pres...
Source: The Tox Cave - May 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
