LITFL Review #207
Welcome to the 207th 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
Brilliant talk by Roger Harris from SMACCUS weaves the pillars of medical ethics with space-time continuum theorem to explore When to Stop Resuscitation. [JS]
The Best of #FOAMed Emergency Medicine
EMUpdates features an excellent talk from Reub...
Source: Life in the Fast Lane - November 23, 2015 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Education LITFL review Source Type: blogs
Advanced Cooling Therapy Releases New Temperature Modulation Device
Advanced Cooling Therapy (ACT), a medical device firm, has expanded personnel in its commercial launch of the Esophageal Cooling Device (ECD).
“The ECD is the first device on the market cleared for temperature modulation via the esophagus. This enables efficient core-cooling, or core-warming, without the complexity and risks associated with intravascular catheter placement, and without the obstruction of patient access seen with surface pads and wraps,” said Robin Drassler, the vice president of North American sales.
The device is placed like a standard gastric tube, making placement quick. Placement ...
Source: Technology & Inventions - November 20, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Advanced Cooling Therapy Releases New Temperature Modulation Device
Advanced Cooling Therapy (ACT), a medical device firm, has expanded personnel in its commercial launch of the Esophageal Cooling Device (ECD).
“The ECD is the first device on the market cleared for temperature modulation via the esophagus. This enables efficient core-cooling, or core-warming, without the complexity and risks associated with intravascular catheter placement, and without the obstruction of patient access seen with surface pads and wraps,” said Robin Drassler, the vice president of North American sales.
The device is placed like a standard gastric tube, making placement quick. Placement requir...
Source: Technology & Inventions - November 20, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Atrial septal defect (ASD)
Illustrated Review with ECG, CXR, Echo Video, Cath Images
X-ray chest in atrial septal defect
X-ray chest PA view in atrial septal defect with pulmonary hypertension
(Click on the image for an enlarged view)
The main pulmonary artery (MPA) is grossly dilated. The right pulmonary artery (RPA) is also quite enlarged. Right atrial enlargement is seen as a shift of the cardiac contour to the right of the spine. Pulmonary vascularity is increased and prominent end on vessels (End on) are also seen. Apex is upwards, suggesting a right ventricular configuration. All features suggest a large secundum atrial septal defect with a l...
Source: Cardiophile MD - November 16, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Angiography and Interventions Cardiology X-ray ECG / Electrophysiology Echocardiography Structural Heart Disease Interventions ASD Crochetage Sign ASD ECG ASD echo ASD Echo Video ASD X-Ray Chest PA Colour Doppler Echo in ASD ECG in A Source Type: blogs
Research & Reviews in the Fastlane 107
This study suggests we’re even worse at it when the ED is busy. Researchers looked at 1116 hand hygiene opportunities presented to nurses, physicians and other healthcare professionals and used time to physician assessment as a marker of ED crowding. Mean hand hygiene compliance was only 29% but more worryingly longer mean time to physician assessment and higher nursing hours were associated with even lower compliance (24%). The bottom line? No matter how busy you are, WASH YOUR HANDS!
Recommended by Lauren Westafer, Natalie May
Emergency Medicine
Tseng HJ et al. Imaging Foreign Bodies: Ingested, Aspirated, and...
Source: Life in the Fast Lane - November 4, 2015 Category: Emergency Medicine Authors: Jeremy Fried Tags: Cardiology Education Emergency Medicine Infectious Disease Intensive Care Neurology Pediatrics R&R in the FASTLANE Respiratory Resuscitation clinical critical care EBM FOAM literature recommendations research and reviews Source Type: blogs
Risk and Consequences of Stroke in Decline, While Overall Incidence Increases
The objective of this study is to show geographic patterns of incidence, prevalence, mortality, disability-adjusted life years (DALYs) and years lived with disability (YLDs) and their trends for ischemic stroke and hemorrhagic stroke in the world for 1990-2013. Stroke incidence, prevalence, mortality, DALYs and YLDs were estimated following the general approach of the Global Burden of Disease (GBD) 2010 with several important improvements in methods. Data were updated for mortality (through April 2014) and stroke incidence, prevalence, case fatality and severity through 2013. Death was estimated using an ensemble modeling ...
Source: Fight Aging! - October 28, 2015 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
Factors predicting stroke after CABG – Cardiology MCQ
Factors predicting stroke after CABG:
a) Presence of intracerebral and extracerebral atherosclerotic disease
b) Demonstration of previous stroke by imaging
c) Atheromatous disease of the aorta
d) All of the above
Correct answer: d) All of the above
Aortic plaques have a high chance of embolization while cannulating the aorta for cardiopulmonary bypass. Avoiding cardiopulmonary bypass with off pump CABG (OPCAB) may have an edge over conventional on pump CABG in this situation. Previous history of stroke or transient ischemic attacks (TIA) within the previous six months is an important risk factor for perioperative stroke. ...
Source: Cardiophile MD - October 15, 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
There is a health care disparity in human genetics
Although we are all very similar, there are genetic differences between us that can affect our health. In different populations, people share different frequencies of certain genes. These gene variants can explain differences in medication responses, incidence of disease, and protection from illness.
For example, warfarin is a widely prescribed medication that is used to prevent clotting and ischemic stroke. The dosing of this medication was previously generic and does not account for differences in different populations. This can be dangerous considering the medication is used to prevent a fatal or debilitating incident. ...
Source: Kevin, M.D. - Medical Weblog - October 12, 2015 Category: Journals (General) Authors: Dr. Mary Tags: Conditions Genetics Source Type: blogs
Funtabulously Frivolous Friday Five 118
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 118
Question 1
The picture below is of an early piece of medical equipment from the 1930s called the “Hyman otor” What would one do with such a device?
+ Reveal the Funtabulous Answer
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Defibrillate
The Hyman otor is the first example of a defibrillation device.
Electrodes with introduced into the stopped heart ...
Source: Life in the Fast Lane - September 25, 2015 Category: Emergency Medicine Authors: Neil Long Tags: Frivolous Friday Five addison's Charles Dickens FFFF frank sign hannibal lecture hyman otor john f kennedy nerve palsy polydactyly romans Sir george Savile Source Type: blogs
Central Nervous System T-waves
A middle-aged woman presented with symptoms of mild ischemic stroke. There were no chest symptoms.An ECG was recorded as part of the workup:Bizarre inverted T-waves in nearly every lead, with greatly prolonged QT interval. QT = 560 ms. Bazett corrected QT = 727 msThese are classic for CNS catastrophe, especially hemorrhagic strokeThey are unusual in a small ischemic stroke.An Echocardiogram showed apical WMA and both LV and RV thrombi.The stroke had a very low NIH score and did not receive any reperfusion the therapy for this.Incredibly, no troponins were ever measured.A CT Coronary Angiogram showed normal coronary a...
Source: Dr. Smith's ECG Blog - September 25, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
LITFL Review 198
Welcome to the 198th 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
A great new #FOAMcc website is born: ICM Case Summaries! This is what it is all about: “Writing ten expanded case summaries is a requirement of the CCT in Intensive Care Medicine training program for doctors in the UK. These summaries are usual...
Source: Life in the Fast Lane - September 20, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs
Considering Klotho Delivery as a Means to Reduce Age-Related Stem Cell Decline
Today I'll point out an open access paper on the longevity-related gene klotho. Some researchers see therapies to adjust levels of the klotho protein produced from this genetic blueprint as a possible way to slow some of the effects of aging, particularly those connected to regeneration and stem cell activity. Work on this is slow-moving and painstaking, as for any similar approaches.
Yet a fairly large section of the medical research community is now devoted to at least partial and temporary restoration of tissue maintenance by stem cells in the old. A good fraction of the frailty and failure of aging results not just fr...
Source: Fight Aging! - September 14, 2015 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs
Health Affairs’ September Issue: Growing Burden Of Noncommunicable Diseases
The September issue of Health Affairs focuses on the growing burden of noncommunicable diseases. Increased wealth worldwide has reduced the frequency of some infectious diseases, while chronic diseases—heart disease, respiratory ailments, cancer, diabetes, mental illness, and others—are more widespread. The September issue was supported by Eli Lilly and Company.
Tracking Global Mortality Over 30 Years: A Mix of Increases And Decreases
Mohammed Ali at Emory University’s Rollins School of Public Health and coauthors examined data on deaths as a result of ischemic heart disease, stroke, diabetes, respiratory d...
Source: Health Affairs Blog - September 8, 2015 Category: Health Management Authors: Tracy Gnadinger Tags: Costs and Spending Elsewhere@ Health Affairs Equity and Disparities Featured Global Health Medicaid and CHIP Population Health Public Health Quality ACA DataWatch Global Mortality HSAs NCDs noncommunicable diseases WHO Source Type: blogs
"How could I convince my interventionalist to come do a cath in the middle of the night?"
I just received this email today. I receive these fairly frequently:Dear Dr. Smith:I am an Emergency physician working in an outlying hospital in _________. We have an interventional hospital to which we refer cath lab patients. I had a 31 year old with typical chest pain and vomiting and the attached ECG. I was sure he was infarcting but couldn’t convince the interventionalist to take him (after emailing him the ECG).I treated the patient aggressively with medical management and transfered him to the tertiary center. They did not take him to the cath lab emergently. When he went to the cath lab t...
Source: Dr. Smith's ECG Blog - August 27, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
More Life, Less Severe Illness, but More Years of Illness
Global trends in life expectancy, at birth, at 30, and at 60, continue onward and upward at a fairly slow but steady pace: approximately two years every decade for life expectancy at birth and a year every decade for remaining life expectancy at 60. The research linked below crunches the numbers for the much of the world from 1990 to 2013, an extension of similar past studies to include more recent data. The authors show that lives are longer and age-related illness less severe, but the period of time spent in disability or illness has grown.
We are machines. Very complex machines, but nonetheless collections of matter su...
Source: Fight Aging! - August 27, 2015 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs
