An E.R. Kicks the Habit of Opioids for Pain - The New York Times
Brenda Pitts sat stiffly in an emergency room cubicle, her face contorted by pain. An old shoulder injury was radiating fresh agony down to her elbow and up through her neck. She couldn't turn her head. Her right arm had fallen slack.
Fast relief was a pill away — Percocet, an opioid painkiller — but Dr. Alexis LaPietra did not want to prescribe it. The drug, she explained to Mrs. Pitts, 75, might make her constipated and foggy, and could be addictive. Would Mrs. Pitts be willing to try something different?
Then the doctor massaged Mrs. Pitts's neck, seeking the locus of a muscle spasm, apologizing as the pat...
Source: Psychology of Pain - June 12, 2016 Category: Anesthesiology Source Type: blogs
When it comes to your health care, buyer beware
A good friend of mine recently found herself between jobs, with a gap in her health insurance and a recurrence of her kidney stones. What she needed were fluids and pain relief, fast. I’m a gastroenterologist, and hoping to minimize the financial impact, I went with her to our local ER and had a conversation with the attending physician. Maybe we could pass on the CT scan and extraneous lab work?
The attending was in her room for less than two minutes and never examined her. But the CT scan and blood work were ordered. My friend received intravenous fluids (about $1 worth), pain meds (about $5 worth of Dilaudid), and...
Source: Kevin, M.D. - Medical Weblog - June 1, 2016 Category: Journals (General) Authors: Michael P. Jones, MD Tags: Physician GI Source Type: blogs
FAQ: Understanding Kidney Stones (Part II)
In a previous post, I wrote about: What are kidney stones, how common are kidney stones, kidney stones composition and risk factors for kidney stones disease.
A first-time kidney stone (urolithiasis) former is at risk of having another episode?
Yes. First-time stone formers have a 50% risk for recurrence within the subsequent 10 years.
Which patients need metabolic evaluation (work-up)?
Those that are recurrent stone formers, who have a strong family history of stones, those with chronic diarrhea or with history of pathologic fractures, osteoporosis, urinary tract infection (UTI) with calculi, gout, solitary kidn...
Source: Unbounded Medicine - May 30, 2016 Category: Surgery Authors: Jon Mikel I ñarritu Tags: Fast Facts kidney stones lithiasis urolithiasis urology Source Type: blogs
FAQ: Understanding Kidney Stones (Part I)
What are kidney stones?
Are small (at the beginning), hard mineral deposits that form in the kidney. Urine contains dissolved salts and minerales. If the urine has high levels of this deposits, you can form kidney stones. Stones can stay in the kidney, but eventually can travel down to the ureter, bladder and urethra. If the stone blocks the ureter, it also blocks the urinary flow and can cause excruciating pain.
How common are kidney stones?
The lifetime prevalence of having kidney stones is estimated at 1% to 15%. It varies according to race, age, gender and geographic location. Specifically, 114.3 per 100,000 people ...
Source: Unbounded Medicine - May 28, 2016 Category: Surgery Authors: Jon Mikel Iñarritu Tags: Fast Facts kidney lithiasis stones urology Source Type: blogs
FAQ: Understanding Kidney Stones (Part I)
What are kidney stones?
Are small (at the beginning), hard mineral deposits that form in the kidney. Urine contains dissolved salts and minerals. If the urine has high levels of this deposits, you can form kidney stones. Stones can stay in the kidney, but eventually can travel down to the ureter, bladder and urethra. If the stone blocks the ureter, it also blocks the urinary flow and can cause excruciating pain.
How common are kidney stones?
The lifetime prevalence of having kidney stones is estimated at 1% to 15%. It varies according to race, age, gender and geographic location. Specifically, 114.3 per 100,000 people w...
Source: Unbounded Medicine - May 28, 2016 Category: Surgery Authors: Jon Mikel I ñarritu Tags: Fast Facts kidney lithiasis stones urology Source Type: blogs
“@deathunderglass is taking over the...
"@deathunderglass is taking over the @muttermuseum@instagram account this week to showcase some of the specimens in the museum collection related to forensic science! @deathunderglass is a collaboration between a forensic pathologist and forensic photographer that generates images of human tissue at high magnification. Whether know it or not, it's likely you have a few anatomic quirks you're not aware of – say, an accessory spleen or two, a double ureter, or an extra coronary ostium in your heart. One of the most common anatomic variants, affecting about 1 in 500 people, is the horseshoe kidney. Most people have two sep...
Source: Kidney Notes - May 10, 2016 Category: Urology & Nephrology Authors: Joshua Schwimmer Source Type: blogs
Don’t forget the power of over the counter remedies
I recently had an enormous kidney stone. Well OK, it seemed enormous to me. But in terms of kidney stones, it was reasonably large; 9 mm, in fact. Large enough that I had to have lithotripsy (the use of sound waves to break up the stone) performed by my friend and most excellent urologist, Dr. Robert McAlpine in Seneca, SC.
As uncomfortable as the whole experience was (and it wasn’t my first rodeo either), I was reminded of something very important, which is that prescription drugs aren’t all they’re cracked up to be. In fact, the best pain relief I had from my kidney stone involved the little blue wonder pill (for w...
Source: Kevin, M.D. - Medical Weblog - May 3, 2016 Category: Journals (General) Authors: Edwin Leap, MD Tags: Meds Medications Primary care Source Type: blogs
Why calcium supplements are unnecessary on the Wheat Belly lifestyle
There is no need for calcium supplements on the Wheat Belly lifestyle. They can even be dangerous. Let me explain.
Calcium is a mineral that the body needs to conduct hundreds of physiologic processes, as well as serve as the structural material for bones and teeth. Without calcium, you’d be sunk.
But taking calcium as a nutritional supplement is like tossing a bunch of bricks into the backyard hoping that they form a nice, neat patio—the world doesn’t work that way. Just because bones contain calcium does not mean that taking calcium orally will cause it to be directed to the bones. In fact, calcium take...
Source: Wheat Belly Blog - April 11, 2016 Category: Cardiology Authors: Dr. Davis Tags: Wheat Belly Lifestyle bone health calciium calcium oxalate stones gluten grains vitamin D Source Type: blogs
God, I love nursing students. And new nurses. And newbies, in general.
The best shifts I have come when I get to precept nursing students or new nurses. It doesn't happen very often, probably because I have a bad, bad reputation with Manglement when it comes to new RNs. I say things like "Don't let that doctor talk down to you!" and then call the doc in question out when he's been an asshole. That does not make me popular with people whose job it is to make sure the fruit plate in the doctors' lounge is fresh and full of papaya.Still. . . .when I get to precept a new nurse, or a student, it's such a freakin' high. People who don't know a lot, or anything, about a discipline ask the best quest...
Source: Head Nurse - March 2, 2016 Category: Nursing Authors: Jo Source Type: blogs
MKSAP: 54-year-old man with a tremor
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 54-year-old man is seen for follow-up evaluation of a tremor in his upper extremities that has been present since age 20 years. The tremor was mild for many years and did not interfere with his work but has become more prominent in recent years. He has difficulty writing and using utensils during meals. He has no associated slowness, stiffness, or change in gait. The patient started a trial of propranolol, which provided better control of the tremor, but after a few months, the tremor again worsened. He has su...
Source: Kevin, M.D. - Medical Weblog - December 19, 2015 Category: Journals (General) Authors: mksap Tags: Conditions Neurology Source Type: blogs
Fragmentation is behind health care’s biggest problems
My friend Jeremy went to an emergency room with belly pain, and soon learned he’d been blessed with a kidney stone. The staff summoned a urologist, but none was available, so they sent him home with a pain prescription. Continuing nevertheless to writhe in agony, Jeremy phoned urologists and learned to his dismay there were only three in the region who accepted his insurance, and none at all in his county.
The next day, he painfully drove thirty miles to see one of those urologists, who recommended lithotripsy, a treatment in which ultrasound shock waves shatter the stone. But this doctor couldn’t get access to...
Source: Kevin, M.D. - Medical Weblog - December 12, 2015 Category: Journals (General) Authors: Jeff Kane, MD Tags: Policy Health reform Source Type: blogs
The Very Inspiring Blogger Award
I extend deep gratitude to both Carol Gino and The Nursing Site Blog for nominating Digital Doorway for The Very Inspiring Blogger Award. This is an award given by bloggers to fellow bloggers who inspire them and who are motivated to maintain the blogosphere as a beautiful place.The Very Inspiring Blogger Award has a goal of honoring bloggers, and to honor and learn more about the people behind the blogs that we nominate. The rules that accompany the award are the following: The first rule is that I am asked to share seven or eight facts about myself. Here we go.....I'm been married to the writer, coach, and performer/mo...
Source: Digital Doorway - November 27, 2015 Category: Nursing Tags: blogs nurse nurses nursing nursing blog Source Type: blogs
How Many Patients Do You Have? Who cares!
How many patients do you have?
I’m not sure what you mean. How many patients do I see on average each day? About twelve.
No. How many patients do you have?
Let’s see: Last week I saw about sixty patients altogether. Five of them were new patients.
No, no. How many patients do you have on your panel?
My panel? I don’t know what you mean by that. I don’t work as an employer in a fully prepaid system where patients are specifically assigned to me. I’m down to only two capitated HMOs, insurance plans that pay me a certain amount (not much) each month for each patient on my list. Some people on the...
Source: Musings of a Dinosaur - November 22, 2015 Category: Primary Care Authors: notdeaddinosaur Tags: Medical Source Type: blogs
Research & Reviews in the Fastlane 105
This study looked at the rate of central line-associated bloodstream infections (CLABSI) in ED placed lines and found the rate (2.0/1000 catheter days) to be the same as that in ICU placed lines (2.3/1000 catheter days). Additionally, they found that the introduction of a central line bundle aimed at standardizing practice was associated with a reduction in CLABSI in the ED (3.0/1000 before the bundle to 0.5/1000 after the bundle).
Recommended by Anand Swaminathan
Critical care
Reitsma S et al. The endothelial glycocalyx: composition, functions, and visualization. Pflugers Arch 2007; 454(3): 345-59. PMID 17256154
We are...
Source: Life in the Fast Lane - October 21, 2015 Category: Emergency Medicine Authors: Soren Rudolph Tags: Airway Anaesthetics Education Emergency Medicine Emergency Medicine Update Intensive Care Pre-hospital / Retrieval Psychiatry and Mental Health Resuscitation Trauma critical care R&R in the FASTLANE recommendations research and r Source Type: blogs
