ST elevation after gunshot to the chest
Conclusion: The ECG in Figure-1 would not be typical for non-traumatic acute pericarditis. However, it could be consistent with traumatic pericarditis (because ECG findings are so variable in traumatic pericarditis).NOTE: The ECG features of acute myocarditis may differ substantially from those of a " pure " pericarditis. There may be a resemblance between these 2 entities — but ST segment deviations (elevation and depression) with myocarditis may not follow the timing seen with pericarditis. In addition, Q waves may develop — so at times it may...
Source: Dr. Smith's ECG Blog - June 8, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
Painless Nasogastric Tube Placement
A 6-year-old boy presented with intermittent abdominal pain, nausea, and vomiting. Because his abdominal examination was unremarkable, the pain intermittent, and constipation a possibility, we provided an enema along with an abdominal pain workup but no radiographs. His pain improved, the abdominal labs were unremarkable, and the child tolerated an oral fluid challenge after treatment with ondansetron.The mother was advised at discharge to return if she became concerned about her child's condition. They did return a few hours later for increased vomiting and abdominal pain. A CT scan demonstrated multiple dilated loops ...
Source: M2E Too! Mellick's Multimedia EduBlog - March 1, 2022 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Ode to a little bile bag
Surgery to remove the gallbladder is a relatively late intervention. The first laparotomy was performed in 1807 in Danville, Kentucky, and surgeons like Billroth and Kocher, were removing thyroids and even parts of the esophagus as early as the 1870s; the pricklish gallbladder was not completely excised until 1882. For years previously, the medical andRead more …Ode to a little bile bag originally appeared inKevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - October 10, 2021 Category: General Medicine Authors: < span itemprop="author" > < a href="https://www.kevinmd.com/blog/post-author/arthur-williams" rel="tag" > Arthur Williams, MD < /a > < /span > Tags: Conditions Surgery Source Type: blogs
Fifth patient report of the National Emergency Laparotomy Audit (NELA): December 2017 to November 2018
Royal College of Anaesthetists - Commissioned by the Healthcare Quality Improvement Partnership as part of the National Clinical Audit Programme, this report analyses the care received by close to 25,000 emergency bowel surgery patients treated in NHS hospitals in England and Wales between December 2017 and November 2018. Amongst the findings is that time to antibiotics in patients with sepsis remains poor with 80.6 per cent not receiving antibiotics within one hour. The report is the fifth report of NELA and offers a series of recommendations to reduce variation in the care of patients undergoing emergency bowel sur...
Source: Health Management Specialist Library - January 6, 2020 Category: UK Health Authors: The King ' s Fund Information & Knowledge Service Tags: Patient safety Quality of care and clinical outcomes Source Type: blogs
Degree escalation and doctoral education are sinking the occupational therapy profession
Occupational therapy started on a simple premise - that man, through the use of his hands as they are energized by mind and will, can influence the state of his own health. That statement was provided to the profession by Mary Reilly, our greatest theoretician.It is a simple concept, borne out of a core philosophy of pragmatism and infused with a dose of all the good intentions of the moral treatment movement. If you carefully read that core philosophy of occupational therapy you will hear the Emersonian reverberations of self-reliance: ' Trust thyself: every heart vibrates to that iron string. ' That is ...
Source: ABC Therapeutics Occupational Therapy Weblog - March 12, 2019 Category: Occupational Health Tags: OT Education OT practice philosophy Source Type: blogs
Last Month in Oncology with Dr. Bishal Gyawali: November 2018
By BISHAL GYAWALI MD
Keynote speech
There was a very sobering piece in NEJM by the FDA last month in which the authors try to explore what went wrong with the Keynote-183, Keynote-185 and checkmate 602 trials testing PD-1 inhibitors combinations with pomalidomide or lenalidomide and dexamethasone in multiple myeloma. Interim analysis of Keynote 183 and 185 revealed detrimental effects on overall survival (OS) with hazard ratios of 1.61 and 2.06, not explained by differences in toxicities alone. The checkmate 602 trial was also halted in light of these findings and also showed higher mortality in the nivolumab combina...
Source: The Health Care Blog - December 17, 2018 Category: Consumer Health News Authors: matthew holt Tags: Pharmaceuticals Physicians Bishal Gyawali Cancer drugs cancer immunotherapy Clinical Trials FDA Oncology PD-1 inhibitors Source Type: blogs
Mastering Intensive Care 028 with John Santamaria
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog
John Santamaria – Genuine care for patients both during and after the ICU stay
How well do you understand what happens to your patients after they leave the ICU?
Do you find out how they go and feed this back to your ICU team?
Most of you give excellent care to your patients whilst they are in the intensive care unit. No doubt this will be compassionate, appropriate, diligent, information-driven, holistic, team-based and communicative care.
But when they leave the ICU, ...
Source: Life in the Fast Lane - March 31, 2018 Category: Emergency Medicine Authors: Andrew Davies Tags: Intensive Care Mastering Intensive Care Andrew Davies ex-ICU genuine care John Santamaria Source Type: blogs
Funtabulously Frivolous Friday Five 230
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog
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 FFFF…introducing Funtabulously Frivolous Friday Five 230.
Question 1:
Braille refined ‘night writing’ so it could effectively be used in the blind population. Who originally commissioned ‘night writing’ for the military?
+ Reveal the Funtabulous Answer
expand(document.getElementById('ddet134191...
Source: Life in the Fast Lane - March 15, 2018 Category: Emergency Medicine Authors: Neil Long Tags: Frivolous Friday Five beard bowel obstruction Braille Charles Barbier Faget's sign Hans Steininger Napoleon orthodontic wire Sutton's law Sutton's slip Source Type: blogs
The Law of Diminishing Returns of Ethicism
SAURABH JHA MD
Many allege that the FIRST trial, which randomized surgical residencies to strict versus flexible adherence to duty hour restrictions, was unethical because patients weren’t consented for the trial and, as this was an experiment, in the true sense of the word, consent was mandatory. The objection is best summarized by an epizeuxis in a Tweet from Alice Dreger, a writer, medical historian, and a courageous and tireless defender of intellectual freedom.
@RogueRad @LVSelbs @ethanjweiss @Skepticscalpel Consent to experimentation. Consent. Consent. Am I not being clear?
— Alice Dreger (@AliceDreger) Nov...
Source: The Health Care Blog - March 20, 2017 Category: Consumer Health News Authors: at RogueRad Tags: Uncategorized Source Type: blogs
The decision a family can ’t make
Just a minute before, I had been in surgery checking on the status of a patient who was undergoing an exploratory laparotomy. She had been doing OK, but deteriorated relatively quickly that afternoon while still in the hospital recuperating from an unrelated operation. The anesthesiologist popped out of the room to tell me what the initial findings looked like. It was not good. That’s when I went to speak to the family that I knew so well. I had cared for all of them for a very long time.
I walked out of the operating room, leaned down and looked into the husband’s deep blue eyes. I then spoke words that no...
Source: Kevin, M.D. - Medical Weblog - November 29, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/shawn-c-jones" rel="tag" > Shawn C. Jones, MD < /a > Tags: Physician Surgery Source Type: blogs
Olympus Vying to Bring Back Laparoscopic Power Morcellation Thanks to PneumoLiner Safety Device
A couple years ago the FDA, realizing the dangers of laparoscopic power morcellation when used for removing the uterus (hysterectomy) or uterine fibroids (myomectomy), recommended that doctors quit using this type of technology. The issue is that women may have undetected cancerous tissues within the affected anatomy and taking a morcellator to them can spread the cancer intraperitoneally. Now a new system from Olympus is aiming to bring back laparoscopic power morcellation while preventing the spread of any cancer that may be present.
Cleared by the FDA back in April and just unveiled at the American Association of Gyn...
Source: Medgadget - November 17, 2016 Category: Medical Equipment Authors: Editors Tags: Ob/Gyn Source Type: blogs
Research and Reviews in the Fastlane 147
In this report two cases where a new method for removing encircling objects from the penis using a ordinary condom was applied. The article in danish with a short abstract, but sufficient self explanatory images are provided.
Recommended by Soren Rudolph
Resuscitation
Laina A et al. Amiodarone and cardiac arrest: Systematic review and meta-analysis. Internat J Cardiol 2016; 221: 780-8. PMID: 27434349
Amiodarone is dead in the dead! The recent ALPs trial in the NEJM grabbed headlines showing that there was no difference in survival to discharge in OHCA patients who got amiodarone versus lidocaine versus placebo. This s...
Source: Life in the Fast Lane - August 17, 2016 Category: Emergency Medicine Authors: Justin Morgenstern Tags: Education Emergency Medicine R&R in the FASTLANE Resuscitation Toxicology and Toxinology Trauma EBM literature recommendations research and reviews Source Type: blogs
We were promised death panels
The day was progressing swimmingly until the charge nurse announced we had an emergent exploratory laparotomy. These things happen; often there’s free air in the abdomen from a ruptured ulcer or diverticulum. Sometimes an exploratory laparotomy is necessary after trauma or a particularly nasty infection. We’re prepared to handle them.
“Where is the patient?” I inquired.
“On the way down from ICU. The surgeon’s on his way in,” I was told.
Hmm … they usually come from the E.D. This may not be typical.
I look up the elderly woman’s medical record on the computer. Two days post...
Source: Kevin, M.D. - Medical Weblog - July 18, 2016 Category: Journals (General) Authors: Physician on FIRE, MD Tags: Physician Hospital Intensive care Source Type: blogs
Research and Reviews in the Fastlane 139
This study is a reanalysis of the data, attempting to identify the threshold where the benefit in functionality is produced, using ranges of <160, 160–169, 170–179, 180–189, and ≥190 mm Hg. The outcome was Rankin Scale at 90 days. Although the ranges proposed by the authors only include a <160 as the lowest, the linear analysis of SBP and Rankin Score shows a direct correlation going as low as 130-139mmHg, therefore the authors conclude that 130-139mmHg for SBP is the optimal range for management of patients with ICH.
The study is a post-hoc analysis of a previous large study (open and unblinded) making no ...
Source: Life in the Fast Lane - June 23, 2016 Category: Emergency Medicine Authors: Soren Rudolph Tags: Clinical Research Education Emergency Medicine R&R in the FASTLANE Resuscitation Trauma Clinical Case critical care research and reviews Source Type: blogs
LITFL Review 221
Welcome to the 221st 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
Sepsis-3 is released, and a fantastic 7 minute vodcast from JAMA on their new consensus definitions for sepsis and septic shock. [SL] Here’s 40 minutes of sepsis goodness–iTunes interviews with the authors. [SO]
This is discussed by many ...
Source: Life in the Fast Lane - February 28, 2016 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs
