My Difficult Airway
Looks can be deceiving. I was not supposed to have a difficult airway, but we found out the hard way that wasn’t true. I was about to undergo an exploratory laparotomy for suspected appendicitis in 1989, and my wife was adamant that an attending anesthesiologist perform my intubation. The anesthesiology resident at a large Midwest teaching hospital made a claim that I suspect many of us did as we advanced through training and began to feel procedurally invincible. He claimed that the attending anesthesiologist rarely did intubations, and that the residents who performed them daily were more prepared. Unaware of any uniqu...
Source: M2E Too! Mellick's Multimedia EduBlog - July 2, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
My Difficult Airway
Looks can be deceiving. I was not supposed to have a difficult airway, but we found out the hard way that wasn’t true. I was about to undergo an exploratory laparotomy for suspected appendicitis in 1989, and my wife was adamant that an attending anesthesiologist perform my intubation. The anesthesiology resident at a large Midwest teaching hospital made a claim that I suspect many of us did as we advanced through training and began to feel procedurally invincible. He claimed that the attending anesthesiologist rarely did intubations, and that the residents who performed them daily were more prepared. Unaware of any uniqu...
Source: M2E Too! Mellick's Multimedia EduBlog - July 2, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Battle of the Bulge: Olecranon Bursitis
Olecranon bursitis, also called baker’s or Popeye elbow, can be a painless or an irritating condition involving the bursa located near the proximal end of the ulna in the elbow over the olecranon. Normal bursae sacs generally are filled with a small amount of fluid, which helps the joint remain mobile. The sac can swell under the soft tissue from overuse or when the area sustains an injury from a bump or fall.
Normal bursae are usually small, but they can grow to be quite large, swollen, and occasionally even infected when they become irritated or inflamed. The swelling is obvious because the space in this area is l...
Source: The Procedural Pause - May 6, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Battle of the Bulge: Olecranon Bursitis
Olecranon bursitis, also called baker’s or Popeye elbow, can be a painless or an irritating condition involving the bursa located near the proximal end of the ulna in the elbow over the olecranon. Normal bursae sacs generally are filled with a small amount of fluid, which helps the joint remain mobile. The sac can swell under the soft tissue from overuse or when the area sustains an injury from a bump or fall.
Normal bursae are usually small, but they can grow to be quite large, swollen, and occasionally even infected when they become irritated or inflamed. The swelling is obvious because the space in this area is lim...
Source: The Procedural Pause - May 6, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Can You Avoid Lumbar Puncture in Febrile Neonates?
I don’t have a problem with lumbar punctures in febrile neonates. In fact, my son ended up with three lumbar punctures before aging out of the febrile seizure protocols. I do have a problem, however, with doing unnecessary spinal taps. The emotional stress of a neonatal LP on parents is significant, and the physical stress of the procedure on the infant is also substantial.
The pain of the needle and the unique restraint required for the procedure are also potentially problematic. The pain of the needle can be minimized by EMLA cream (eutectic mixture of local anesthetics [lidocaine and prilocaine]) and local anes...
Source: M2E Too! Mellick's Multimedia EduBlog - May 1, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Can You Avoid Lumbar Puncture in Febrile Neonates?
I don’t have a problem with lumbar punctures in febrile neonates. In fact, my son ended up with three lumbar punctures before aging out of the febrile seizure protocols. I do have a problem, however, with doing unnecessary spinal taps. The emotional stress of a neonatal LP on parents is significant, and the physical stress of the procedure on the infant is also substantial.
The pain of the needle and the unique restraint required for the procedure are also potentially problematic. The pain of the needle can be minimized by EMLA cream (eutectic mixture of local anesthetics [lidocaine and prilocaine]) and local ...
Source: M2E Too! Mellick's Multimedia EduBlog - May 1, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
The Pervasiveness of Health Care Corruption as Shown by Another Roundup of Legal Settlements
Legal settlements are one way to document unethical and even corrupt behavior by large health care organizations, even if they may not deter bad behavior in the future. It is time for another roundup of settlements by large pharmaceutical and device companies, presented in alphabetical orderAbbott LaboratoriesThis one goes back to late December, 2013. As described in the Chattanoogan (from Tennessee):Abbott Laboratories, a global healthcare company, has agreed to pay $5.475 million to settle alleged violations of the False Claims Act, and other federal laws and regulations in connection with the operation of ...
Source: Health Care Renewal - April 30, 2014 Category: Health Management Tags: Abbott antitrust Baxter Endo Health Solutions fraud Hospira kickbacks legal settlements Neurontin Pfizer restraint of competition RICO Source Type: blogs
Cockroach in the Ear
I took a surprisingly enjoyable course in medical entomology as an undergrad at Ohio State University. Admittedly, decades later, the only things I remember from that course are that only four of the 4500 species of cockroaches are classified as pests: the German, Asian, American, and Oriental cockroaches.
The majority of cockroach species live in their natural habitats in woods, tropical forests, or deserts, but these four have taken up residence with humans and have become serious pests. They may have distinctly cosmopolitan names, but it is believed that they all started in Africa. Their mouths can chomp through ca...
Source: M2E Too! Mellick's Multimedia EduBlog - April 2, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Cockroach in the Ear
I took a surprisingly enjoyable course in medical entomology as an undergrad at Ohio State University. Admittedly, decades later, the only things I remember from that course are that only four of the 4500 species of cockroaches are classified as pests: the German, Asian, American, and Oriental cockroaches.
The majority of cockroach species live in their natural habitats in woods, tropical forests, or deserts, but these four have taken up residence with humans and have become serious pests. They may have distinctly cosmopolitan names, but it is believed that they all started in Africa. Their mouths can chomp through card...
Source: M2E Too! Mellick's Multimedia EduBlog - April 2, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Incessant Regular Wide Complex Tachycardia
A male in his 50's presented after a witnessed syncopal episode. He reported multiple syncopal events over the last 1-2 months with increasing frequency, as well as recent fatigue. He had a remote history of in-hospital cardiac arrest during surgery. He had no anginal symptoms, no CP or SOB. Prehospital tracings were concerning for monomorphic sustained regular wide complex tachycardia with repeated runs of bigeminy, and no clear evidence of a current of injury.In the ED, he had VT on the monitor, and the following 12-lead ECG:There is a regular monomorphic wide complex tachycardia with no P-waves. The co...
Source: Dr. Smith's ECG Blog - March 11, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
Endo Health Solutions Lidoderm Settlement and Corporate Integrity Agreement, CME Obligations
Endo Health Solutions, Inc. and its subsidiary Endo Pharmaceuticals Inc. (Endo) have agreed to pay $171.9 million to resolve civil allegations of marketing their adhesive pain patch Lidoderm for off-label uses. As part of the settlement, Endo will enter into a Corporate Integrity Agreement (CIA) with the Department of Health and Human Services Office of Inspector General.
The Department of Justice (DOJ) announcement states: "[F]rom March 1999 through December 2007, Endo caused false claims to be submitted to federal health care programs…by promoting Lidoderm for unapproved uses, some of which were not medically accep...
Source: Policy and Medicine - March 11, 2014 Category: Health Medicine and Bioethics Commentators Authors: Thomas Sullivan Source Type: blogs
Cardiac Arrest: To the cath lab with ongoing chest compressions
CONCLUSION Beta-blockade should be considered in all patients with RVF in the ED prior to cessation of resuscitative efforts. (Source: Dr. Smith's ECG Blog)
Source: Dr. Smith's ECG Blog - February 28, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
Endo Health to Pay $192.7M in Settlement
Endo Health will pay almost $193 million to resolve claims that it improperly marketed the shingles treatment Lidoderm for unapproved uses like treating lower back pain.The Malvern, Pa., drugmaker will pay $171.9 million in civil false claims settlements largely to the federal government, with $34.2 million from that total going to 47 states and the District of Columbia. Endo also agreed to pay $20.8 million as part of a deferred prosecution agreement.Federal prosecutors said Friday that Endo Health Solutions Inc. marketed the drug for unapproved uses between 2002 and 2006.Endo said it was pleased to resolve the issue, and...
Source: PharmaGossip - February 24, 2014 Category: Pharma Commentators Authors: insider Source Type: blogs
Growing Wings: The Challenge of Teaching Our Trainees to Fly Out of the Nest in the Current Healthcare Environment
“Tombstones? Do the EKG changes look like tombstones?” were the first questions I asked my 4th year medical student subintern when he called me. I took a deep breath and tried to suppress the sick sensation in my abdomen when he answered, “Yes, I think so”. The moment of truth had transpired with the initial literal and figural spreading of my immediate post-intern wings. I’m not sure how my newly minted PGY-2 vessel actually transported itself from the housestaff quarters at the community hospital to the patient’s bedside but I think a business card handcrafted paper wings that were awarded to me in a ri...
Source: DB's Medical Rants - February 9, 2014 Category: Health Medicine and Bioethics Commentators Authors: Darilyn Moyer Tags: Medical Rants Source Type: blogs
Foreign Body to the Face and Facial Laceration Repair
Part 1 in a Series
Wound care and suture repair are two of the most frequently encountered issues in the emergency department. It is the midlevel provider’s job to be familiar with proper wound care and suturing techniques as well as quick and safe treatment of soft tissue skin injuries. You can use various suturing techniques and styles, but it is important to find a few that really work for you, often tailored to the area of injury.
This month, we are focusing on lacerations and puncture wounds to the soft tissue of the face. Future posts will touch on other suturing skills, with some great tips from our plastic surge...
Source: The Procedural Pause - January 31, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
