What to do for stubborn low back pain
A while back, I covered the updated evidence-based treatment guidelines for acute (less than four weeks) and subacute (less than twelve weeks) low back pain. I promised a post on chronic (more than twelve weeks) back pain.
Well, as I write this, I am suffering from a recurrence of my own low back pain, which radiates down my right leg at times. This has been literally and figuratively a pain in my rear end, for years.
Being a doctor who practices what I preach, I am putting all the advice I dispense to good use.
First, look for possible triggers
This fall, I had gotten away from my regular core-strengthening routine (night...
Source: Harvard Health Blog - December 7, 2017 Category: Consumer Health News Authors: Monique Tello, MD, MPH Tags: Back Pain Health Pain Management Source Type: blogs
Items which should not be routinely prescribed in primary care: findings of consultation and next steps
NHS England - This paper outlines the findings of the public consultation in relation to the prescribing of 18 items considered to be of low clinical value. The paper also outlines the next steps following the findings of the consultation. Two evidence reviews on the effectiveness of homeopathy and lidocaine plasters accompany this report.ReportEvidence reviewsPress release (Source: Health Management Specialist Library)
Source: Health Management Specialist Library - December 1, 2017 Category: UK Health Authors: The King ' s Fund Information & Knowledge Service Tags: NHS finances and productivity Source Type: blogs
The cost of chronic pain
There is a saying that being poor is expensive. From personal experience, I know this to be true. But I think it also needs to be said that, especially in the United States, chronic illness can be quite expensive as well. In fact, there is a huge intersection between poverty and disability/illness. As with many intersections, it is a chicken-or-egg scenario, difficult to determine which is begetting which. But one thing is clear: there are often blind spots about these expenses in the medical community and how they can impact chronically ill people already struggling with finances.
Recently I attended a seminar on the topi...
Source: Harvard Health Blog - November 10, 2017 Category: Consumer Health News Authors: Laura Kiesel Tags: Health Health care Health policy Pain Management Source Type: blogs
Weird and Wild: Scalp Abscesses and Kerions
Welcome back to the weird and wild, "what do I do with that?" series! We want to take you back to the magical land of abscesses. This scalp abscess case study and Procedural Pause pearl will help you relieve significant pain and decrease the risk for skin infections and complications. This case made it to our weird and wild list for being rare and interesting.Scalp abscesses and kerions can be tricky and complicated. At first glance, they can appear small and harmless. They are often underappreciated for this reason, but require immediate attention. There are several types of wound infections and rashes tha...
Source: The Procedural Pause - November 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
My 14 Year Old Cancer Patient May Be Addicted to Opioids. What Do I Do?
By JULIE KIM, MD
I’m a pediatric oncologist, but cancer is not always the most serious problem my young patients face. Currently one of them, a 14-year-old boy, his mother, or both may be opioid addicts. I may be enabling their addiction.
Tragically, their situation is not unique. Adolescent patients are at risk for addiction from opioid pain medications just as adult patients are. But pediatric patients are overlooked in this war against opioid addiction. No policies protect them or those caring for them.
Usually pain is short-term, and only limited opioids are needed. Most providers, including those caring for children...
Source: The Health Care Blog - October 25, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Cancer Julie Kim Opioids Source Type: blogs
Cardiogenic shock with wide complex tachycardia and poor LV function in a young woman
A 30-something woman presented with CP and SOB. She was hypoxic and intubated. She had very poor LV systolic function on bedside echo. There were no B-lines and the RV was normal.The following ECG was recorded:Wide complex regular tachycardia at a rate of 140, no P-wavesWhat do you think?What do you want to do?This ECG was texted to me on my iPhonewithout any clinical information, with the question: " VT or SVT with aberrancy? "Here was my response:" Tough one, as they always are. Looks like SVT with LBBB (LBBB morphology strongly supports SVT). Lead aVR is all negative. I am going to s...
Source: Dr. Smith's ECG Blog - October 14, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
Wine Glass in the Foot: A Case Study
Emergency department providers welcome the weird, the wild, the wonderful, and the unexpected. Routine chest pain workups and negative abdominal CTs occasionally bore us. Last summer we had the pleasure of meeting a man who was a line cook at a local restaurant. He came via ambulance for a foreign body in his foot. What we saw was unanticipated—he arrived with half a wine glass lodged in the sole of his foot. The stemware was lodged in the patient's foot, going through his shoe and sock. Photos by Martha Roberts.The patient was laughing and not in much pain. He said he had a high pain tolerance and could barel...
Source: The Procedural Pause - October 2, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
30 yo woman with chest pain and a " normal ECG " by the computer, this one prehospital
This was sent by paramedics in the Northwest Ambulance Service in the UK. James Alameddine credits his partner, Gary Wilson.CaseA 30 year old woman complained of chest pain and called 911.She had a prehospital 12-lead ECG recorded:As you can see, the computer interpretation is " normal "What do you think?This very perceptive medic noticed that the T-wave in V4 is far too tall for the QRS. Very abnormal. But computers are not programmed to find all abnormalities, including many that are dangerous. This is this one.How about ST Elevation?There is (as the computer measures -- at the side) more than 1 mm of...
Source: Dr. Smith's ECG Blog - September 30, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
A Role for Magnetism in the ED
Children have this strange predilection for placing small objects in body cavities and orifices. Besides putting foreign bodies in their mouths, an act that often leads to ingestion or aspiration, the ear canals and nares are their favorite locations for depositing plastic beads, toy parts, paper materials, small vegetables, jewelry, screws, and nails, and that frequently brings them to the emergency department. Unsuccessful attempts to remove the foreign bodies in the ED lead to a consultation or referral to an ENT specialist. The timing, technique, and tools used to remove a foreign body will depend on the anatom...
Source: M2E Too! Mellick's Multimedia EduBlog - September 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Losing (and Regaining) Your Grip
Tennis elbow, also known as lateral epicondylitis, is a painful and persistent problem that can be transient or chronic. The syndrome is caused by overuse of the elbow, although not always caused by one too many games of tennis.Lateral epicondylitis is an inflammation of the tendons that join the forearm muscles to the outside of the elbow. Overused and abused tendons can be damaged or even destroyed. Performing the same repetitive motions over and over again can irritate and annoy the tendons, resulting in severe pain, tenderness, and even inability to use the affected extremity.Many treatments are available for latera...
Source: The Procedural Pause - August 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Losing (and Regaining) Your Grip
Tennis elbow, also known as lateral epicondylitis, is a painful and persistent problem that can be transient or chronic. The syndrome is caused by overuse of the elbow, although not always caused by one too many games of tennis.Lateral epicondylitis is an inflammation of the tendons that join the forearm muscles to the outside of the elbow. Overused and abused tendons can be damaged or even destroyed. Performing the same repetitive motions over and over again can irritate and annoy the tendons, resulting in severe pain, tenderness, and even inability to use the affected extremity.Many treatments are available for latera...
Source: The Procedural Pause - August 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Summer Safety: How to Treat Your Child ’s Sunburn
Pool time and outdoor play may increase your child’s chance for developing sunburn. Here are some tips from the experts at the University of Maryland Children’s Hospital on the best way to treat your child.
What causes sunburn?
Sunburn appears within 6 to 12 hours after the skin is exposed to ultraviolet (UV) rays from the sun. Artificial light sources like sun lamps and tanning beds can also cause sunburns. The skin becomes red and painful, and swelling of the skin, tenderness and blisters can develop. Severe sunburn can also cause nausea, chills and malaise (“feeling sick”). The burned area remains red and pai...
Source: Life in a Medical Center - June 15, 2017 Category: Universities & Medical Training Authors: UMMC Tags: Children's Health risks skin sunburn sunscreen UV rays Source Type: blogs
