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
Anorectal Procedures: Thrombosed Hemorrhoids
We are going to get up close and personal this month to talk about hemorrhoids. You should be familiar with these painful offenders because half to two-thirds of people between 45 and 65 will suffer from their cruelty. (Am Surg 2009;75[8]:635.) Patients may seek emergency department care if they experience bleeding or severe pain from hemorrhoids.Hemorrhoids are highly vascular structures that are round or oval in shape. They arise from the rectal and anal canal, and sometimes appear around the anus itself. It is important to note that hemorrhoids do not have arteries and veins but special blood vessels called sinusoid...
Source: The Procedural Pause - August 1, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Research and Reviews in the Fastlane 142
This study demonstrated that very early administration (pre-hospital) did not change outcomes in terms of infarct size. There was also no reduction in ventricular dysrhythmias. Once again we see that earlier is not always better.
Recommended by Anand Swaminathan
The R&R iconoclastic sneak peek icon key
The list of contributors
The R&R ARCHIVE
R&R Hall of famer You simply MUST READ this!
R&R Hot stuff! Everyone’s going to be talking about this
R&R Landmark paper A paper that made a difference
R&R Game Changer? Might change your clinical practice
R&R Eureka! Revolut...
Source: Life in the Fast Lane - July 13, 2016 Category: Emergency Medicine Authors: Jeremy Fried Tags: Cardiology Clinical Research Education Emergency Medicine Pediatrics R&R in the FASTLANE critical care EBM literature recommendations research and reviews Source Type: blogs
MKSAP: 86-year-old woman with pain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
An 86-year-old woman is evaluated in her assisted-living facility for pain. Four weeks ago, she developed herpetic lesions on her right posterior thorax in a T7 distribution. She was treated with acyclovir, and the lesions healed; however, she has persistent severe burning pain. The pain is so severe that she is unable to leave her bed to attend meals. Medical history is remarkable for hypertension, mild cognitive impairment, and osteoporosis. She ambulates short distances but uses a walker for longer distances....
Source: Kevin, M.D. - Medical Weblog - July 2, 2016 Category: Journals (General) Authors: mksap Tags: Conditions Neurology Source Type: blogs
Unity Farm Journal Fourth Week of April 2016
It’s Spring harvest time and we’ve been up at dawn gathering lettuce for delivery to Tilly and Salvy’s in Natick, our local farmstand. Tilly and Salvy’s is a fourth generation farm/farm stand and they have agreed to sell Unity Farm products including vegetables, mushrooms and our cider/mead. Our organic lettuces (bibb, boston, butter, romaine, winter density) are grown without pesticides, herbicides or chemicals of any kind on a bed of alpaca manure compost, peet and vermiculite. We picked them at 6am when the hoop house was 36F, hydrocooled them in 36F water, and delivered them to t...
Source: Life as a Healthcare CIO - April 21, 2016 Category: Information Technology Source Type: blogs
Research and Reviews in the Fastlane 131
This study only shows an association and not causality and will need further prospective studies to elucidate the truth. However, in the absence of better evidence, either agent appears reasonable as the first line but rocuronium has a number of advantages (absence of contraindications, longer paralysis).
Recommended by: Anand Swaminathan
Read More: Does Succinylcholine Increase Mortality in Severe TBI Patients? (UMEM Education Pearls), Rocuronium vs. Succinycholine (Core EM)
The R&R iconoclastic sneak peek icon key
The list of contributors
The R&R ARCHIVE
R&R Hall of famer You simply MUST READ th...
Source: Life in the Fast Lane - April 20, 2016 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Cardiology Education Emergency Medicine Gastroenterology Intensive Care LITFL Neurology Pre-hospital / Retrieval Resuscitation EBM literature R&R in the FASTLANE recommendations research and reviews Source Type: blogs
A Perfect Resuscitation Saves a Patient with Refractory Ventricular Fibrillation
This was contributed by Dr. Johanna Moore, one of my Hennepin Colleagues who researches CPR, along with Keith Lurie and Demetris Yannopoulos. She translated her research knowledge into a spectacular resuscitation.Case A 54 year old male presented via ambulance to the Emergency Department (ED) in cardiac arrest. He was found down outside a clinic, where bystander CPR was initiated by clinic staff. The amount of down time was unclear but thought to be minimal as this was a high traffic pedestrian area. He received an estimated 5 minutes of manual CPR, then, after medic arrival, 20 minutes of LUCAS CPR, including u...
Source: Dr. Smith's ECG Blog - April 16, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
STEMI with Life-Threatening Hypokalemia and Incessant Torsades de Pointes
Conclusions: In the select group of hypokalemic patients studied, potassium infusions of 20 to 40 mmol delivered over 1 hr were safe to administer and effectively increased serum potassium levels in a dosedependent and predictable fashion. Furthermore, these results were independent of the patient's underlying renal function or associated diuretic administration. (Crit Care Med 1991; 19:694)Concentrated Potassium Chloride Infusions in Critically Ill Patients with HypokalemiaThe Journal of Clinical Pharmacology. Volume 34, Issue 11, pages 1077–1082, November 1994Although concentrated infusions of pota...
Source: Dr. Smith's ECG Blog - April 7, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
Can I Get a Side of Fat with that Overdose?
An 88-year-old woman with a history of dementia presented with dizziness. Her daughter reported that she may have taken at least 12 tablets of diltiazem, which she mistook for her other medications. She is alert and oriented with normal vital signs. Her heart rate is 40 beats per minute and blood pressure is 70/45 mm Hg. Boluses of calcium gluconate and high-dose insulin therapy are initiated. The patient remains hypotensive at 80/40 mm Hg. Toxicology is consulted about intravenous lipid emulsion therapy.How does lipid emulsion therapy work?Two main theories describe the mechanism of action of intravenous lipid emulsion...
Source: The Tox Cave - April 1, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Ultrasound: Foreign Body Removal
Part 2 in a SeriesAre you ready for summer? That means more bare feet, flip-flops, and the potential for foreign bodies of the foot and toe. We will continue to highlight tools and tricks to help you master soft tissue foreign body removal in the emergency department. A refresher on the basics of ultrasound is available in our blog post from last month: http://emn.online/1UGtduz.Foreign bodies of the toe or foot are common presentations in emergency departments, and one way to determine the size and shape of retained superficial foreign bodies is to use ultrasound and the linear probe. This simple technique may hel...
Source: The Procedural Pause - April 1, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
LITFL Review 225
Welcome to the 225th 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
Never has Infectious Diseases sounded so interesting! This superb talk from Mark Crislip ‘The pus whisperer’ on the art of hunting out the offending organism! [SL]
Chris Hicks lays down some knowledge on making teams work: stress inoculation ...
Source: Life in the Fast Lane - March 27, 2016 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs
Should Fluoro be Your New Go-To?
Part Three in a Three-Part Series
This is the third and final part of our series on foreign bodies and fluoroscopy. Click here for part one and here for part two.
This month, we walk you through a step-by-step guide with bonus video footage to aid in your technique. This progressive procedure is absolutely significant to your practice, and we hope you all get a chance to try it.
The Approach
n Identification of foreign body on plain film or ultrasound
n Saphenous or posterior tibial nerve block
n Enlargement of the wound or entrance site using incision...
Source: The Procedural Pause - January 4, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
