Chest pain relieved by Maalox and viscous lidocaine
An otherwise health male in his early 40's presented with "burning" in his epigastrium that radiated to his throat and was relieved with Maalox and lidocaine. He had an ECG recorded:Sinus Rhythm. This was read as normal by the emergency physician and by the computer. QTc is 400 ms. What do you think? See below.There are a few subtle signs of coronary occlusion here. First, look at V4-V6. The T-wave is almost as tall as the R-wave. This should not be. Here is a normal relationship:Second, look at aVL. It has a massive T-wave compared to the size of the QRS. T...
Source: Dr. Smith's ECG Blog - December 23, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
Lumbar Puncture: Golden Rules
We feel it is extremely important to highlight some golden rules and additional pearls after our recent lumbar puncture series. (Read the first two articles about positioning and technique at http://bit.ly/1zRSOdC and http://bit.ly/1wY8MiJ.) These tips will help you ensure the best outcome for your patients.
Be Prepared
§ Be aware that patients will be anxious.
□ Spend dedicated time reviewing the procedure and informed consent.
□ Make sure that they feel only the lidocaine injection.
□ Most patients will do better with Versed as long as there are no contraindications.
§ Be prepared for patients ...
Source: The Procedural Pause - December 5, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Lumbar Puncture: Golden Rules
We feel it is extremely important to highlight some golden rules and additional pearls after our recent lumbar puncture series. (Read the first two articles about positioning and technique at http://bit.ly/1zRSOdC and http://bit.ly/1wY8MiJ.) These tips will help you ensure the best outcome for your patients.
Be Prepared
§ Be aware that patients will be anxious.
□ Spend dedicated time reviewing the procedure and informed consent.
□ Make sure that they feel only the lidocaine injection.
□ Most patients will do better with Versed as long as there are no contraindications.
§ Be prepared for pa...
Source: The Procedural Pause - December 5, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Wide Complex Tachycardia: Lewis Leads Do Not Differentiate VT from SVT with Aberrancy
An 83 yo complained of palpitations and dizziness and presyncope. He had a history of systolic heart failure with an EF of 40-45% and h/o coronary stents. He is on digoxin and coumadin for atrial fib. He denied chest pain or shortness of breath. EMS arrived and noted HR in the 170's. He was not in shock. There was no pulmonary edema. Mental status and blood pressure were normal.They recorded the following rhythm strips:V5A very wide complex regular tachycardia. By ECG alone (without considering pretest probability), the differential is VT vs. SVT with aberrancy vs. AVRT vs. ...
Source: Dr. Smith's ECG Blog - December 1, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
The people treating Ebola patients should be volunteers
I was recently injecting anesthetic into a boil for incision and drainage. The abscess swelled and returned an arcing spray of lidocaine laden with blood and pus, soaking the thigh of my cotton scrub pants. A cheap plastic gown would have protected me — I usually wear one. But I couldn’t find one and had other tasks waiting. My mind went to Ebola and exposed nurse necks.
What if this were my hospital’s first Ebola patient, who also happened to have an abscess in need of treatment?
Continue reading ...
Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find ...
Source: Kevin, M.D. - Medical Weblog - November 7, 2014 Category: Journals (General) Authors: Chris Porter, MD Tags: Conditions Infectious disease Source Type: blogs
Lumbar Puncture Made Simple
Part 2 of a Three-Part Mini-Series on Lumbar Puncture
This month we are back (no pun intended) with the second part of our mini-series focused on perfect patient positioning and lumbar puncture (LP). Part one can be found at http://bit.ly/ProceduralPause.
Now that you have the proper skills to position your patient for an LP, the procedure should be pretty simple, right? The answer is yes! We want you all to be experts. We know that you can and will master an LP after reading these short and sweet LP guidelines and clinical pearls.
Lumbar puncture in the emergency department.
Manual of Clinical Anesth...
Source: The Procedural Pause - November 3, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Lumbar Puncture Made Simple
Part 2 of a Three-Part Mini-Series on Lumbar Puncture
This month we are back (no pun intended) with the second part of our mini-series focused on perfect patient positioning and lumbar puncture (LP). Part one can be found at http://bit.ly/ProceduralPause.
Now that you have the proper skills to position your patient for an LP, the procedure should be pretty simple, right? The answer is yes! We want you all to be experts. We know that you can and will master an LP after reading these short and sweet LP guidelines and clinical pearls.
Lumbar puncture in the emergency department.
Manual of Clinical Anesthesiology;...
Source: The Procedural Pause - November 3, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Shire Corporate Integrity Agreement: New Payment Disclosure Requirements
We recently wrote about Shire’s $56.5 million settlement to resolve False Claims Act allegations involving the company’s ADHD drugs Adderall XR and Vyvanse. Shire agreed to a Corporate Integrity Agreement (CIA) with HHS-OIG in exchange for avoiding exclusion from participation in Medicare, Medicaid, or other Federal health care programs.
Shire’s agreement became effective September 15; view it here.
Shire’s CIA has similar requirements and structure to previous agreements, with some noteworthy changes, especially in the physician payment disclosure category. We have compared Shire’s CIA to the Agreements entered ...
Source: Policy and Medicine - October 20, 2014 Category: American Health Authors: Thomas Sullivan Source Type: blogs
Techniques that May Actually Save Your V-Fib Patient
Winning teams have depth, and games are often won from the bench or deep in the batting order. That is certainly true when competing against ventricular fibrillation, and a few tools you might not know can help these patients.
A 55-year-old man with severe coronary heart disease and previous four-vessel coronary artery bypass surgery collapsed at a mall. He also had an unprotected left main atherosclerotic plaque. Bystanders immediately began chest compressions, and the available AED, unfortunately, advised no shock.
Paramedics started bag-valve-mask ventilation and high-quality mechanical compressions with a Lucas devi...
Source: Spontaneous Circulation - October 1, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Techniques that May Actually Save Your V-Fib Patient
Winning teams have depth, and games are often won from the bench or deep in the batting order. That is certainly true when competing against ventricular fibrillation, and a few tools you might not know can help these patients.
A 55-year-old man with severe coronary heart disease and previous four-vessel coronary artery bypass surgery collapsed at a mall. He also had an unprotected left main atherosclerotic plaque. Bystanders immediately began chest compressions, and the available AED, unfortunately, advised no shock.
Paramedics started bag-valve-mask ventilation and high-quality mechanical compressions with a Lucas d...
Source: Spontaneous Circulation - October 1, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Positioning is Everything
Part 1 of a Mini-Series on Lumbar Puncture
We love breaking down and simplifying complicated procedures so you can perform them easily and efficiently. The next few blog posts will focus on strengthening your practice.
We want to give appropriate and safe care. We also want to consider patient satisfaction, dignity, and comfort when we complete any procedure. This month, we are focusing on procedures that require perfect patient positioning. Half the battle of any procedure is setting up your stage to perform, no matter how complex or simple the task at hand may be. Successful procedures are all about positioning and...
Source: The Procedural Pause - October 1, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Positioning is Everything
Part 1 of a Mini-Series on Lumbar Puncture
We love breaking down and simplifying complicated procedures so you can perform them easily and efficiently. The next few blog posts will focus on strengthening your practice.
We want to give appropriate and safe care. We also want to consider patient satisfaction, dignity, and comfort when we complete any procedure. This month, we are focusing on procedures that require perfect patient positioning. Half the battle of any procedure is setting up your stage to perform, no matter how complex or simple the task at hand may be. Successful procedures are all about positioning...
Source: The Procedural Pause - October 1, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Prolonged (63 minutes) Ventricular Fibrillation, Followed by Unusual Cardiogenic Shock
In this study, 5% of VF arrest was due to PE: V fib is initial rhythm in PE in 3 of 60 cases. On the other hand, if the presenting rhythm is PEA, then pulmonary embolism is likely. When there is VF in PE, it is not the initial rhythm, but occurs after prolonged PEA renders the myocardium ischemic.--Another study by Courtney and Kline found that, of cases of arrest that had autopsy and found that a presenting rhythm of VF/VT had an odds ratio of 0.02 for massive pulmonary embolism as the etiology, vs 41.9 for PEA. (Source: Dr. Smith's ECG Blog)
Source: Dr. Smith's ECG Blog - September 19, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
Public Disclosure Bar Blocks Recovery in Stryker False Claims Act Case
The U.S. Court of Appeals for the Eighth Circuit rejected a whistleblower suit against Stryker Corp. and other pain pump manufacturers because the allegations were based on information that had already been made public. The Court upheld the District Court in ruling that the plaintiff failed to pass the “public disclosure bar” necessary for whistleblowers to recover under the False Claims Act (FCA). Whistleblowers are able to share in the government's recovery when they are integral to the discovery of the fraud.
The Eighth Circuit referenced a frequently cited quote in its opinion, which describes the public dis...
Source: Policy and Medicine - September 16, 2014 Category: American Health Authors: Thomas Sullivan Source Type: blogs
A Very Wide Complex Tachycardia. What is the Rhythm? Use Lewis Leads!!
A patient with a history of severely reduced left ventricular function, renal insufficiency and atrial fibrillation presented with slight dyspnea, without chest pain or syncope.He had this initial ECG:There is a very wide, regular, QRS at 250 ms. There are no P-waves apparent. There are few isolated conditions which result in this. What is one?Here is the patient's previous ECG: There is a wide complex with a Left Bundle Branch Block morphology. There are no P-waves here either, so it appears to be a junctional rhythm. (The Differential Diagnosis would also include accelerated idioventricular ...
Source: Dr. Smith's ECG Blog - August 16, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
