Welcome to my World: Perpetual Alarm Fatigue
By HANS DUVEFELT, MD
Part of a series on primary care challenges and their solutions.
I missed a drug interaction warning the other day when I prescribed a sulfa antibiotic to Barton, a COPD patient who is also taking dofetilide, an uncommon antiarrhythmic.
The pharmacy called me to question the prescription, and I quickly changed it to a cephalosporin.
The big red warning had popped up on my computer screen, but I x-ed it away with my right thumb on the trackball without reading the warning. Quite honestly, I am so used to getting irrelevant warnings that it has become a reflex to bring the cursor to the spot where I can ...
Source: The Health Care Blog - August 15, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
Dyspnea and Convex ST elevation, Marked LVH, with Bedside Echos
Case 1.Chief complaint: A 60-something African American male with 5 days of increasing SOB with dyspnea on exertion.This male in his 60's has a PMH of CAD with MI and CABG, HTN with LVH, hyperlipidemia, and mild HF with only moderately reduced ejection fraction (and some diastolic dysfunction as well).He presents with 5 days of worsening shortness of breath with orthopnea as well as chest pain. His BP is 191/90. He also has a history of venous thromboembolism and has not been taking his anticoagulants. He was also off of his BP meds (lisinopril, amlodipine and carvedilol).Here is his ED ECG (ECG #1):...
Source: Dr. Smith's ECG Blog - July 13, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
MKSAP: 52-year-old woman with type 2 diabetes mellitus
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 52-year-old woman presents for follow-up evaluation after being diagnosed with type 2 diabetes mellitus 6 weeks ago. Her initial HbA1c level was 8.0%. Management at this time is with lifestyle modifications. She has worked closely with a diabetes educator and a nutritionist since her diagnosis. She has lost 3.2 kg (7 lb) by making changes to her diet and activity level. Review of her blood glucose log for the past 2 weeks shows preprandial blood glucose values in the 150 to 160 mg/dL (8.3-8.9 mmol/L) range and...
Source: Kevin, M.D. - Medical Weblog - June 25, 2016 Category: Journals (General) Authors: mksap Tags: Conditions Diabetes Endocrinology Source Type: blogs
The Black List Part II (Features Which Should Be In Every EHR, But For Some Reason Aren’t)
By HAYWARD ZWERLING, MD
I have been involved in HIT for 2.5 decades as a designer and primary programmer of a commercial EMR which I developed for my practice and was sold from 2000 until 2015. As a result of that experience, and 15 years of interactions with the physicians who used my EMR, I developed some insights about which features have real utility to the practicing physician and how to design an EMR so that it is efficient and intuitively obvious how to use the EMR. I have since learned that many of those useful features and design considerations have not been incorporated into all EMRs.
In my previous posting on Th...
Source: The Health Care Blog - June 19, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized The Black List Source Type: blogs
99306 CPT ® Code Description, Progress Notes, RVU, Distribution (Level 3 Initial Nursing Facility Care)
This 99306 CPT ® lecture reviews the procedure code definition, progress note examples, RVU values, national distribution data and explains when this code should be used in the nursing facility setting (nursing home). CPT stands for Current Procedural Terminology. This code is part of a family of medical billing codes described by the numbers 99304-99306. CPT ® 99306 represents the high (level 3) initial nursing facility care visit (whether you are the attending or a consultant) and is part of the Healthcare Common Procedure Coding System (HCPCS). This procedure code lecture for initial nursing facility ca...
Source: The Happy Hospitalist - May 7, 2016 Category: Internal Medicine Authors: The Happy Hospitalist Source Type: blogs
99306 CPT® Code Description, Progress Notes, RVU, Distribution (Level 3 Initial Nursing Facility Care)
This 99306 CPT® lecture reviews the procedure code definition, progress note examples, RVU values, national distribution data and explains when this code should be used in the nursing facility setting (nursing home). CPT stands for Current Procedural Terminology. This code is part of a family of medical billing codes described by the numbers 99304-99306. CPT® 99306 represents the high (level 3) initial nursing facility care visit (whether you are the attending or a consultant) and is part of the Healthcare Common Procedure Coding System (HCPCS). This procedure code lecture for initial nursing facility c...
Source: The Happy Hospitalist - May 6, 2016 Category: Internal Medicine Authors: Tamer Mahrous Source Type: blogs
99306 CPT ® Code Description, Progress Notes, RVU, Distribution (Level 3 Initial Nursing Facility Care)
< div dir="ltr" style="text-align: left;" trbidi="on" > This 99306 CPT ® lecture reviews the procedure code definition, progress note examples, RVU values, national distribution data and explains when this code should be used in the nursing facility setting (nursing home). & nbsp;CPT stands for Current Procedural Terminology. This code is part of a family of medical billing codes described by the numbers 99304-99306. & nbsp;CPT ® 99306 represents the high (level 3) initial nursing facility care visit (whether you are the attending or a consultant) and is part of the Healthcare Common Procedure Coding System (HCPCS). & nb...
Source: The Happy Hospitalist - May 6, 2016 Category: Internal Medicine Authors: Tamer Mahrous Source Type: blogs
MKSAP: 55-year-old man is evaluated following a screening for type 2 diabetes mellitus
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 55-year-old man is evaluated following a screening for type 2 diabetes mellitus. He is asymptomatic. He has a history of hypertension and hyperlipidemia. There is no history of anemia, liver disease, or kidney disease. Medications are lisinopril and rosuvastatin.
On physical examination, blood pressure is 123/76 mm Hg and pulse rate is 72/min. His body-mass index (BMI) is 28. The remainder of the examination is unremarkable.
Laboratory studies show hematocrit 45.6%, creatinine 1.0 mg/dL (88.4 µmol/L), fasting...
Source: Kevin, M.D. - Medical Weblog - April 23, 2016 Category: Journals (General) Authors: mksap Tags: Conditions Diabetes Source Type: blogs
Digitizing Self-Healthcare with Google, Pfizer, Under Armour, Walgreens and WebMD
How can digital technologies enable self-healthcare in novel ways? This was the theme of a meeting sponsored by Pfizer Consumer Healthcare and hosted by Google, with the title, “Advancing Consumer Health through New Technology and Next Generation OTC Healthcare” held on 12th April 2016 at Google offices in Manhattan’s Chelsea neighborhood.
Pharmaceutical brand drugs switching to over-the-counter packaged goods, the Cellscope Otoscope used by parents checking their young children’s earaches, connected shoes and earbuds for athletic enhancement, and omni-channel retail shopping….these are a few of the signals we s...
Source: Disruptive Women in Health Care - April 20, 2016 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Rx Source Type: blogs
MKSAP: 77-year-old woman with a left middle cerebral artery ischemic stroke
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 77-year-old woman is evaluated 4 months following a left middle cerebral artery ischemic stroke. The severity of her stroke required prolonged initial hospitalization and a 3-month stay in a rehabilitation center before returning home. Residual deficits include dense right-sided hemiparesis and dysphagia requiring oral feeding with thickened liquids. Medical history is otherwise significant for hypertension and diabetes mellitus. Current medications are aspirin, chlorthalidone, lisinopril, tolterodine, and ins...
Source: Kevin, M.D. - Medical Weblog - April 16, 2016 Category: Journals (General) Authors: mksap Tags: Conditions Neurology 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
Shared decision making is still the exception and not the rule
Joe had one of the best geriatricians in the city. So when he got a call from the pharmacist saying his new prescription was ready, he assumed that it had to do with his recent annual visit and blood draw. His suspicions were confirmed, a few minutes later, when he got through to the nurse at the office.
Joe was politely informed that he had high cholesterol and was being put on a statin. Although he hung up the phone satisfied and raced out to the pharmacy to pick up his new pills, a casual observer might find a few things concerning.
Neither the doctor nor the nurse actually talked to Joe about the significance of high...
Source: Kevin, M.D. - Medical Weblog - March 25, 2016 Category: Journals (General) Authors: Jordan Grumet, MD Tags: Physician Geriatrics Source Type: blogs
How Good Medicine Has Become The Exception
Joe had one of the best geriatricians in the city. So when he got a call from the pharmacist saying his new prescription was ready, he assumed that it had to do with his recent annual visit and blood draw. His suspicions were confirmed, a few minutes later, when he got through to the nurse at the office. Joe was politely informed that he had high cholesterol and was being put on a statin. Although he hung up the phone satisfied and raced out to the pharmacy to pick up his new pills, a casual observer might find a few things concerning.Neither the doctor nor the nurse actually talked to Joe about the significance of h...
Source: In My Humble Opinion - February 16, 2016 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
MKSAP: 59-year-old woman with continued substernal chest pain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 59-year-old woman is evaluated for continued substernal chest pain. She presented with exertional chest pain 6 months ago that occurred with minimal ambulation. She was evaluated with a stress nuclear medicine myocardial perfusion study that showed no ST-segment changes but a small area of inducible ischemia in the lateral area of the left ventricle and an ejection fraction of 45%. She was initially treated medically but has continued to have chest pain with exertion despite the addition of multiple antiangina...
Source: Kevin, M.D. - Medical Weblog - January 30, 2016 Category: Journals (General) Authors: mksap Tags: Conditions Heart Source Type: blogs
