Do you know about behcet ’s syndrome?
I was reading some medical records the other day and came upon a condition known as Behcet’s syndrome. It is actually a rare disease, but more frequent and severe in patients from the Eastern Mediterranean and Asia. Inherited (genetic) and environmental factors, such as microbe infections, are suspected to be factors that contribute to the development of Behcet’s. The syndrome is not proven to be contagious. The symptoms of Behcet’s syndrome depend on the area of the body affected. Behcet’s syndrome can involve inflammation of many areas of the body. These areas include the arteries that supply bloo...
Source: Nursing Comments - January 24, 2016 Category: Nursing Authors: Stephanie Jewett, RN Tags: Advice/Education Caregiving General Public Nursing/Nursing Students Patients/Specific Diseases Behcet's disease Behcet's syndrome cortisone genital ulcers inflammation mouth ucerations skin test Source Type: blogs

This is critical advice for doctors today: “You’ve gotta like your patients”
Although I didn’t think much of the statement when I first heard it from my residency director, now, nearly twelve years later, I realize its value.  I learned so much during those three years.  I learned to prepare for success prior to every procedure I started to avoid clumsily searching for needed equipment mid-procedure.  I learned what an eternity of time I gained during an intubation if I could be calm and conscientious enough to pre-oxygenate the patient.  I learned how to adjust the angle of the spinal needle when it met bone during a lumbar puncture.  I learned a lot about how to giv...
Source: Kevin, M.D. - Medical Weblog - November 19, 2015 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation
The post below originally ran on the Better Health blog on May 5th. It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately, one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors and had the courage to tackle the problem head-on. Three years ago, Avik Som organized “Problem Day” at his medical school (Washington University School of Medicine in St. Louis, MO) and invited his professors...
Source: Disruptive Women in Health Care - May 12, 2015 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Innovation Source Type: blogs

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation
People's Choice Winning Idea: NephroZip It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately, one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors and had the courage to tackle the problem head-on. Three years ago, Avik Som organized “Problem Day” at his medical school (Washington University School of Medicine in St. Louis, MO) and invited his professors to an unrestricted &ldq...
Source: Better Health - May 5, 2015 Category: American Health Authors: Dr. Val Jones Tags: Expert Interviews Research American Resident Project Collaboration DemoDay Engineers Healthcare Innovation IdeaLabs Medical Students Washington University School of Medicine Source Type: blogs

MKSAP: 30-year-old woman is evaluated for a 1-year history of fatigue
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 30-year-old woman is evaluated for a 1-year history of fatigue, headaches, poor sleep, depression, intermittently blurred vision, and weakness when climbing stairs. She takes no medication. Following a physical exam and lab studies, what diagnostic tests should be performed next? On physical examination, vital signs are normal. Bilateral ptosis and diplopia are noted, but funduscopy findings are normal. Strength testing reveals mild weakness of the hip flexors. Tendon stretch reflexes are normal, as ar...
Source: Kevin, M.D. - Medical Weblog - May 3, 2015 Category: Journals (General) Authors: Tags: Conditions Cancer Source Type: blogs

Research and Reviews in the Fastlane 075
Welcome to the 75th edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.This edition contains 7 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&...
Source: Life in the Fast Lane - March 19, 2015 Category: Emergency Medicine Authors: Jeremy Fried Tags: Cardiology Emergency Medicine Infectious Disease Neurology R&R in the FASTLANE Respiratory Toxicology and Toxinology literature recommendations research and reviews Source Type: blogs

Research and Reviews in the Fastlane 074
Welcome to the 74th edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.This edition contains 7 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&...
Source: Life in the Fast Lane - March 12, 2015 Category: Emergency Medicine Authors: Jeremy Fried Tags: Clinical Research Emergency Medicine LITFL R&R in the FASTLANE critical care literature recommendations research and reviews Trauma Source Type: blogs

Making it as a Midlevel among the Wolves
This spring, more advanced providers will be graduating from nurse practitioner and physician assistant programs than ever before. With that in mind, we want to take a break from procedures and focus on transitioning to becoming a provider.   If it were easy, everyone would be doing it. Always let the patient be your guide when you work in the emergency department. Don’t get hung up on workplace drama or fear of making a mistake. No one is perfect, and it will take time to find your niche. It is up to you to do a good job and seize the day, each and every day from here on out. We only hope we can help you find s...
Source: The Procedural Pause - February 18, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Making it as a Midlevel among the Wolves
This spring, more advanced providers will be graduating from nurse practitioner and physician assistant programs than ever before. With that in mind, we want to take a break from procedures and focus on transitioning to becoming a provider.   If it were easy, everyone would be doing it. Always let the patient be your guide when you work in the emergency department. Don’t get hung up on workplace drama or fear of making a mistake. No one is perfect, and it will take time to find your niche. It is up to you to do a good job and seize the day, each and every day from here on out. We only hope we can help you find...
Source: The Procedural Pause - February 18, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

EMA Journal October 2014
This study, by Yaylaci et al, analysed the accuracy and reliability of YouTube videos related to CPR, with reference to Resuscitation Guidelines 2010 Of the 209 videos assessed, only a small minority (n=24) were compatible with the 2010 Guidelines. ARC NSW Chair, Paul Middleton, advises that although well-designed videos can create awareness and be useful as tools in training, a properly accredited training course is the most appropriate means for people wanting to learn CPR [Media Release PDF]*NEW* CLINICAL PROCEDURES SECTION: Lumbar Puncture  (#FOAMed)This new section for EMA offers an adjunct to other training reso...
Source: Life in the Fast Lane - January 30, 2015 Category: Emergency Medicine Authors: Mike Cadogan Tags: Education EMA Journal LITFL ACEM clinical procedures CPR training discharge planning Incident reporting lumbar puncture trainee focus 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 contraindicat...
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 contrai...
Source: The Procedural Pause - December 5, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

In the midst of a lumbar puncture: Thinking of Stevie Nicks
Like most second-year medical students, I have the MP3 files of Goljan’s high yield pathology review lectures on my phone. Unlike most medical students, I rarely bring myself to listen to them, always opting for their Motown or punk counterparts instead. I often feel guilty about this — listening to them would make for more efficient car rides and walks home — but, as I learned while shadowing in the ER a few weeks ago, maybe listening to music can be important, too. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find ou...
Source: Kevin, M.D. - Medical Weblog - November 9, 2014 Category: Journals (General) Authors: Tags: Education Medical school Neurology 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 Ane...
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 Cli...
Source: The Procedural Pause - November 3, 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 positio...
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 pos...
Source: The Procedural Pause - October 1, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Research and Reviews in the Fastlane 036
This study found that a high percentage (49%) of patients with serious adverse outcomes after an ED visit for COPD were not initially admitted to the hospital. The authors used logistic regression to derive a decision instrument to aid in determining which patients with COPD exacerbation should be admitted based on risk stratification. The study does not show that admission improves outcomes but the instrument may prove useful for risk stratification if it is prospectively validated. Recommended by: Anand Swaminathan Emergency Medicine, Critical care, Anaesthetics Barends CRM ,Absalom AR. Tied up in science: unknotting ...
Source: Life in the Fast Lane - June 26, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Anaesthetics Emergency Medicine Evidence Based Medicine Featured Health Infectious Disease Intensive Care Respiratory Resuscitation critical care literature R&R in the FASTLANE recommendations research and reviews 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]) an...
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]...
Source: M2E Too! Mellick's Multimedia EduBlog - May 1, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Alzheimer's Association Awards Largest Ever Research Grant ($8 Million) To Expand The A4 Alzheimer's Prevention Trial
The Alzheimer's Association's goal with this award is to jump-start the development of new detection methods, treatments, and prevention strategies for Alzheimer's disease and other dementias.The Alzheimer's Association today announced its largest ever research grant – $8 million over four years – to support the Longitudinal Evaluation of Amyloid Risk and Neurodegeneration (LEARN) study as a companion study to the Anti-Amyloid Treatment in Asymptomatic Alzheimer's Disease (A4) Study, a pioneering Alzheimer's prevention trial that is starting this year.The grant was awarded to Reisa Sperling, M.D., M.M.Sc., prof...
Source: Alzheimer's Reading Room, The - March 11, 2014 Category: Dementia Authors: Bob DeMarco Source Type: blogs

Critical Care Compendium update
LITFL’s Critical Care Compendium is a comprehensive collection of pages concisely covering the core topics and controversies of critical care. Currently there are almost 1,500 entries with more in the works… Some pages are more developed than others, and all the pages are being constantly revised and improved. Links to new references and online resources are added daily, with an emphasis on those that are free and open access (FOAM!). These pages originated from the FCICM exam study notes created by Dr Jeremy Fernando in 2011, and have been updated, modified and added to since. As such will be partic...
Source: Life in the Fast Lane - November 17, 2013 Category: Emergency Medicine Doctors Authors: Chris Nickson Tags: Critical Care Compendium Education eLearning Emergency Medicine Featured CCC LITFL collection Source Type: blogs

Healthcare Update Satellite — 11-14-2013
See more news from around the web over at my other blog at DrWhitecoat.com An example of the downside to government-run health care. Patients in Venezuela can’t get proper medical care. 300 cancer patients were just sent home when supply shortages and “overtaxed equipment” made it “impossible … to perform non-emergency surgeries.” 70% of the radiation therapy machines are inoperable. Basic supplies such as needles, syringes, medications, operating room equipment, X-ray film, and blood needed for transfusions are all in short supply. There is no anesthesia for elective surgery. Patients ...
Source: WhiteCoat's Call Room - November 15, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

NICE fever guidelines for kids
Fever is the most common presentation to Paeds ED and it can be difficult to identify a focus.  This causes us (me anyway) a great deal of concern.  After 10 years in paediatrics it still is the one thing weighing at the back of my mind – how to identify the child with the life-threatening bacterial infection amongst all the viral illnesses.  NICE have updated their guidance in May 2013. Often, they make it easy for us.  Knowing how to recognise a sick child comes pretty early on in your paediatric experience.  It’s the ones that don’t look desperately sick that are tricky.  ...
Source: Life in the Fast Lane - May 28, 2013 Category: Emergency Medicine Doctors Authors: Tessa Davis Tags: Emergency Medicine Featured Pediatrics fever Guidelines NICE NICE guidelines paediatric Source Type: blogs

NICE fever guidelines for kids
Fever is the most common presentation to Paeds ED and it can be difficult to identify a focus.  This causes us (me anyway) a great deal of concern.  After 10 years in paediatrics it still is the one thing weighing at the back of my mind – how to identify the child with the life-threatening bacterial infection amongst all the viral illnesses.  NICE have updated their guidance in May 2013. Often, they make it easy for us.  Knowing how to recognise a sick child comes pretty early on in your paediatric experience.  It’s the ones that don’t look desperately sick that are tricky.  ...
Source: Life in the Fast Lane - May 28, 2013 Category: Emergency Medicine Doctors Authors: Tessa Davis Tags: Emergency Medicine Featured Pediatrics fever Guidelines NICE NICE guidelines paediatric Source Type: blogs

Papilledema and obstructive sleep apnea syndrome.
CONCLUSIONS: We propose that PE in SAS is due to episodic nocturnal hypoxemia and hypercarbia resulting in increased ICP secondary to cerebral vasodilation. In these individuals, intermittent ICP elevation is sufficient to cause persistent disc edema. These patients may be at increased risk for developing visual loss secondary to PE compared with patients with obesity-related pseudotumor cerebri because of associated hypoxemia. The diagnosis of SAS PE may not be appreciated because daytime cerebrospinal fluid pressure measurements are normal and because patients tend to present with visual loss rather than with sym...
Source: neurologyminutiae - April 12, 2013 Category: Neurologists Source Type: blogs

Proving a Negative
A young lady comes to the emergency department and wants to be evaluated for a … somewhat nonurgent … problem. Chief complaint: “I’ve lost 50 lbs in the past month.” She felt a little weak as well, but she had just lost too much weight. No other symptoms. The patient weighed 132 pounds. Her skin wasn’t sagging. Her jeans didn’t appear to be new and they seemed to fit pretty well. Nothing about her seemed abnormal on exam. But she insisted that she weighed 180 pounds just a month earlier. No old records in the computer. I asked her if she could show me a recent picture of herself ...
Source: WhiteCoat's Call Room - April 11, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Patient Encounters Policy Source Type: blogs

Papilledema pearls
  1. Cotton wool spots OFF disk may suggest hypertensive syndrome   2.  Hemorrhages off disc suggest central retinal vein occlusion   3.  New onset pulsatile tinnitus is significant finding indicating need to look for increased ICP, as well as transient obscurations, graying of vision for twenty seconds, with postural change and headache.  Field before acuity is affected, disc edema usually affected.   4.  MRI findings  may include disc enhancement, occassionally, enhanced perioptic space (40 %), flattening of posterior globe (80 %), empty sella  Get MRI/MRV   5....
Source: neurologyminutiae - April 9, 2013 Category: Neurologists Source Type: blogs

Increasing Success with Infant Spinal Taps
I think infant lumbar punctures are actually easier than spinal taps on older children and adults. Unfortunately, success, as measured by acquiring sparkling clear (nontraumatic) spinal fluid, is sometimes elusive. Twenty to thirty percent of spinal taps in the training setting, in fact, can be traumatic or unsuccessful. (Pediatr Emerg Care 2010;26[7]:487.) Three easy steps, however, can increase one’s odds for success.   Use Local AnesthesiaThe evidence shows that the success rate is improved when injected or topical anesthesia is used, but this practice is commonly ignored by practitioners. The literature clea...
Source: M2E Too! Mellick's Multimedia EduBlog - April 3, 2013 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Costs of Care essay contest winners
Neel Shah reports on the winners of the Costs of Care essay contest.  Recall the theme:"Preference will be given to stories that best demonstrate the importance of cost-awareness in medicine. Examples may include a time a patient tried to find out what a test or treatment would cost but was unable to do so, a time that caring for a patient generated an unexpectedly a high medical bill, or a time a patient and care provider figured out a way to save money while still delivering high-value care."All four essays are excellent, but I want to include one here by a patient, Erin Plute, from Emory University in Geo...
Source: Running a hospital - January 15, 2013 Category: Health Managers Source Type: blogs

chicken feet
i hate kalafong (hell). there are many reasons for this (here, here, here, here, here), most emotional, i confess. but if i am honest there is one incident that stands head and shoulders above the myriad of traumas that i experienced there. one of the strange idiosyncrasies of kalafong (hell) is that some time during each night shift, all the sisters of each ward get together in the duty room and eat chicken feet. i have no explanation for this. maybe there is an abundance of chicken feet in the area. maybe the sisters are paid in part with chicken feet that absolutely must be eaten before they leave for home after their ...
Source: other things amanzi - May 29, 2012 Category: Surgeons Authors: Bongi Source Type: blogs