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 are result...
Source: Kevin, M.D. - Medical Weblog - May 3, 2015 Category: Journals (General) Authors: mksap Tags: Conditions Cancer Source Type: blogs
Research and Reviews in the Fastlane 075
This study further defends the pathway of early discharge from the ED without evocative testing in subsets of patients with low risk chest pain.Recommended by Anand SwaminathanNeurology Edwards C, et al. Residency Training: A failed lumbar puncture is more about obesity than lack of ability. Neurology 2015; 84(10):e69-72. PMID: 25754807This is an interesting article exploring the reasons for LP failure. The authors reviewed all elective LPs done by Neurology residents in a LP clinic. They recorded all the demographic of the patient and the characteristics of the proceduralist. The overall LP failure rate was 19% and it w...
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
This study is further evidence that the HEART pathway is a safe approach to the management of low risk chest pain and decreases unnecessary health care utilization.Recommended by Anand SwaminathanThe Best of the Rest Resuscitation Sanghavi BS et al. Outcomes After Out-of-Hospital Cardiac Arrest Treated by Basic vs Advanced Life Support. JAMA Intern Med. 2015;175(2):196-204. PMID: 25419698The OPALS trial, published in 2004, demonstrated the lack of added benefit of ACLS over BLS in out-of-hospital cardiac arrest (OHCA). ACLS continues to be standard care despite repeatedly demonstrating improved ROSC without improved ...
Source: Life in the Fast Lane - March 11, 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 success...
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 success i...
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 resource...
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 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
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 out how. (...
Source: Kevin, M.D. - Medical Weblog - November 9, 2014 Category: Journals (General) Authors: Allison Goldberg 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 Anesthesiology;...
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 Anesth...
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 positioning...
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 and...
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 25, 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]) and local ...
Source: M2E Too! Mellick's Multimedia EduBlog - May 1, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
