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 anes...
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., professor of...
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 particularly us...
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 can no longer get organ d...
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. Let’s be honest, at 4am, every hot...
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. Let’s be honest, at 4am, every hot...
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 ...
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 on...
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/M...
Source: neurologyminutiae - April 8, 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 clearly supp...
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 Georgia:The p...
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
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 shift....
Source: other things amanzi - May 29, 2012 Category: Surgery Authors: Bongi Source Type: blogs
