Research and Reviews in the Fastlane 191
This article has spawned a lot of controversy. It is worth reading to understand why. Recommended by: Justin Morgenstern Emergency Medicine Samuels EA, et al. “Sometimes You Feel Like the Freak Show”: A Qualitative Assessment of Emergency Care Experiences Among Transgender and Gender-Nonconforming Patients. Annals of emergency medicine. 2017. PMID: 28712604 This is a qualitative study of transgender patients who visited an ED in the US. This article is a must read as providers often lack insight into the complexities of caring for transgender patients and systemic barriers to conscientious care. T...
Source: Life in the Fast Lane - January 10, 2018 Category: Emergency Medicine Authors: Justin Morgenstern Tags: Emergency Medicine Gastroenterology R&R in the FASTLANE Respiratory Resuscitation EBM Education recommendations research and reviews Source Type: blogs

Funtabulously Frivolous Friday Five 206
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old fashioned medical trivia FFFF…introducing Funtabulously Frivolous Friday Five 206. Question 1 What condition is Ewart on the left, Conner on the right and when those two disappear Bamberger is present? + Reveal the Funtabulous Answer expand(document.getElementById('ddet626308324'));expand(document.getElementById('ddetlink626308324'))...
Source: Life in the Fast Lane - September 22, 2017 Category: Emergency Medicine Authors: Neil Long Tags: Education akathisia Bamberger's sign Bertolotti's syndrome chlorine urine Conner's sign Ewart's sign gaetan dugas Hawkinsinuria low back pain patient zero Source Type: blogs

Another Case of Vomiting
​A 26-year-old man presented to the emergency department with nausea, vomiting, and abdominal pain. He said he had had the pain, which he said encompassed his entire abdomen, for three days.​He had been unable to tolerate anything by mouth. His vitals on presentation included a heart rate of 115 bpm, blood pressure of 126/70 mm Hg, respiratory rate of 22 bpm, and pulse oximetry of 100% on room air.Physical examination revealed dry mucus membranes, dry skin, tachycardia without murmurs, and clear lungs. Abdominal examination demonstrates hyperactive bowel sounds without pain on palpation or hepatosplenomegaly. The patie...
Source: The Tox Cave - December 1, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

An open letter to Heather Bresch: What is legal is not always ethical
Dear Ms. Bresch, I couldn’t help but notice the barrage of negative press you’ve received lately regarding the significant price increases in EpiPens. A 461 percent increase since 2007, to be exact. People who require this medication for themselves or their children are up in arms about spending over $600 for a twin pack of autoinjectors. Most of these people have life-threatening anaphylaxis if they are exposed to certain allergens. To them, whether or not they have an EpiPen could mean life or death. Now, I don’t want to bore you with the medical stuff. You are not a clinician; you are a business woman....
Source: Kevin, M.D. - Medical Weblog - September 3, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/anonymous" rel="tag" > Anonymous < /a > Tags: Meds Medications Source Type: blogs

Research and Reviews in the Fastlane 142
This study demonstrated that very early administration (pre-hospital) did not change outcomes in terms of infarct size. There was also no reduction in ventricular dysrhythmias. Once again we see that earlier is not always better. Recommended by Anand Swaminathan The R&R iconoclastic sneak peek icon key The list of contributors The R&R ARCHIVE R&R Hall of famer You simply MUST READ this! R&R Hot stuff! Everyone’s going to be talking about this R&R Landmark paper A paper that made a difference R&R Game Changer? Might change your clinical practice R&R ...
Source: Life in the Fast Lane - July 13, 2016 Category: Emergency Medicine Authors: Jeremy Fried Tags: Cardiology Clinical Research Education Emergency Medicine Pediatrics R&R in the FASTLANE critical care EBM literature recommendations research and reviews Source Type: blogs

Research and Reviews in the Fastlane 130
In this study, valproate was less efficient and requiring more rescue medications compared to Ketorolac and Metoclopramide. It appears that valproate is not as helpful as a rescue medication as previously thought. Recommended by: Daniel Cabrera Emergency Medicine, Pre-Hospital/Retrieval Bhalla MC et al. Simple Triage Algorithm and Rapid Treatment and Sort, Assess, Lifesaving, Interventions, Treatment, and Transportation mass casualty triage methods for sensitivity, specificity, and predictive values. Am J Emerg Med 2015; 33(11): 1687-91. PMID: 26349777 If you haven’t been exposed to mass casualty triage befo...
Source: Life in the Fast Lane - April 13, 2016 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Airway Emergency Medicine Gastroenterology Intensive Care Pediatrics Pre-hospital / Retrieval EBM Education literature R&R in the FASTLANE recommendations research and reviews Resuscitation Source Type: blogs

T-wave inversion in a young woman with hyperventilation and carpopedal spasm
This case is another good one contributed by Brooks Walsh, with an excellent review.A 24 year-old African-American female presented to the ED with nausea and vomiting for 1 day. She also complained of paresthesias and cramping in her hands and wrists, as well as perioral paresthesias. She had no significant  personal or family medical history. Vitals signs and exam were remarkable only for hyperventilation with clear lungs, and bilateral carpopedal spasms.An ECG was obtained to assess the QTc prior to administering ondansetron:A bedside focused echocardiogram did not demonstrate overt septal or concentric hypertrophy....
Source: Dr. Smith's ECG Blog - January 13, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs

MKSAP: 60-year-old woman with gastroparesis
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 60-year-old woman is evaluated during a routine follow-up appointment. She has gastroparesis associated with long-standing type 2 diabetes mellitus. Improved blood sugar control and efforts to eat small, frequent meals did not result in symptom improvement. In addition to these interventions, metoclopramide was started 6 months ago, after which her nausea and periodic vomiting resolved. However, she has had some restlessness at night with the urge to repeatedly cross and uncross her legs. Several weeks...
Source: Kevin, M.D. - Medical Weblog - December 5, 2015 Category: Journals (General) Authors: Tags: Conditions Diabetes GI Source Type: blogs

I’m a stickler about words. And here’s why.
It’s metoprolol. m-e-t-o-p-r-o-l-o-l The nurse on the other end of the phone sighs as she tolerates my tirade regarding pronunciation. They all know that I am particular about such things. For metoprolol is neither metoclopramide or metolazone, and the difference could be life altering. 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)
Source: Kevin, M.D. - Medical Weblog - May 9, 2015 Category: Journals (General) Authors: Tags: Physician Hospital Source Type: blogs

Words
It's metoprolol.m-e-t-o-p-r-o-l-o-lThe nurse on the other end of the phone sighs as she tolerates my tirade regarding pronunciation.  They all know that I am particular about such things.  For metoprolol is neither metoclopramide or metalazone, and the difference could be life altering. I live in a world of words.  Trained in a language created to parse pertinent details.  Dysarthria or dysphagia?  Paroxysmal nocturnal dyspnea, dyspnea on exertion, or orthopnea? Each variant a spectrum of flavor.  A morsel chewed, swallowed, and digested into its basic parts to be rattled off in staccato sente...
Source: In My Humble Opinion - April 26, 2015 Category: Primary Care Authors: Jordan Grumet Source Type: blogs

IV valproate inferior for acute migraine
Friedman BW, Garber L, Yoon A, et al.  Randomized trial of iv valproate vs.metoclopramide v. ketorolac for acute migraine.  Neurology 2014; 82:976-983.   Authors randomized 330 patients in ER to get 1000 mg, 10 mg, or 30 mg of respective drugs above over an iv drip over 15 minutes in a double blind trial.  On the primary measure of pain relief, valproate lost big to the other two drugs.  On secondary measures of needing a rescue medication, iv valproate also lost.   Comment-- great to have this knowledge but the two winning drugs each had relatively low sustained headache relief, 4 v. 1...
Source: neurologyminutiae - April 18, 2015 Category: Neurology Source Type: blogs

Research and Reviews in the Fastlane 071
Welcome to the 71st 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 - February 18, 2015 Category: Emergency Medicine Authors: Soren Rudolph Tags: Education Emergency Medicine Neurosurgery Pediatrics Resuscitation Trauma critical care examination Intensive Care R&R in the FASTLANE research and reviews Source Type: blogs

Research and Reviews in the Fastlane 053
This study combines the results from the WARFASA and ASPIRE trials looking at aspirin prophylaxis. The results are promising. Aspirin 100 mg reduced the rate of recurrent VTE from 7.5%/year to 5.1%/year (HR = 0.68) without a significant change in bleeding rate (0.5%/year vs 0.4%/year). We often see patients in the ED with a history of unprovoked VTE who are on no long-term prophylaxis. This article argues that we consider aspirin for all these patients. Recommended by: Anand Swaminathan Trauma Stevens AC, Trammell TR, Billows GL, Ladd LM, Olinger ML. Radiation Exposure as a Consequence of Spinal Immobilization and Extri...
Source: Life in the Fast Lane - October 14, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Alternative Medicine Anaesthetics Cardiology Education Emergency Medicine Haematology Intensive Care Neurology Pediatrics R&R in the FASTLANE Respiratory Resuscitation Toxicology and Toxinology Trauma critical care literature Source Type: blogs

Cases: Second-Line Anti-emetic Therapies for Refractory Chemotherapy-Induced Nausea and Vomiting (CINV)
Discussion:Nausea and vomiting (NV) are commonly reported side effects with chemotherapy.1 The primary pathway for NV involves the chemotherapy drugs directly stimulating the chemoreceptor trigger zone (CTZ), in the area postrema at the base of the fourth ventricle. Activated receptors in the CTZ transmit signals to the vomiting center in the brainstem to produce NV. Receptors in the CTZ include serotonergic receptor 5-hydroxytryptamine type 3 (5-HT3), dopaminergic (D2) and neurokinin type 1 (NK-1) receptors. In addition, chemotherapy can damage GI mucosa causing local release of 5-HT3 neurotransmitters by gut enterochrom...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 25, 2014 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Gastroparesis Awareness Month: A Day In The Life
This is my second post for Gastroparesis Awareness Month.  Read my first post, Tube Love, here.  My first post was a love poem to my feeding tube.  :-)  My second one is a little more serious and a lot longer.  I apologize for the length.  I have trouble reading lengthy posts myself.  But sometimes I’m incapable of summarizing myself, so I have to write posts that are too long for even me to read.  I hope you’ll at least be able to skim through the important parts.  I’ve tried to break up the text with lots of photos, to see if that helps any. A DAY IN THE LIFE...
Source: Ballastexistenz - August 23, 2014 Category: Autism Authors: Mel Baggs Tags: Adrenal insufficiency Aspiration pneumonia Bronchiectasis Education Feeding tube Food Gastroparesis Life Skills Medical Medical stuff Personal history Treatment adult tubie adult tubies awareness awareness months bipap ce Source Type: blogs

The Role Of Black Box Warnings In Safe Prescribing Practices
TweetNote: In addition to Lara Maggs, Aaron Kesselheim also coauthored this post.  In the Health Affairs article, “Era of Faster Drug Approval Has Also Seen Increased Black-Box Warnings and Market Withdrawals,” published in the August issue, Cassie Frank and coauthors compare the number of approved prescription drugs that received black-box warnings or were withdrawn from the market for safety-related reasons prior to the 1992 Prescription Drug User Fee Act (PDUFA) with black-box warnings and safety-related withdrawals in the post-PDUFA era. PDUFA for the first time authorized FDA to collect user fees...
Source: Health Affairs Blog - August 20, 2014 Category: Health Management Authors: Lara Maggs and Aaron Kesselheim Tags: All Categories Bioethics Patient Safety Pharma Policy Public Health Source Type: blogs

Research and Reviews in the Fastlane 035
This study suggests that antiemetics are not nearly as potent as widely believed. These drugs have been shown to be effective in preventing nausea (i.e. pretreatment for chemo) but it’s appears that the mechanism for halting nausea is different than that for preventing it. Recommended by: Anand Swaminathan Read More: Nausea? We’ve Got Placebo for That The Best of the Rest Emergency Medicine, Pulmonary 1. Kew KM, Kirtchuk L, Michell C. Intravenous magnesium sulfate for treating adults with acute asthma in the emergency department. Cochrane Database Syst Rev. 2014 May 28;5 PubMed ID: 24865...
Source: Life in the Fast Lane - June 18, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Anaesthetics Cardiology Emergency Medicine Evidence Based Medicine Featured General Surgery Intensive Care Palliative care Pediatrics Respiratory Resuscitation Trauma critical care literature R&R in the FASTLANE recommendatio Source Type: blogs

Research and Reviews in the Fastlane 035
This study suggests that antiemetics are not nearly as potent as widely believed. These drugs have been shown to be effective in preventing nausea (i.e. pretreatment for chemo) but it’s appears that the mechanism for halting nausea is different than that for preventing it. Recommended by: Anand Swaminathan Read More: Nausea? We’ve Got Placebo for That The Best of the Rest Emergency Medicine, Pulmonary 1. Kew KM, Kirtchuk L, Michell C. Intravenous magnesium sulfate for treating adults with acute asthma in the emergency department. Cochrane Database Syst Rev. 2014 May 28;5 PubMed ID: 24865...
Source: Life in the Fast Lane - June 18, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Anaesthetics Cardiology Emergency Medicine Evidence Based Medicine General Surgery Intensive Care Palliative care Pediatrics Respiratory Resuscitation Trauma critical care literature R&R in the FASTLANE recommendations resear Source Type: blogs

Cases: "Am I really going to have to live like this?": The Role of Octreotide in Patients with Persistent Nausea and Vomiting after Venting Gastrostomy
Discussion:Malignant bowel obstruction can occur with any cancer but is most commonly associated with advanced ovarian cancer, where it occurs in up to 50% of patients. It generally indicates a poor prognosis and carries a heavy symptom burden predominated by nausea, vomiting and abdominal pain. Patients with carcinomatosis, like Ms BB, are generally not candidates for surgical correction of the obstruction or endoscopic stenting. Fortunately, medical management can be very effective. Abdominal pain is treated with opioids and nausea is treated with metoclopramide in partial obstructions and haloperidol in complete obstruc...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 10, 2014 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Buy Codeine Online for cough, fever, pain and diarrhea
If you are staying anywhere in UK then there’s good news for you. You can buy codeine from the internet and this is really quite simple. You just got to have a computer at home from where you can opt for online buying option and in this way you can get the desired medication and in this case codeine at your door steps. Also, the online deal would be a bit cheaper as compared to the offline option. There are many problems that can be treated with the help of codeine. Just go through the information given below and you will understand how useful codeine is. Codeine is useful for many health issues Lots of studies have ...
Source: Mental Nurse - December 26, 2013 Category: Nurses Authors: Iqcguest Tags: Health amily planning cough drug interactions fever pain and diarrhea Source Type: blogs

Acupuncture is a theatrical placebo: the end of a myth
Conclusions It is clear from meta-analyses that results of acupuncture trials are variable and inconsistent, even for single conditions.  After thousands of trials of acupuncture, and hundreds of systematic reviews (Ernst et al., 2011), arguments continue unabated.  In 2011, Pain carried an editorial which summed up the present situation well. “Is there really any need for more studies? Ernst et al. (2011) point out that the positive studies conclude that acupuncture relieves pain in some conditions but not in other very similar conditions. What would you think if a new pain pill was shown to relieve muscu...
Source: DC's goodscience - May 30, 2013 Category: Professors and Educators Authors: David Colquhoun Tags: Academia acupuncture badscience Bait and switch quackademia CAM quackery Source Type: blogs

Cases: Transdermal Granisetron for Refractory Nausea and Vomiting
Discussion: There were many factors that likely contributed to the dramatic improvement in Ms Emma N’s refractory nausea and vomiting. Better psychiatric care through the palliative care psychologist and psychiatrist almost certainly played a role in her overall clinical turn-around. The close attention, serial visits and supportive counseling she received in the Palliative Care clinic could also have been therapeutic. Up-titration of her olanzapine also likely was helpful. Olanzapine is an atypical antipsychotic that works on multiple receptors including dopaminergic, serotonergic, adrenergic, histaminergic and musc...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 1, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Transdermal Granisetron for Refractory Nausea and Vomiting
Discussion: There were many factors that likely contributed to the dramatic improvement in Ms Emma N’s refractory nausea and vomiting. Better psychiatric care through the palliative care psychologist and psychiatrist almost certainly played a role in her overall clinical turn-around. The close attention, serial visits and supportive counseling she received in the Palliative Care clinic could also have been therapeutic. Up-titration of her olanzapine also likely was helpful. Olanzapine is an atypical antipsychotic that works on multiple receptors including dopaminergic, serotonergic, adrenergic, histaminergic and musc...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 1, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs