Research and Reviews in the Fastlane 129
This study looks at CMAC DL vs CMAC VL and found that 1st pass success rate was not statistically significantly different. The most important insights in this trial are in the discussion where the authors note a high number of protocol violations:
“This may demonstrate that emergency intubation is a dynamic process, and that plans may change second-to-second based on new information gained immediately before or during tracheal intubation.”
Airway management is a complex process and it’s unlikely that we’ll ever have a study looking at one particular facet that has a profound effect on success rates....
Source: Life in the Fast Lane - April 6, 2016 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Airway Cardiology Education Emergency Medicine Pediatrics Resuscitation EBM literature R&R in the FASTLANE recommendations research and reviews Source Type: blogs
CDC Chronic Pain Guidelines: Not so bad, but...
by Tom QuinnIn case you didn’t notice, the US Centers for Disease Control published their long-awaited (dreaded?) “CDC Guideline for Prescribing Opioids for Chronic Pain.” It made a pretty big splash: Five editorials plus the full Guideline in the online Mar 15 JAMA, front page New York Times feature article, the first hour on NPR’s “Diane Rehm Show,” (Mar 17) and multiple others. It is specifically aimed at primary care prescribers, who write about half of the scripts for opioids in the US. It is intended to “support clinicians caring for patients outside the context of active cancer care or palliative o...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 30, 2016 Category: Palliative Care Tags: CDC ethics opioids pain quinn The profession Source Type: blogs
DM / DNB Cardiology Entrance Mock Test 22
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Source: Cardiophile MD - March 21, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs
He couldn’t eat, drink or work. And doctors couldn’t explain his searing pain. - The Washington Post
Kim Pace was afraid he was dying. In six months he had lost more than 30 pounds because a terrible stabbing sensation on the left side of his face made eating or drinking too painful. Brushing his teeth was out of the question and even the slightest touch triggered waves of agony and a shocklike pain he imagined was comparable to electrocution. Painkillers, even morphine, brought little relief.
Unable to work and on medical leave from his job as a financial consultant for a bank, Pace, then 59, had spent the first half of 2012 bouncing among specialists in his home state of Pennsylvania, searching for help from doctors w...
Source: Psychology of Pain - March 16, 2016 Category: Anesthesiology Source Type: blogs
Research and Reviews in the Fastlane 126
This article is a well done, RDCT comparing non-dissociative dose intravenous ketamine (0.3 mg/kg) to intravenous morphine (0.1 mg/kg). The authors found no statistically significant difference between the two at 30 minutes. This data gives further credence to the use of ketamine for acute pain relief in the ED though it does not demonstrate superiority.
Recommended by Anand Swaminathan
Cardiology
Kim S, et al. Searching for answers to clinical questions using google versus evidence-based summary resources: a randomized controlled crossover study. Academic medicine : journal of the Association of American Medical Coll...
Source: Life in the Fast Lane - March 16, 2016 Category: Emergency Medicine Authors: Jeremy Fried Tags: Airway Cardiology Emergency Medicine R&R in the FASTLANE EBM Education literature recommendations research and reviews Source Type: blogs
DATA SIMPLIFICATION: Abbreviations and Acronyms
Over the next few weeks, I will be writing on topics related to my latest book, Data Simplification: Taming Information With Open Source Tools (release date March 17, 2016). I hope I can convince you that this is a book worth reading. Blog readers can use the discount code: COMP315 for a 30% discount, at checkout."A synonym is a word you use when you can't spell the other one." -Baltasar GracianPeople confuse shortening with simplifying; a terrible mistake. In point of fact, next to reifying pronouns, abbreviations are the most vexing cause of complex and meaningless language. Before we tackle the complexities of abbre...
Source: Specified Life - March 14, 2016 Category: Information Technology Tags: abbreviations acronyms complexity computer science data analysis data repurposing data simplification simplifying data Source Type: blogs
Louisiana Mother Knows 8 Vaccine Doses Killed Her 2 Month-Old Son
Two month-old Reid Thomas Englehart was vaccinated on May 20, 2015. He was given eight vaccine doses, which included the DTaP, Hib, polio, pneumococcal, hepatitis B and the oral rotavirus vaccines. These are the routine vaccines given to two month-old babies, even premature babies, in the United States and elsewhere. [1]
At the time of his appointment, Reid was still wheezing from a previous infection and still had a residual cough, but his doctor insisted it was fine to vaccinate him, after a test came back that Reid was negative for pertussis.
Nine days later, without a struggle and without any obstruction of his airways...
Source: vactruth.com - March 7, 2016 Category: Allergy & Immunology Authors: Augustina Ursino Tags: Augustina Ursino Case Reports on Vaccine Injury Human DTaP vaccine Hepatitis B vaccine HiB Pneumococcal conjugate (PCV7) Polio Vaccine Reid Thomas Englehart Rotavirus Vaccine Vaccine Death Source Type: blogs
Kay’s food addictions . . . gone
Kay shared her Wheat Belly experience over her first 4 weeks:
“After over 30 years of battling food addiction and morbid obesity, I had just about given up. You name it, I have tried it, even lap-band surgery which worked temporarily but, of course, did not solve the problem.
“Now, for the first time in my life, I am not struggling with food: I am not craving, obsessing, or even really thinking about food. I’ve been doing Wheat Belly about a month and am down about 20 pounds, but the most striking thing is that my desire to eat compulsively is GONE. I am utterly stunned by this.
“I can’t beg...
Source: Wheat Belly Blog - February 28, 2016 Category: Cardiology Authors: Dr. Davis Tags: Wheat Belly Success Stories addictions binge eating bulimia exorphins food addictions gluten grains opiates Source Type: blogs
Subacute STEMI. Should the patient go for emergent PCI, or can he wait until the next day?
This was sent by a very good medical student, who had a very good question. He wishes to remain anonymous.A 56 y/o male presented with Chest Pain radiating to the left jaw, starting at 8pm the previous night (15 hours prior), which was 10/10 at that time. He decided to wait it out at home, then presented at around 11 AM, pain now reported at 2/10. Here is the initial ECG (see the patient's previous ECG below for comparison):There is sinus rhythm and new inferior QS-waves with less than 1 mm of inferior ST elevation, and reciprocal ST depression in aVL, and T-wave inversion. Such T-wave inversion is common...
Source: Dr. Smith's ECG Blog - February 8, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
Apparent Pseudo-STEMI patterns are not necessarily Pseudo. Beware.
This was contributed by an ECG enthusiast who wishes to remain anonymous.LVH is a well-described “mimic” of STEMI. However, a diagnosis of LVH does not exclude an acute coronary occlusion, and the clinical context, including symptoms and old ECGs, must be taken into account.A 50 year-old woman came to the ED with recent-onset chest pain.:She had a history of hypertension, as well as concentric LVH on a very recent echo. Furthermore, she had markedly elevated systolic BP > 200 mm Hg.Her initial ECG:There is STE in lead III, < 1 mm, as well as STD with inverted T waves in leads I and aVL. This pattern of STE an...
Source: Dr. Smith's ECG Blog - February 5, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
The interview before transferring to a new doctor
Today I met a man who wanted to interview me before transferring his records.
He was about my age and seemed polite and pleasant enough. He told me his doctor of a dozen years had started to taper him off his long-term narcotics after he reported some of them missing because of theft. He used to take the equivalent of about 1,200 mg of morphine per day for his back pain. Our office classifies anything over 120 mg of morphine as a high-risk dose.
He left that practice and transferred his care to a hospital run clinic across his hometown. His next doctor at first prescribed him the medications, and then quickly begun taperin...
Source: Kevin, M.D. - Medical Weblog - February 3, 2016 Category: Journals (General) Authors: A Country Doctor, MD Tags: Physician Pain management Primary care Source Type: blogs
Brain Drain
I find it incredible that, buried in the common advice to consume more “healthy whole grains,” is advice to consume what is, in effect, a mind-active drug. Wheat and grain consumption have very real effects on the brain, thinking, and emotions, some of which are reversible, some of which are permanent. Many of the effects are due to the gliadin protein of wheat, rye, and barley. Dr. Alessio Fasano has mapped out the segments of the gliadin protein that, upon partial digestion (humans are incapable of complete digestion of this grass protein) yield the following peptides (protein fragments):
Red = direct cytotox...
Source: Wheat Belly Blog - January 26, 2016 Category: Cardiology Authors: Dr. Davis Tags: Wheat-Free Lifestyle adhd appetite bipolar Depression emotions gluten grains mind opiates schizophrenia Source Type: blogs
What Do We Know About Medical Errors Associated With Electronic Medical Records?
By ROSS KOPPEL
Recently, the Journal of Patient Safety published a powerful and important article on the role of EHRs in patient harm, errors and malpractice claims. The article is open access. Electronic Health Record–Related Events in Medical Malpractice Claims by Mark L. Graber, Dana Siegal, Heather Riah, Doug Johnston, and Kathy Kenyon.
The article is remarkable for several reasons:
Considerably over 80% of the reported errors involve horrific patient harm: many deaths, strokes, missed and significantly delayed cancer diagnoses, massive hemorrhage, 10-fold overdoses, ignored or lost critical lab results, ...
Source: The Health Care Blog - January 11, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
Opioid Drugs for Mental Anguish: Basic Research and Clinical Trials
The prescription opioid crisis of overdosing and overprescribing has reached epic proportions, according to the North American media. Just last week, we learned that 91% of patients who survive opioid overdose are prescribed more opioids! The CDC calls it an epidemic, and notes there's been “a 200% increase in the rate of overdose deaths involving opioid pain relievers and heroin.” A recent paper in the Annual Review of Public Health labels it a “public health crisis” and proposes “interventions to address the epidemic of opioid addiction” (Kolodny et al., 2015).In the midst of this public and professional outc...
Source: The Neurocritic - January 7, 2016 Category: Neuroscience Authors: The Neurocritic Source Type: blogs
Funtabulously Frivolous Friday Five 130
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…introducing Funtabulously Frivolous Friday Five 130
Question 1
Lady Windermere Syndrome (named after Oscar Wilde’s play) refers to infection of the right middle lobe of the lung (or lingula) with Mycobacterium avium complex (MAC) in elderly women. What predisposing activity does this eponym allude to?
+ Reveal the Funtabulous Answer
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Voluntary cough suppressio...
Source: Life in the Fast Lane - December 19, 2015 Category: Emergency Medicine Authors: Niall Hamilton Tags: Frivolous Friday Five Tocoloshe MAC exanthems heroin Rinderpest Mycobacterium avium complex Lady Windermere Syndrome Source Type: blogs
