A teenager with chest pain, a troponin below the limit of detection, and " benign early repolarization "
Sent by anonymous, written by Pendell MeyersA male in his teens presented with complaints of chest discomfort and dyspnea beginning while exercising but without obvious injury. He immediately stopped exercising and symptoms started to improve. Later that evening he felt recurrent central chest discomfort, shortness of breath, and vomited. Symptoms have been constant since this second episode, and are still present on arrival, which seems to have been less than 1 to 2 hours from onset of symptoms. No similar symptoms in the past. No prior exertional complaints of chest pain, dizziness, lightheadedness, or undue shortness of...
Source: Dr. Smith's ECG Blog - January 9, 2023 Category: Cardiology Authors: Pendell Source Type: blogs

Using Ultrasound for Paracentesis
​Paracentesis can be a quick and simple procedure with the right equipment and a well-rehearsed approach. It's important to practice this skill in the procedure lab and to familiarize yourself with the kit in your department a few times a year. This month, we focus on paracentesis set-up and basics, and next month we will review the nuts and bolts of completing the procedure.Important equipment for paracentesis: Five or six collection bottles, antiseptic prep, and a paracentesis kit. Consider longer needles for abdominal walls thicker than 2.5 cm.Grab the ultrasound and a pen. Position your patient at a 45-degree ang...
Source: The Procedural Pause - February 3, 2020 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Mallinckrodt Settles Anti-Competitive Practices Suit
Mallinckrodt and the Federal Trade Commission (FTC) recently agreed to settle allegations of raising drug prices and engaging in anti-competitive practices by paying a $100 million fine and allowing a competitor to produce a similar medication. The drug, H.P. Acthar Gel, is used to treat infantile spasms and multiple sclerosis. Mallinckrodt allegedly raised the price of the prescription from $40 per vial to over $34,000 per vial. According to New York Attorney General Eric Schneiderman’s office, Mallinckrodt’s United States subsidiary (Questcor) purchased the drug in 2001 and raised the price an estimated 85,000% over...
Source: Policy and Medicine - August 1, 2017 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

LITFL Review 271
LITFL: Life in the Fast Lane Medical Blog LITFL: Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog Welcome to the 271st LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chunk of FOAM. The Most Fair Dinkum Ripper Beauts of the Week Get your conspiracy theory on with The Poison Review team and their round up on what we know about ...
Source: Life in the Fast Lane - February 26, 2017 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

LITFL Review 271
LITFL: Life in the Fast Lane Medical Blog LITFL: Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog Welcome to the 271st LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chunk of FOAM. The Most Fair Dinkum Ripper Beauts of the Week Get your conspiracy theory on with The Poison Review team and their round up on what we know about ...
Source: Life in the Fast Lane - February 26, 2017 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

Medical errors are not the third leading cause of death
I read it again this week, and I wonder why the editors of our medical journals continue to perpetuating this falsehood. An article in a prominent journal stated again that medical errors are the third leading cause of death in the United States. We all know this is not the case, and yet editors continue to let this be stated in their journals as if it were fact. Ever since the offending article was published last year making this ridiculous claim, other authors have perpetuated it as if it were true. Yet it is painfully obvious to every practicing physician that it is not true. The top ten causes of death, according to th...
Source: Kevin, M.D. - Medical Weblog - February 13, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/cory-fawcett" rel="tag" > Cory Fawcett, MD < /a > Tags: Physician Malpractice Source Type: blogs

Mallinckrodt to Pay $100M to Settle Antitrust Violations
Conclusion The states of Alaska, Maryland, New York, Texas, and Washington joined in the FTC’s complaint. Under the settlement, the states will receive $10 million from the $100 million judgment and an additional $2 million as payment for attorney’s fees and costs. In a statement issued Wednesday, Mallinckrodt said, "We are pleased to confirm that we have entered into a settlement agreement with the FTC staff to fully resolve this matter, subject to approval by the commission. We will comment further at the appropriate time."       Related StoriesHistory Repeating – Is Insys a ...
Source: Policy and Medicine - January 30, 2017 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

MKSAP: 53-year-old woman with swelling of the face, hands, and feet
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 53-year-old woman is evaluated for a 3-month history of swelling of the face, hands, and feet. She has untreated hepatitis C virus infection. She takes lithium for bipolar disorder. She has no additional symptoms. On physical examination, temperature is normal, blood pressure is 134/93 mm Hg, pulse rate is 71/min, and respiration rate is 18/min. Bilateral periorbital edema and swelling of the hands and legs are noted. The remainder of the examination is unremarkable. Laboratory studies: Complete blood count...
Source: Kevin, M.D. - Medical Weblog - May 30, 2015 Category: Journals (General) Authors: Kevin Tags: Conditions Nephrology Source Type: blogs

A Fisherman’s Friend… or Foe?
aka Toxicology Conundrum 052 A 64 year-old male was brought in after a collapse at home. He had been sitting on the couch with his wife when she noticed that he had gone limp and was not breathing. Bystander CPR was performed for 15 minutes until ambulance crews arrived. He received 2x DC 200J shock for ventricular fibrillation, after which he had a return of spontaneous circulation, with HR 80 sinus rhythm, BP 90/60 and GCS 3. In the Emergency department he received 300mg Amiodarone, and cooling was commenced as per out of hospital cardiac arrest protocol at that time. He had a further episode of VF arrest soon after ar...
Source: Life in the Fast Lane - March 5, 2014 Category: Emergency Medicine Doctors Authors: Kylie McNamara Tags: Clinical Case Emergency Medicine Featured Intensive Care Toxicology Toxicology Quiz cardiac arrest ECG Glycyrrhizic acidm hypokalemia laboratory results licorice liquorice Source Type: blogs

The puzzling edema solved
The answers, both on this blog and on twitter, showed great thought processes. Here is how I discussed it with my team, and the data we used. The patient had peripheral edema, but had a good oxygen saturation and no dyspnea. We had a previous echocardiogram that showed very mild pulmonary hypertension, so we did not believe that this was the reason for worsening edema. Next I asked for an albumin level, and it was 2.9 down from 3.9 two weeks earlier. Why would the albumin be so low? Low albumin must be: 1. Decreased protein intake 2. Decreased albumin production (i.e., cirrhosis) 3. Increased losses – either urine...
Source: DB's Medical Rants - October 21, 2013 Category: Health Medicine and Bioethics Commentators Authors: rcentor Tags: Attending Rounds Source Type: blogs

Goodbye, nephrotic syndrome!
Joanna posted this intriguing and wonderful tale of nephrotic syndrome reversed with wheat elimination: No more nephrotic syndrome since starting Wheat Belly–this is MASSIVE. I need to share my story Dr Davis. I’m 30, I had heavy proteinuria [protein loss in the urine] for years. I went strictly wheat-free in July, 2012, and today I discovered its down to 0.5 g [per day]. No meds, just my interest in nutrition, in particular my 10 months on Wheat Belly. I’ve lost 20 kg [44 pounds], I weigh 54 kg [118.8 pounds] now, zero fluid retention, and the receptionist at the doctor’s office didn’t recogn...
Source: Wheat Belly Blog - May 16, 2013 Category: Cardiology Authors: Dr. Davis Tags: Wheat-elimination success stories Source Type: blogs

Oh, the Prices we Pay ... for Questionable Drug Marketing to Enrich Corporate Insiders - the Case of Questcor's H P Acthar Revisited
In 2007, we first discussed the case of the amazing pricing of H P Acthar, a very old drug of questionable usefulness, as an example of the irrationality of health care prices in the US, and of the failure of the organizations that ought to resist outrageous pricing in our mixed, pseudo-market based health care system to do so.  A recent New York Times article has updated this case.BackgroundAs we wrote in 2007, ACTH (adrenocorticotrophic hormone) is a naturally occurring hormone that stimulates the activity of the adrenal gland, which produces cortisol and other glucocorticoid and mineralocorticoid hormones. &nb...
Source: Health Care Renewal - January 3, 2013 Category: Health Medicine and Bioethics Commentators Tags: executive compensation deception institutional conflicts of interest key opinion leaders Questcor marketing health care prices manipulating clinical research ACTH suppression of medical research Source Type: blogs