MKSAP: 32-year-old man with an intermittent pruritic rash
Test your medicine knowledge with the  MKSAP challenge, in partnership with the American College of Physicians. A 32-year-old man is evaluated for an intermittent pruritic rash of 8 years’ duration. Medical history is significant for mild persistent asthma. His only medications are an albuterol inhaler and an inhaled glucocorticoid. On physical examination, vital signs are normal. There […]Find jobs at  Careers by KevinMD.com.  Search thousands of physician, PA, NP, and CRNA jobs now.  Learn more. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - February 9, 2019 Category: General Medicine Authors: < span itemprop="author" > < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > < /span > Tags: Conditions Dermatology Source Type: blogs

Ask D'Mine: Bronchial Meds and Blood Sugar
Our weekly DiabetesMine advice column takes a question about how bronchial inhaler albuterol might impact diabetes management. (Source: Diabetes Mine)
Source: Diabetes Mine - February 1, 2019 Category: Endocrinology Authors: Wil Dubois Source Type: blogs

Teva ’s ProAir Digihaler FDA Approved to Monitor Asthma and COPD Treatment
Teva Pharmaceutical, based in Israel, landed the first FDA approval for a digital inhaler with built-in sensors. The ProAir Digihaler (albuterol sulfate 117 mcg) Inhalation Powder is indicated for people suffering from asthma & COPD as a way of preventing and treating bronchospasm, a tightening of the muscles that line the airways. The ProAir Digihaler monitors how it’s used and uploads the data to an accompanying smartphone app via Bluetooth wireless connectivity. Specifically, the device detects every time it has been use to administer treatment, as well as the inspiratory airflow during each inh...
Source: Medgadget - December 26, 2018 Category: Medical Devices Authors: Editors Tags: Cardiology Medicine Source Type: blogs

Found comatose with prehospital ECG showing " bigeminal PVCs " and " Tachycardia at a rate of 156 "
This patient with a history diabetes was found with a GCS of 4.Prehospital EKG and strips (not shown) had " heart rate 156 " (according to the computer interpretation) and " Bigeminal PVCs "The prehospital 12-lead looked just like the first ED ECG:What do you think?Answer: The " bigeminal PVCs " is really a QRS followed by a very narrow peaked T-wave, which was so narrow that it was mistaken for a separate QRS.  The heart rate is 78, not 156.  Notice also thevery long ST segment, most easily seen in inferior leads.This ECG is pathognomonic for severe hyperK, and the long ST segment i...
Source: Dr. Smith's ECG Blog - December 11, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs

Two cases of ST Elevation with Terminal T-wave Inversion - do either, neither, or both need reperfusion?
Written by Pendell Meyers with edits by Steve SmithI was sent these 2 ECGs with no clinical information other than chest pain:Do either or both of these ECGs show ischemic changes? If so, what should you do and why?Let's take them one at a time.What would your response be?I responded: " Awesome classic benign T wave inversion! That's the patient's baseline normal variant. ... But if it were a good story with exertional syncope or something you'd have to treat it like it could be HOCM, etc. Tell me more. "There is sinus rhythm with very large voltage and associated repolarization abnormalities. In V3-V6 there are ...
Source: Dr. Smith's ECG Blog - December 5, 2018 Category: Cardiology Authors: Pendell Source Type: blogs

AAP Bronchiolitis Guidelines a Mismatch with Clinical Practice
​I recently met with a group from our children's hospital to standardize the hospital management of bronchiolitis according to the latest American Academy of Pediatrics guidelines. (Pediatrics 2014;134[5]:e1474; http://bit.ly/2QIGbMX.) Unfortunately, these guidelines seem to cause confusion for experienced and inexperienced emergency physicians alike.This confusion comes from the guidelines raising unaddressed issues and new questions, most importantly not tackling important aspects of frontline clinical practice. These guidelines were developed with the best evidence currently available, and their application mostly cau...
Source: M2E Too! Mellick's Multimedia EduBlog - December 4, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Something Smells Fishy
​A 32-year-old woman and her 36-year-old husband with no past medical history presented to the ED with palpitations, headache, a feeling of warmth all over, and a rash extending from their upper chests to their faces.The blood pressures of the wife and husband were 91/56 mm Hg and 93/61 mm Hg, respectively. Both were mildly tachycardic with heart rates of 112 bpm and 108 bpm. The patients described intense pruritus, and they had patchy blanching and erythema over their chests and faces with mild eyelid edema. They reported that their symptoms started five to 10 minutes after sharing an ahi tuna poke bowl.What Is the...
Source: The Tox Cave - November 1, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Live the Wheat Belly lifestyle, get off prescription medications
Take a look at the list of medications people have been able to stop by following the Wheat Belly lifestyle. These represent medications prescribed by doctors to, in effect, “treat” the consequences of consuming wheat and grains. They prescribe drugs to treat inflammation, swelling, skin rashes, gastrointestinal irritation, high blood sugars, airway allergy, joint pain, high blood pressure, leg edema and other abnormal effects caused by wheat and grains. The list includes anti-inflammatory and pain medication, acid reflux drugs, injectable and oral drugs for diabetes, numerous anti-hypertensive agents, asthma i...
Source: Wheat Belly Blog - October 27, 2018 Category: Cardiology Authors: Dr. Davis Tags: News & Updates autoimmune blood sugar bowel flora cholesterol Gliadin gluten-free grain-free grains Inflammation undoctored Weight Loss wheat belly Source Type: blogs

Two cortisone stories involving Peekaboo and yours truly …
First, the news about Peekaboo. When I met with the vet a few days ago, he repeated that we wouldn’t be able to give her the current anti-inflammatory drug forever. Too bad, since she eagerly takes it in her wet food in the morning, and it seems to have no side effects. Oh well. He suggested I substitute it with a drug called Contramal, which is basically Tramadol, and with another one that contains quercetin (I checked it out, it’s okay, so she’s on that now). Tramadol is a different story. That’s the drug that Piccolo was on for some time last summer, and I am CONVINCED (although I have no proof, ...
Source: Margaret's Corner - September 7, 2018 Category: Cancer & Oncology Authors: Margaret Tags: Blogroll cortisone Medrol Source Type: blogs

12 Year Old Asthmatic with Intermittent Dyspnea Unresponsive to Albuterol---What is it, and Why Now?
This case was written by one of ourgreat Hennepin 2nd year residents, Aaron Robinson, with lots of comments and edits by Smith.Thanks to Dr. Smith and Dr. Travis Olives for being part of this case. A 12 year old girl with a history of mild intermittent asthma presented to the emergency department with worsening shortness of breath over the past couple of days. She is up to date on her vaccinations and has no PMHx besides asthma and a noncontributory family history. She does not identify any specific triggers for her asthma. Initial screen in triage revealed normal vitals signs and a normal temperature. Upon interviewi...
Source: Dr. Smith's ECG Blog - August 7, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs

An elderly woman found down with bradycardia and hypotension
Submitted by Alex Bracey, with edits by Pendell Meyers and Steve SmithA female in her 70s with PMH of hypertension, coronary artery disease, and a remote history of an aortic valve replacement was brought into the ED after being found down by her son. On arrival she was confused. Her initial ECG isshownbelow.What do you think? - Sinus bradycardia with HR of ~50 BPM (plus artifact that mimics PVCs) - Peaked T waves particularly visible in leadsV1-V3, I, and aVL - RBBB with QRS duration 152 ms (comparison to prior shows similar RBBB morphology but with QRS duration of 116 ms)In addition to being bradycardic as seen on this E...
Source: Dr. Smith's ECG Blog - June 6, 2018 Category: Cardiology Authors: Pendell Source Type: blogs

It isn ’ t plantar fasciitis after all …
On the recommendation of our GP, yesterday I went to one of Florence’s most famous chiropractors who is also a physiotherapist and an acupuncturist. I told him (and another female doctor who was there taking notes) my heel pain story. He asked me a few questions and then declared: “It’s not plantar fasciitis.” I was stunned. So what is it?, I asked. He gave me an exhaustive and detailed explanation, which, unfortunately, I remember only in bits and pieces. But here’s the gist: my heel pain turned out to be merely the final step of a series of events that began when I got new eyeglasses back in...
Source: Margaret's Corner - April 17, 2018 Category: Cancer & Oncology Authors: Margaret Tags: Blogroll cat allergy eyeglasses heel pain Source Type: blogs

Potato Poisoning (Not due to Solanine in greens!). With Positive Modified Sgarbossa Criteria.
In this study of consecutive patients with LBBB who were hospitalized and had an echocardiogram, 13% had a QRS duration greater than 170 ms, and only 1% had a duration greater than 190 ms.Clinical CourseThe clinicians recognized this as hyperkalemia.  The lab result was too high to measure (greater than 9.4 mEq/L).p.p1 {margin: 0.0px 0.0px 0.0px 0.0px; font: 11.0px Helvetica; background-color: #fefefe}The patient received albuterol x 6, calcium gluconate x 5 g, D50 (50 ml) x 2, 5 units regular insulin, 40 mg furosemide, and 50 mL of Na bicarb.It turns out he had been told several days earlier that his K was low a...
Source: Dr. Smith's ECG Blog - April 17, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs

A middle aged man with unwitnessed cardiac arrest
Written by Pendell Meyers, with edits by Steve SmithThanks to my attending Nic Thompson who superbly led this resuscitationWe received a call that a middle aged male in cardiac arrest was 5 minutes out. He was estimated to be in his 50s, with no known PMHx. He arrived with chest compressions ongoing, intubated, and being bagged. EMS report was that the patient had unknown down time with unwitnessed arrest, found initially in VFib arrest, defibrillated x1 followed by PEA arrest alternating with asystolic arrest during transport.He arrived in PEA arrest with a slow and wide cardiac waveform during initial rhythm check, with ...
Source: Dr. Smith's ECG Blog - April 6, 2018 Category: Cardiology Authors: Pendell Source Type: blogs

How hospitals can impact generic drug companies
The costs of many generic drugs have skyrocketed. In some cases, the price of a single pill has increased over 500 percent. But help may be on the way. Recently several large and respected non-profit hospital systems indicated that they will “fire a shot across the bow” of the generic drug business. That would be a game-changer. Why has the price of generics skyrocketed? Some large drug companies have purchased (or outcompeted) generic drug manufacturers. This has created a monopoly for some widely used and long-standing products, such as the EpiPen and the albuterol inhaler. In effect, the companies ...
Source: Kevin, M.D. - Medical Weblog - February 6, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mark-kelley" rel="tag" > Mark Kelley, MD < /a > Tags: Meds Hospital-Based Medicine Public Health & Policy Source Type: blogs

MKSAP: 75-year-old man with very severe COPD
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 75-year-old man is seen for routine follow-up for very severe COPD. He has constant dyspnea and air hunger and spends most of the day in a chair. He has had no change in baseline cough and sputum production. He has had multiple COPD exacerbations that required ICU admission and intubation. He has not benefited from pulmonary rehabilitation in the past. He quit smoking 3 years ago. His medical history is also notable for hypertension, type 2 diabetes mellitus, and a myocardial infarction 3 years ago. Hi...
Source: Kevin, M.D. - Medical Weblog - February 3, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Palliative Care Pulmonology Source Type: blogs

Drug price hikes sometimes have catastrophic effects on patients
When I found out my patient was in the hospital again for the third time in six months, I wondered why her asthma had flared. Was the cold weather bothering her? Was her treatment regimen inadequate? When I spoke with her, I discovered the heartbreaking truth: she had been limiting her albuterol inhaler use because she simply could not afford to take it as much as she needed. For many of the over 600,000 Massachusetts residents who suffer from asthma, albuterol is a necessity. Albuterol inhalers allow asthmatics to go about their lives without worrying about the threat of debilitating respiratory attacks. Un...
Source: Kevin, M.D. - Medical Weblog - November 9, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/zoe-tseng-and-suhas-gondi" rel="tag" > Zoe Tseng, MD and Suhas Gondi < /a > Tags: Meds Public Health & Policy Pulmonology Source Type: blogs

Test almost all of your most important ECG rhythm interpretation skills with this case.
Sent by Anonymous, written by Meyers, edits by Smith:A female in her 70s with history of HTN woke up around 2am with severe shortness of breath. EMS found the patient in moderate respiratory distress, hypoxemic on room air, with diffuse rales. CPAP was initiated. The prehospital ECG is unavailable but reportedly showed a wide complex regular tachycardia at around 150 bpm. 150mg amiodarone was given for presumed VT with no obvious effect.She arrived at the ED at 2:52 AM. She had normal mental status, and was in moderate respiratory distress with diffuse rales, with respiratory rate 30/min, and initial blood pressure 129/60....
Source: Dr. Smith's ECG Blog - October 26, 2017 Category: Cardiology Authors: Pendell Source Type: blogs

A Buggy Case
​A 35-year-old man with a history of asthma presented with an exposure after spraying his garage with an insecticide he bought at the hardware store. Shortly after spraying the insecticide, he noticed eye itchiness, tingling, pruritus over his arms and legs, and shortness of breath. His blood pressure was 130/85 mm Hg, heart rate 70 bpm, respiratory rate 14 bpm, temperature 98.7°F, and SpO2 96% on room air.​He was alert and anxious, his skin was warm with mild erythema, and he had urticaria over his forearms and ankles. His lung exam revealed diffuse wheezing bilaterally. His eyes were watery, and his pupils were 4...
Source: The Tox Cave - July 3, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

An interesting finding, and absence of another, in an intoxicated patient found down
CONCLUSION: Administration of subcutaneous terbutaline obviates the need for intravenous access and should be considered as an alternative to nebulized or inhaled beta-agonists to treat acute hyperkalemia in patients with CKD. As with the use of any beta-adrenergic agonist, close cardiovascular monitoring is necessary to avoid or minimize toxicity during therapy.Hypokalemic effects of intravenous infusion or nebulization of salbutamol in patients with chronic renal failure: comparative study.AULiou HH, Chiang SS, Wu SC, Huang TP, Campese VM, Smogorzewski M, Yang WC SOAm J Kidney Dis. 1994;23(2):266. To exami...
Source: Dr. Smith's ECG Blog - July 1, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs

‘Out-the-Door’ v. ‘Kitchen-Sink’ Asthma Management
​Are you one of those clinicians who frequently finds himself frustrated with asthma patients who improve to a point but not enough to discharge home? Even though this has to be a common problem, no one seems to talk or write much about it. I was feeling deeply frustrated about these patients, and it led me to serious clinical introspection. Why does everyone write about the crashing asthma patient, but hardly anyone addresses the problematic patient with improving but recalcitrant bronchospasm?Most articles typically cover every available therapeutic option, including the proverbial “kitchen sink” for managi...
Source: M2E Too! Mellick's Multimedia EduBlog - June 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Weakness and Hypotension, with Bradycardia.
This dialysis patient called 911 for weakness. Medics found the patient to be hypotensive and bradycardic.The patient was taking carvedilol and amlodipine, but denied overdose.The medics recorded this ECG:The medics were considering external pacing.What is a better initial therapy?The patient was stable enough that no therapy was needed, but the correct therapy would be IV Calcium. This ECG represents hyperkalemia until proven otherwise and, if it is due to hyperK, it will often respond immediately to calcium therapy.He arrived and had this ED ECG recorded:There are no visible P-waves. Rate is 35.There is a narro...
Source: Dr. Smith's ECG Blog - May 18, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs

Massive caffeine overdose: How does the ECG fit in?
This is the ECG of a patient with a massive caffeine overdose:What do you see?There is sinus tachycardia. There is some right axis deviation. There is ST depression withsagging ST segments in II, III, and aVF, and also in V5 and V6. There is what appears to be a very long QT (although the computer measured a QT of 357). This apparent long QT is a result of a large U-wave mimicking a T-wave. One should especially think of U-waves when the QT looks impossibly long. The sagging ST segments + U-wave give what I call a" wavy " appearance to the entire tracing, especially in lead II.I am n...
Source: Dr. Smith's ECG Blog - May 8, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs

The tricky thing about asthma
In mid-January, health headlines announced that nearly one-third of adults diagnosed with asthma don’t actually have this respiratory condition at all. This announcement appeared everywhere from Fox News Health to the Chicago Tribune. As a primary care doc, a medical writer, and an asthma sufferer, I was very skeptical of these dramatic announcements, and with good reason. An editorial that accompanied this study provides important perspective that suggests the news headlines were exaggerated and misleading. Taking a closer look at the study Let’s talk about the study, which is a good one, and has merit. Canadi...
Source: Harvard Health Blog - March 6, 2017 Category: Consumer Health News Authors: Monique Tello, MD, MPH Tags: Asthma and Allergies Lung disease Source Type: blogs

MKSAP: 67-year-old man with worsening exertional dyspnea
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 67-year-old man is evaluated for a 6-month history of worsening exertional dyspnea. He has a history of severe COPD diagnosed 4 years ago and previously had minimal exertional symptoms. However, he now notes shortness of breath when walking short distances that is limiting his activity level. He does not have chest pain, gastrointestinal symptoms, or sleep-related symptoms. Medical history is otherwise unremarkable. Medications are a twice-daily fluticasone/salmeterol inhaler and an as-needed albuterol...
Source: Kevin, M.D. - Medical Weblog - February 11, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Pulmonology Source Type: blogs

Notes to myself – 2
Pentobarb coma – BIS should be 10-20 and SR (suppression ratio) should be 70-80 Consider lev albuterol Should give vaccines after coiling of spleen or before if possible No calcium channel blockers post MI definitely and post op in general Toradol inhibits spine healing Don’t do endoscopes with patients in supine position don’t ambulate patients with known dvt’s. wait 2-3 days until clots get stuck. dvt’s even with filter get heparin as much as possible for post phlebitic syndrome and to retard new clot formation diffuse alveolar hemorrhage – secondary to chemo, goodpasture’s, wege...
Source: Inside Surgery - December 31, 2016 Category: Surgery Authors: Editor Tags: General Source Type: blogs

Decision Making at the End of Life: Joint #patientpref and #hpm Tweetchat
By Meredith MacMartinFred was a sick guy. He had been diagnosed with COPD years ago, and more recently developed heart failure, and although he and his wife Nancy tried to stick with his medication regimen and monitor his salt intake, his shortness of breath had been making it harder and harder to even get around the house. He followed regularly with his primary care doctor, and talked about what he would want in terms of medical care if and when he got sicker. His wife knew that he didn ’t want to go to the hospital if it could be avoided, and that he definitely did not want to end up in an ICU on a ventilator, or g...
Source: Pallimed: A Hospice and Palliative Medicine Blog - December 7, 2016 Category: Palliative Care Source Type: blogs

When a cough just won ’t go away
Who has never had a cough? I bet no one can raise their hand. We see this in clinic all the time. But chronic cough— one that lasts at least eight weeks — can be hard for patients to deal with and difficult for doctors to figure out. In the October 20, 2016 issue of the New England Journal of Medicine, lung experts describe a step-by-step approach doctors can use to help treat patients with chronic cough. Most often a prolonged cough is due to one of the “usual suspects.” But when it’s not, we have a long list of increasingly rarer conditions that we should run through and rule out. If it isn&...
Source: Harvard Health Blog - November 7, 2016 Category: Consumer Health News Authors: Monique Tello, MD, MPH Tags: Cold and Flu Health Lung disease Source Type: blogs

MKSAP: 62-year-old man is evaluated for declining exercise capacity
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 62-year-old man is evaluated for declining exercise capacity over the past year. He was diagnosed with moderate COPD 3 years ago. His symptoms had previously been well controlled with tiotropium and as-needed albuterol. He has not had any hospitalizations. He is adherent to his medication regimen, and his inhaler technique is good. He quit smoking 2 years ago. All immunizations are up to date, including influenza and pneumococcal vaccination. A chest radiograph performed 3 months ago for increased coug...
Source: Kevin, M.D. - Medical Weblog - August 13, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Pulmonology Source Type: blogs

ST Elevation. What is it?
A young woman was &nbsp;found down, unresponsive, with legs crossed. &nbsp;She was intubated by medics. &nbsp;A prehospital EKG (not found, but reportedly identical to the first ED ECG below) was read as ***STEMI*** and after prehospital cath lab activation, the patient was transported to the ED. On arrival, she was mechanically ventilated and not in apparent shock. &nbsp;Here is the ED ECG: This is a pathognomonic ECG. &nbsp;The computer reads the QRS duration as 133 ms. &nbsp;I have posted several of these in the past. What is it? Answer : it is pathognomonic of severe hy...
Source: Dr. Smith's ECG Blog - July 24, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs

MKSAP: 66-year-old man with polyuria and polydipsia
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 66-year-old man is evaluated in the office after being treated in the emergency department for an exacerbation of chronic obstructive pulmonary disease. While in the emergency department, he was noted to have a random blood glucose level of 211 mg/dL (11.7 mmol/L). His HbA1c was 7.8% at the time. A repeat random fingerstick blood glucose level in office is 204 mg/dL (11.3 mmol/L). The patient reports recent polyuria and polydipsia. He has lost 6 kg (13.2 lb) over the last 3 months. He has chronic epiga...
Source: Kevin, M.D. - Medical Weblog - July 23, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Diabetes Endocrinology Source Type: blogs

Research and Reviews in the Fastlane 141
This study showed that while it’s feasible to acutely lower systolic blood pressure
Source: Life in the Fast Lane - July 7, 2016 Category: Emergency Medicine Authors: Jeremy Fried Tags: Airway Clinical Research Emergency Medicine Neurology Neurosurgery Pediatrics R&R in the FASTLANE Resuscitation critical care EBM Education literature recommendations research and reviews Source Type: blogs

No Pea'ce in the Pods​
Discussion of Recent Literature. Pediatr Emerg Care 2013;29(6):743.Davis MG, Casavant MJ, et al. Pediatric Exposures to Laundry and Dishwasher Detergents in the United States: 2013-2014. Pediatrics 2016;137(5):e20154529.Russell JL, Wiles DA, et al. Significant Chemical Burns Associated with Dermal Exposure to Laundry Pod Detergent. J Med Toxicol 2014;10(3):292.Tags: detergent pod, laundry detergent, vomiting, poisoning, erythema, decontaminationPublished: 7/2/2016 10:06:00 AM (Source: The Tox Cave)
Source: The Tox Cave - July 2, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

LITFL Review 232
Welcome to the 232nd 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 chuck of FOAM. The Most Fair Dinkum Ripper Beauts of the Week Cliff Reid offers an amazing reflection on training, stress exposure and pushing one self to achieve even in the face of defeat. [AS] Nadim Lalani writes one of the most incredible pieces I have ever read on courageous collegiality in medicine, a...
Source: Life in the Fast Lane - May 22, 2016 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review LITFL R/V Source Type: blogs

What medications have you been able to stop on the Wheat Belly lifestyle?
I posed this question on the Wheat Belly Facebook page recently and received an overwhelming response. Here, I share a partial list of the responses: medications people have been able to stop by following the Wheat Belly lifestyle. Just take a look at this incredible list: these represent medications prescribed by doctors to, in effect, “treat” the consequences of consuming wheat and grains. They prescribe drugs to treat the inflammation, swelling, skin rashes, gastrointestinal irritation, high blood sugars, airway allergy, and other abnormal effects all caused by wheat and grains. The list includes anti-infl...
Source: Wheat Belly Blog - October 6, 2015 Category: Cardiology Authors: Dr. Davis Tags: Wheat Belly Lifestyle asthma cholesterol diabetes drugs gluten grains hypertension prescription medication reflux Source Type: blogs

Extreme Bradycardia after Diarrhea and Dehydration. Best ED treatment?
A patient presented with weakness.  He was found to be bradycardic, so this ECG was recorded:There is atrial flutter with 3rd degree AV block and Left ventricular escape.  Why is it not slow AV conduction with RBBB?  The QRS occurs at different points on the flutter wave.  There is complete dissociation due to complete AV block.More historyThe patient has a history of congenital heart disease repaired as a child. He reports having had an extra pacemaker transiently but this was removed at a very young age. The patient describes a history of progressive bradycardia. In recent years, the patient states th...
Source: Dr. Smith's ECG Blog - October 2, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs

Rising Cost Of Drugs: Where Do We Go From Here?
The trends are clear: patients and institutions across the nation are concerned about skyrocketing drug prices. This post offers some information about drug pricing, explores the notion of market intervention, and proposes a series of responses to high pharmaceutical costs. A few jaw-dropping facts quickly illustrate the pattern of rising drug costs. The average annual cost of cancer drugs increased from roughly $10,000 before 2000 to over $100,000 by 2012, according to a recent study in Mayo Clinic Proceedings. Several breakthrough specialty medications and orphan drugs recently approved by the Food and Drug Administratio...
Source: Health Affairs Blog - August 31, 2015 Category: Health Management Authors: Ifrad Islam Tags: Costs and Spending Drugs and Medical Technology Featured Medicaid and CHIP Payment Policy Public Health Big Pharma CMS FDA Gilead Sciences hepatitis C Pricewaterhouse Coopers Source Type: blogs

Test your medicine knowledge: 72-year-old woman with COPD
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 72-year-old woman is evaluated during a routine examination. She has very severe COPD with multiple exacerbations. She has dyspnea at all times with decreased exercise capacity. She does not have cough or any change in baseline sputum production. She is adherent to her medication regimen, and she completed pulmonary rehabilitation 1 year ago. She quit smoking 1 year ago. Her medications are a budesonide/formoterol inhaler, tiotropium, and an albuterol inhaler as needed. On physical examination, pulse r...
Source: Kevin, M.D. - Medical Weblog - June 27, 2015 Category: Journals (General) Authors: Tags: Conditions Pulmonology Source Type: blogs

Michigan Baby Dies, Pathologists Confirm Vaccines Responsible
Conclusion It is very clear that vaccine-related deaths and injuries are being intentionally hidden. Parents of vaccine-injured children are doing their own investigations and coming forward more, seeking the truth denied to them by health officials. Inform your friends, family and neighbors that this is going on, that children are dying from the vaccines. Be brave. Help preserve your fundamental right to choose what gets injected into you or your child’s body. Making good medical decisions can only be done when you are informed. Our hearts go out to Danny and his family and all of the other precious children who hav...
Source: vactruth.com - May 14, 2015 Category: Allergy & Immunology Authors: Augustina Ursino Tags: Augustina Ursino Human Top Stories cytokine storm DTaP vaccine Elijah Daniel French L.J. Dragovic M.D. MMR vaccine Vaccine Adverse Event Reporting System (VAERS) Vaccine Death Source Type: blogs

What Flame Broils My Patty
You know what flame broils my patty? This broken ass health care system that allows most prescription companies to give patients oral contraceptives for free but immediately life saving medications are prohibitively expensive.Glucagon Emergency kits should be $0 copay because they immediately treat low blood sugar that can result in LOSS OF CONSCIOUSNESS, COMA, and DEATH.Epipens and Auvi-Q should be $0 copay because they immediately treat severe allergic reactions that can lead to CLOSURE OF BREATHING AIRWAYS and DEATH.Rescue inhalers such as Proair, Ventolin HFA, Proventil HFA, and Xopenex HFA should be $0 ...
Source: FAST FOOD Pharmacy - March 30, 2015 Category: Drugs & Pharmacology Source Type: blogs

MKSAP: 72-year-old man with dyspnea at rest
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 72-year-old man is evaluated for dyspnea at rest. He has end-stage COPD and is on a home hospice program. He has weight loss, reduced functional capacity, and muscle atrophy. His medications are ipratropium, salmeterol, fluticasone, albuterol as needed, and prednisone. He is uncomfortable, with chronic air hunger that has gradually increased over the past 2 weeks. Otherwise, his symptoms have been stable without change in cough, sputum production, or fever. Following a physical exam, what is the most a...
Source: Kevin, M.D. - Medical Weblog - February 7, 2015 Category: Journals (General) Authors: Tags: Conditions Pulmonology Source Type: blogs

Fighting high health costs.  Because I can.
Sometime while I was still in high school, my mom began to have trouble breathing. She had never had asthma before; an albuterol inhaler helped for a while. Still, cold season was a nightmare, and later, so was allergy season, and every year seemed to get worse. After college, I moved back in with my parents. She fought her way through the cold season, dutifully driving 20 miles (and later 40, after being asked to teach at a different campus) to a community college near our town, where she taught as an adjunct. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A socia...
Source: Kevin, M.D. - Medical Weblog - February 3, 2015 Category: Journals (General) Authors: Tags: Patient Hospital Intensive care Patients Source Type: blogs

8 tips to save money on generic drugs
80 percent of prescriptions in the U.S. are for generic medications. Generics are supposed to be less expensive alternatives to brand name drugs. However, prices for certain generics are rapidly increasing. 50 percent of generic medications increased in price in the last year and 10 percent more than doubled in cost during the same time period. Among them are thyroid replacement hormone, doxycycline, digoxin and other heart medications, tetracycline, albuterol (pill form), and certain medications for blood pressure and high cholesterol. Continue reading ... Your patients are rating you online: How to respond. Ma...
Source: Kevin, M.D. - Medical Weblog - December 6, 2014 Category: Journals (General) Authors: Tags: Meds Medications Patients Source Type: blogs

Research and Reviews in the Fastlane 058
This study (n=60) randomized patients in the ED getting IV opioids to morphine (0.1 mg/kg) + placebo or morphine (0.1 mg/kg) + ketamine (group 1 0.15 or group 2 0.30 mg/kg). Patients in the ketamine arm had significantly decreased pain without significant adverse effects, although the group with the higher dose of ketamine had a seeming increase in side effects without added analgesic benefit. The literature is mounting that low dose ketamine has utility in the acute analgesia armamentarium but selecting the right population will likely be key (and more is not better). Recommended by: Lauren Westafer Further Listening: Cli...
Source: Life in the Fast Lane - November 21, 2014 Category: Emergency Medicine Authors: Soren Rudolph Tags: Education R&R in the FASTLANE Review Source Type: blogs

MKSAP: 72-year-old woman with severe COPD
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 72-year-old woman is evaluated during a routine examination. She has very severe COPD with multiple exacerbations. She has dyspnea at all times with decreased exercise capacity. She does not have cough or any change in baseline sputum production. She is adherent to her medication regimen, and she completed pulmonary rehabilitation 1 year ago. She quit smoking 1 year ago. Her medications are a budesonide/formoterol inhaler, tiotropium, and an albuterol inhaler as needed. On physical examination, pulse r...
Source: Kevin, M.D. - Medical Weblog - November 1, 2014 Category: Journals (General) Authors: Tags: Conditions Pulmonology Source Type: blogs

Research and Reviews in the Fastlane 050
This study compared bedside US by EPs vs radiology US vs CT as the INITIAL test in patients expected with nephrolithiasis. It found there was no difference in serious outcomes between the groups, but the rate of serious outcomes was overall very low. Obviously patients that got only an US had lower radiation exposure and lengths of stay. But what is interesting is that 40% of patients with an initial ED US went on to get a CT also. This study does not state that patients should ONLY undergo US, just that it should be the INITIAL test. If it cuts down on our CT ordering, it sounds like a good start. (Zack Repanshek) Recomme...
Source: Life in the Fast Lane - September 29, 2014 Category: Emergency Medicine Authors: Jeremy Fried Tags: Cardiology Clinical Research Emergency Medicine Infectious Disease R&R in the FASTLANE Radiology Resuscitation critical care Education Intensive Care literature recommendations Research and Review Source Type: blogs

Pacemaker Panic #2
ECG Exigency 016 A 68-year old woman presents by ambulance to the Emergency Department. Per the ambulance crew, she was brought from home after experiencing 7 out of 10 chest discomfort and weakness. She has a history of hypertension that is well controlled with furosemide, and has a pacemaker because her “heart used to go funny.” The ambulance crew are basic life support only, so the patient has received 324mg of aspirin, and oxygen by nasal cannula. Upon arrival she is seated upright on the stretcher breathing rapidly, with the following vitals: heart rate 107, blood pressure 180/110, respirations 20 and slig...
Source: Life in the Fast Lane - September 19, 2014 Category: Emergency Medicine Authors: Mat Goebel Tags: Cardiology Clinical Case ECG Education Emergency Medicine EKG failure hyperkalaemia hyperkalemia pacemaker pacer pacing ppm Source Type: blogs