Research and Reviews in the Fastlane 041
This study prospectively validated whether an age-adjusted D-dimer cutoff was associated with an increased diagnostic yield of D-dimer in elderly patients with suspected PE. Compared with a fixed D-dimer cutoff, the combination of pretest clinical probability assessment with age-adjusted D-dimer cutoff was associated with a larger number of patients in whom PE could be considered ruled out with a low likelihood of subsequent clinical venous thromboembolism. So if this is not your clinical practice already, maybe time to use age adjust d-dimer values?
Recommended by: Jerremy Fried
Read More: Age Adjusted D-Dimer Testing (RE...
Source: Life in the Fast Lane - July 29, 2014 Category: Emergency Medicine Authors: Soren Rudolph Tags: Clinical Research R&R in the FASTLANE critical care Emergency Medicine Intensive Care literature recommendations research and reviews Source Type: blogs
MKSAP: 35-year-old man with nonproductive cough and fever
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 35-year-old man is evaluated for a 2-week history of nonproductive cough and fever. He has a 20-year history of asthma. Three weeks ago, he visited friends in Indiana. He has no dyspnea, hemoptysis, or worsening of his baseline asthma symptoms. His only medication is an albuterol inhaler as needed.
On physical examination, temperature is 38.0 °C (100.4 °F), blood pressure is 130/70 mm Hg, pulse rate is 88/min, and respiration rate is 16/min. Crackles are heard in both lungs.
Laboratory studies show a normal ...
Source: Kevin, M.D. - Medical Weblog - March 15, 2014 Category: Family Physicians Tags: Conditions Infectious disease Source Type: blogs
Complaint of Weakness. Alert. Hemodynamically Stable. What is it?
A male in his 60's, dialysis patient, complained of weakness. He was alert and had no SOB or Chest pain. BP was 85/57 with a pulse of 65. Here is his ECG:What is it? See below.This is pathognomonic for hyperkalemia and is nearly end stage, almost a complete sine wave morphology. It seems miraculous that a patient can have this ECG and not be in profound shock, but it is true. He may die at any moment though.His potasssium was 8.8 mEq/L.There were access problems, but he did get insulin, glucose, bicarb, calcium gluconate, and albuterol, all while preparing emergency dialysis. The treatme...
Source: Dr. Smith's ECG Blog - February 20, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
Popular Quotes By Famous People (Had They Been a Doctor or a Nurse).
Ever wonder what Bill Clinton or Martin Luther King or Jesus would have said if they were a doctor or a nurse? Ever wonder what their famous quotes would have sounded like had they been in the medical field? The Happy Hospitalist has. Doctors and nurses are different. Their training changes them. In some ways for the good and and some ways for the bad. For many , they develop a different sense of humor. That's good for you because that's how we found out what Bill Clinton actually would have said if he tried albuterol instead of marijuana. We discover what Martin Luther Kin...
Source: The Happy Hospitalist - January 4, 2014 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous 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, 2013 Category: Surgeons Authors: Editor Tags: General Source Type: blogs
An Idiotically-Designed EHR Medication Discontinuation "Feature"
Over at The Healthcare Blog, Michael Chen, MD, a family physician and EHR designer in Portland, Oregon wrote a piece entitled "Why EHR Design Matters" (http://thehealthcareblog.com/blog/2013/12/18/why-ehr-design-matters/). I am cited.Dr. Chen reports on a major commercial EHR with the following "feature":... In this well known EHR, you are presented a medication list for a patient. As a physician, you assume that this list is a current medication list and is up to date. However, the reality is that this EHR system automatically removes a medication from the list when it is determined to be expired even if i...
Source: Health Care Renewal - December 19, 2013 Category: Health Medicine and Bioethics Commentators Tags: healthcare IT dangers healthcare IT defects Michael Chen MD The Healthcare Blog Source Type: blogs
Several Wide Complex Rhythms in One Patient. Test yoursefl: Will You See What I Did Not See?
This time I'm going to tell you that the case is mine because the mistakes were mine. I sat down to write one narrative, but as I looked at all the ECGs, I realized that some of my rhythm analyses were wrong and had to write a different narrative.Now it all looks so clear and obvious when I'm sitting down without a sick patient in front of me. But, to test yourself, I'm going to let you look at the ECGs before I explain them:1. Presenting ECG in a dialysis patient feeling weak: 2. His previous ECG: What treatment would you give?3. This happened after immediately giving Calcium: 4. This was presen...
Source: Dr. Smith's ECG Blog - December 6, 2013 Category: Cardiology Authors: Steve Smith Source Type: blogs
Terbutaline and Albuterol for Lowering of Plasma Postassium
CONCLUSION: We conclude that in patients with terminal renal failure undergoing maintenance hemodialysis, intravenous bicarbonate is ineffective in lowering plasma potassium rapidly, and epinephrine is effective in only half the patients, whereas insulin in glucose is a fast and reliable form of therapy for hyperkalemic emergencies. Plasma aldosterone levels are appropriate in relationship to plasma potassium levels, and levels of other potassium-influencing hormones are generally normal. ADDepartment of Medicine, Kantonsspital, Aarau, Switzerland.PMID3052050 6 PubMed ...
Source: Dr. Smith's ECG Blog - December 6, 2013 Category: Cardiology Authors: Steve Smith Source Type: blogs
Medical Mispronunciations and Misspelled Words: The Definitive List.
Hearing medical mispronunciations and seeing misspelled words are an under appreciated joy of working in healthcare. Physicians often forget just how alien the language of medicine is to people who don't live it everyday. The best part about being a physician is not helping people recover from critical illness. The best part is not about listening and understanding with compassion and empathy. Nope, the best part about being a physician is hearing patients and other healthcare providers butcher the language of medicine and experiencing great entertainment in the process. Doctors c...
Source: The Happy Hospitalist - October 2, 2013 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs
Lessons Learned from a Medical Mission
Nurses can serve as excellent physician extenders.My mentors in austere medicine warned me that with an interpreter I would be lucky to see 30 patients per day. That concerned me because the local missionaries indicated at our first organizational meeting in the Dominican Republic that we were expecting to see 100 patients per day. On top of that, 100 cards were being handed out at each of the four locations we would be visiting.
As the single physician in the group of 19 team members (seven nurses), these seemed like very high expectations. Working in a setting that uses physician extenders and emergency medicine resid...
Source: M2E Too! Mellick's Multimedia EduBlog - May 2, 2013 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
MKSAP: 35-year-old woman with an acute exacerbation of asthma
A 35-year-old woman is evaluated in an urgent care center for an acute exacerbation of asthma. She has a history of frequent asthma exacerbations requiring unscheduled visits; however, between these exacerbations, her examination and pulmonary function studies have been unremarkable. Her current medications are inhaled budesonide and inhaled albuterol.
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 - April 27, 2013 Category: Family Physicians Tags: Conditions Pulmonology Source Type: blogs
So, I Guess We'll Go With Asthma.
I finally caved and went to my new family doctor today over my crazy exercise induced allergies that are so bizarre and I couldn't figure out. I did tons of internet research, so did my husband, and we found a lot of people with the same thing who couldn't find an answer.He came in and I was just embarrassed to be there AGAIN. Obviously we both know I'm healthy - I was just there for a physical and had blood work and I couldn't possibly be more healthy as far as those things are concerned. I had told him on a previous visit for some reason, I don't know why, about my issues with coughing in the past,...
Source: bipolar.and.me - April 11, 2013 Category: Mental Illness Source Type: blogs
Post #37 Asthma: A Pedi Perspective - Part 5 of 5
Frequently Asked Questions: I have asthma. Does this mean my child will have it too?There is definitely a genetic component to asthma, but how big a role genes play is unclear. While there isn't a specific asthma gene, it is more likely that your child will inherit the tendency to develop asthma. Why does asthma seem to come and go?Asthma is inflammatory in nature, and there are certain things (triggers) that can cause a flare up. I don't like the thought of my child being on daily medication. I also worry about the medication losing its effectiveness, and then not working when we really need it to. Can't he jus...
Source: A Pediatrician's Blog - February 16, 2013 Category: Pediatricians Source Type: blogs
Post #35 Asthma: A Pedi Perspective - Part 3 of 5
Tenets of treatment Inhaled medications are the mainstay of therapy, and are delivered two different ways. The first is a nebulizer, which is a machine that emits humidified air combined with medication. The child inhales the air through a mask.The other way to receive inhaled medication is through "Metered Dose Inhalers." MDIs are the puffers that most people are familiar with. Medication is sprayed directly into the mouth, but a contraption called a "spacer" helps make sure the medication goes directly into the lungs. Using an MDI without a spacer leads to half of the medication missing its mark – a waste of money that...
Source: A Pediatrician's Blog - February 16, 2013 Category: Pediatricians Source Type: blogs
Dear Diary
Well, I thought we escaped it, but we didn’t. The past week has been full of emesis, diarrhea, and disinfectant spray. Just when we think that things are on the mend, someone else in the family starts having a stomach ache. The vomiting is the worst. When it starts out, it sounds like a loud belch … until you hear the progression of the sounds. Yeah. Too much information. But on a good note, I have seen that my kids are immune to boredom. They were able to watch the same episodes of Disney sit-coms a half dozen times and still got mad when I turned off the television.
I’ve cut back on my work hours a litt...
Source: WhiteCoat's Call Room - February 8, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Random Thoughts Source Type: blogs
