Double Trouble: Both-Bone Fractures
Both-bone forearm fractures may make you feel a little nervous. A completely crooked forearm is definitely a disturbing sight. Both-bone forearm fractures (especially of the midshaft) typically require surgical intervention, but relocation of bony injuries, regardless of site or complexity, is an important and necessary skill you need to know. Plus, you will be required to assist with sedation, reduction, and splinting when the orthopedic team is involved.Correcting and stabilizing two bones (instead of one) may seem tricky, but we are going to help you do it right. This complex procedure should be done with orthoped...
Source: The Procedural Pause - August 31, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Bupropion Overdose Followed by Cardiac Arrest and, Later, ST Elevation. Is it STEMI?
A young woman presented with status seizures and apparent overdose of bupropion. There was a question of cocaine use too (with later suspicion of possible ingestion or body stuffing).She had status seizures for which she was intubated and medically treated (successfully) with propofol and benzos.An ECG was recorded:Sinus tach, with a slightly widened QRS (113 ms) and slightly long QTThere is a slightly abnormally large R-wave in aVR.So there might be some sodium channel blockade here, which is expected with cocaine.Bicarbonate was given.This was recorded 8 hours later:QRS = 148 ms and large R-wave in aVR (very danger...
Source: Dr. Smith's ECG Blog - July 20, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
Learning the health care ecosystem is an uphill battle
The short white coat, breast pocket full of colorful pens, side pockets bulging with gauze pads and suture kits, a simultaneous look of bewilderment, excitement and fear. Pathognomonic signs of the third-year medical student on wards. Third year of medical school is a period of learning how to diagnose disease, treat patients and understand what it means to be a doctor in this health care landscape. There is not enough time in the mere weeks you will be rotating through a clerkship to master all the literature, so you utilize the necessary resources for success, while hoping the rest diffuses into your consciousness. The s...
Source: Kevin, M.D. - Medical Weblog - March 30, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mohammed-ahmed" rel="tag" > Mohammed Ahmed < /a > Tags: Education Public Health & Policy Washington Watch Source Type: blogs
The problem of drug shortages in the emergency department
I first experienced the impact of drug shortages in the U.S. in my first month of my residency training in emergency medicine. The most common drug used to sedate patients for intubation, etomidate, was on national shortage. I learned to use the second most common drug, Propofol, until it went on shortage too. We use it as the first line medication for sedation for painful procedures like re-aligning broken bones, draining painful abscesses and intubating. We resorted to using older combinations of medications that just didn’t work as well.
That was over six years ago. And now, we have even more shortages all the time. L...
Source: Kevin, M.D. - Medical Weblog - March 26, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/susan-derry" rel="tag" > Susan Derry, MD < /a > Tags: Physician Emergency Medicine Infectious Disease Source Type: blogs
Here ’s what you learn when a young patient dies
“This is a 17-year-old boy who came in as a category 1 trauma yesterday for a rollover MVC with bilateral uncal herniation, epidural hematoma and subdural hematoma currently intubated and sedated with propofol and fentanyl.”
As the overnight resident presented this patient on PICU, we could see everyone’s early morning smiles fading slowly and beginning to understand the grave consequences anticipated in this severe traumatic brain injury. We could see the wheels churning in the doctors’ brains, emotions churning in parents’ minds and tears turning in the rest of the family. The family understood how severe this ...
Source: Kevin, M.D. - Medical Weblog - January 4, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/shubham-bakshi" rel="tag" > Shubham Bakshi, MD < /a > Tags: Physician Critical Care Pediatrics Source Type: blogs
Conversations with our Fathers
LITFL • Life in the Fast Lane Medical Blog
LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog
This is a guest post by Dr Ben Symon (@symon_ben). Ben is a paediatric emergency physician in Queensland and one of the creators of Simulcast.
When I was thirteen years old, my father told me about the Milgram Shock Experiment. I vividly remember sitting at our kitchen table as he told me that study participants willingly dialled up the voltage of an electric shock on another person and that despite believing the shock might kill the confederate, the majority completed the ...
Source: Life in the Fast Lane - December 19, 2017 Category: Emergency Medicine Authors: Chris Nickson Tags: Education acceptance active listening ben symon leadership openness patient safety rejection Speaking up Source Type: blogs
When your doctor ’s computer crashes
Earlier this week, as I write this, our office lost a skirmish against technology.
It was my procedure day, where lucky patients file in awaiting the pleasures of scope examinations of their alimentary canals. A few will swallow the scope (under anesthesia), but most will have back-end work done. We are a small private practice equipped with an outstanding staff. We do our best every day to provide them with the close personal attention they deserve.
The first patient of the day is on the table surrounded by the medical team. The nurse anesthetist and I have already briefed the patient on what is about to transpire. Propof...
Source: Kevin, M.D. - Medical Weblog - July 7, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/michael-kirsch" rel="tag" > Michael Kirsch, MD < /a > Tags: Tech Health IT Source Type: blogs
Alzheimer's and Anesthesia
Alzheimer's and anesthesia don't mix well. Some physicians are advising their patients that are already diagnosed with Alzheimer ’s to avoid surgery unless absolutely necessary.By Sydney S. Farrier, LCSWHow often have you heard the comment about an older person who recently underwent a major surgery, "She was fine until she had that (hip surgery, knee replacement, cardiac surgery, etc) but now she seems confused."Learn More -What is the Difference Between Alzheimer ’s and DementiaThis week I was visiting with an attractive woman in her 80's who had a knee surgery under a general anesthesia a couple of years ago. About ...
Source: Alzheimer's Reading Room, The - June 26, 2017 Category: Neurology Tags: alzheimer's alzheimer's anesthesia Alzheimers Dementia anesthesia dementia care of dementia patients dementia care dementia made worse by anesthesia dementia news health Source Type: blogs
Ultrasound Helps Release Drugs from Nanoparticles Into Brain
Researchers at Johns Hopkins University have come up with a simple way of using ultrasound to release drugs from special nanoparticles delivered into the brain. The technology would allow for targeted drug delivery, making sure the medication is delivered where the ultrasound beam is focused while preventing its from influencing the rest of the body.
The biodegradable plastic nanoparticles are made of a hydrophilic exterior, to travel through the body, and a hydrophobic interior, to contain propofol, a commonly used small molecule anesthetic tried in this study. They are too large to move through the blood-brain barrier, ...
Source: Medgadget - January 23, 2017 Category: Medical Equipment Authors: Editors Tags: Nanomedicine Neurology Neurosurgery Oncology Source Type: blogs
David Newman betrayed patients and emergency medicine
I remember that morning in January 2016 very well. I opened up my twitter feed to find many people linking to an article that made me stop dead in my tracks. The New York Post was reporting that Dr. David Newman had been accused of sexually assaulting a patient in his emergency department. He was accused of giving the patient a dose of propofol and then sexually assaulting her.
My initial reaction was denial and anger. It wasn’t denial and anger that this happened but that it ever took place and that the media was reporting it before charges were filed. I will admit my initial reaction was, “This must have be...
Source: Kevin, M.D. - Medical Weblog - December 31, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/steve-carroll" rel="tag" > Steve Carroll, DO < /a > Tags: Physician Emergency Source Type: blogs
Research and Reviews in the Fastlane 163
This study found an OR of 1.16 (0.92-1.46) for mortality in the group that received antibiotics > 3 hours after triage. No one is arguing to withhold antibiotics from septic patients. Rather, we should avoid giving everyone antibiotics simply to meet a quality measure that isn’t based on data.
Recommended by Anand Swaminathan
Emergency Medicine
Ferguson I et al. Propofol or Ketofol for Procedural Sedation and Analgesia in Emergency Medicine-The POKER Study: A Randomized Double-Blind Clinical Trial. Annals of emergency medicine. 68(5):574-582.e1. 2016. PMID: 27460905
We now have another study, this time a mul...
Source: Life in the Fast Lane - December 7, 2016 Category: Emergency Medicine Authors: Justin Morgenstern Tags: Education Emergency Medicine Pediatrics R&R in the FASTLANE Resuscitation EBM literature recommendations research and reviews Source Type: blogs
LITFL Review 259
Welcome to the 259th 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
‘The speaker wasted my time.’ So how do you deal with negative feedback on your presentation? Our own Swami talks us through using negativity to spur us on to excellence. [CC]
The Best of #FOAMed Emergency Medicine
“First 10 in EM...
Source: Life in the Fast Lane - November 27, 2016 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs
Fight Aging! Newsletter, September 26th 2016
This study included 647 patients 80 to 106 years of age who had audiometric evaluations at an academic medical center (141 had multiple audiograms). The degree of hearing loss was compared across the following age brackets: 80 to 84 years, 85 to 89 years, 90 to 94 years, and 95 years and older. From an individual perspective, the rate of hearing decrease between 2 audiograms was compared with age. The researchers found that changes in hearing among age brackets were higher during the 10th decade of life than the 9th decade at all frequencies for all the patients (average age, 90 years). Correspondingly, the annual rate of ...
Source: Fight Aging! - September 25, 2016 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
A Selection of Views on Cryonics from the Cryonics Community
Here I'll point out a good article on cryonics and its nuances in the online press; it includes thoughts from people working at cryonics providers, people signed up for cryopreservation, and advocates with various viewpoints. Like any community there are a range of opinions on what constitutes progress and the best strategy for moving ahead, and just as many motivations as there are individuals involved. What is cryonics? It is the low-temperature preservation of at least the brain as closely following death as possible. Early preservations in the 1960s and 1970s were a matter of straight freezing, and thus the preserved i...
Source: Fight Aging! - September 24, 2016 Category: Research Authors: Reason Tags: Healthy Life Extension Community Source Type: blogs
