Research and Reviews in the Fastlane 185
This article on remifentanyl tolerance and hyperalgesia is nerdy, focussed on perioperative anaesthesia, but good.
Recommended by: Matthew MacPartlin
Emergency Medicine
Verma AA et al, for the GEMINI Investigators. Pulmonary Embolism and Deep Venous Thrombosis in Patients Hospitalized With Syncope: A Multicenter Cross-sectional Study in Toronto, Ontario, Canada. JAMA Intern Med. PMID: 28492876
A quick update on PESIT. This retrospective chart review tried to replicate the PESIT inclusion criteria. They identified 1305 patients admitted with first time syncope. Ultimately, 11 were diagnosed with PE and 10 with DVT, re...
Source: Life in the Fast Lane - June 7, 2017 Category: Emergency Medicine Authors: Justin Morgenstern Tags: Anaesthetics Emergency Medicine Intensive Care R&R in the FASTLANE critical care EBM Education literature recommendations research and reviews Source Type: blogs
Starr –Edwards mitral prosthetic valve on CXR
Starr–Edwards mitral prosthetic valve on X-ray Chest PA view
Chest X-ray PA view shows the four strut cage of Starr-Edwards prosthetic mitral valve, which is now out of production. The ring is seen towards the upper and right edge and the cage with four struts is directed downwards and left. The ball within the cage is not radio opaque enough to be seen on this chest X-ray. But it will be seen well on cine-fluoroscopy, which is used to assess the movement during cardiac cycle. Lack of good movement would indicate a stuck valve, which can lead on to acute pulmonary edema. Stuck valve could be thrombus within the valve st...
Source: Cardiophile MD - May 22, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology ball and cage valve chest X-ray PA view Prosthetic mitral valve right atrial enlargement Starr-Edwards prosthetic mitral valve Starr-Edwards prosthetic valve Starr-Edwards valve sternal wires valve cage valve ring Source Type: blogs
Refractory V FIb Arrest, put on ECMO, regains an organized rhythm, and a 12-lead is recorded.
I received this case from:Dominic Larose MD CCFP(EM) FACEPAlain Vadeboncoeur MD CSPQMontreal Heart InstituteHi Steve,Here is a case I had a while ago. The patient was seen on the street, with sudden LOC. An off duty fireman was a bystander, so the cardiac arrest was recognised and immediate CPR was begun at 11:58. First responders arrived afterwards, and the patient was shocked twice with an AED. ALS crew arrived 6 minutes later, and ACLS protocol was performed. The patient was in recurrent VF with wide complex PEA in between. Epinephrine and amiodarone were given. Seven shocks were given. The patient was transported ...
Source: Dr. Smith's ECG Blog - May 22, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
Research and Reviews in the Fastlane 182
This study was called LOV-ED. Initiation of a mechanical ventilation protocol in the ED using a low tidal volume strategy, PEEP protocols, rapid FiO2 weaning, and head-of-bed elevation resulted in dramatic clinical improvement in the composite primary outcome: ARDS or ventilator-associated conditions; NNT = 14. And a secondary outcome, mortality, was also improved, NNT = 7. There is no way to account for all the confounders or other process improvements that may have also led to better outcomes, but the use of propensity analysis makes this association very believable. REBEL EM has a great deep-dive on this article.
Starti...
Source: Life in the Fast Lane - May 18, 2017 Category: Emergency Medicine Authors: Jeremy Fried Tags: Education Emergency Medicine Intensive Care Pediatrics R&R in the FASTLANE EBM literature recommendations research and reviews Source Type: blogs
Research and Reviews in the Fastlane 182
This study was called LOV-ED. Initiation of a mechanical ventilation protocol in the ED using a low tidal volume strategy, PEEP protocols, rapid FiO2 weaning, and head-of-bed elevation resulted in dramatic clinical improvement in the composite primary outcome: ARDS or ventilator-associated conditions; NNT = 14. And a secondary outcome, mortality, was also improved, NNT = 7. There is no way to account for all the confounders or other process improvements that may have also led to better outcomes, but the use of propensity analysis makes this association very believable. REBEL EM has a great deep-dive on this article.
Starti...
Source: Life in the Fast Lane - May 18, 2017 Category: Emergency Medicine Authors: Jeremy Fried Tags: Emergency Medicine Intensive Care Pediatrics R&R in the FASTLANE EBM Education literature recommendations research and reviews Source Type: blogs
MDCalc Launches Long-Awaited Android App: Exclusive Interview
MDCalc, makers of popular online clinically useful calculators, has been around for over 12 years, and is still owned and run by the two practicing docs who founded it, Dr. Graham Walker and Dr. Joe Habboushe.
Interestingly, MDCalc has seen its largest growth in the past three years, adding dozens of new calculators and swelling its number of users. As the founders quickly pointed out, while speaking with Medgadget, they have traditionally included only the most reliable and validated scores, knowing full well that other services often include everything under the sun, which may be confusing to doctors.
The iOS version of...
Source: Medgadget - May 12, 2017 Category: Medical Devices Authors: Alice Ferng Tags: Exclusive Net News Source Type: blogs
Out of hospital cardiac arrest
(OHCA) is a catastrophic event, which is equivalent to demise unless prompt cardiopulmonary resuscitation (CPR) and follow up care are available. Majority of the cardiac arrests occur at home (80%) and some of them at public places (20%). Only one fifth of them are in a shockable rhythm when the emergency medical services (EMS) arrive. There is a 10% decrease in survival on each passing minute after cardiac arrest. Bystander initiated CPR improves the chance of survival as it buys time till the arrival of EMS. The chance of receiving bystander CPR varies widely between countries and locations, with 43% in certain countrie...
Source: Cardiophile MD - May 9, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology AED automatic external defibrillator Bystander CPR bystander initiated CPR cardiopulmonary resuscitation Chain of Survival OCT OHCA Optical coherence tomography PCI Percutaneous coronary intervention public acces Source Type: blogs
Unusual ST Elevation in V1 and V2, and LVH, in a Patient with Chest Pain
p.p1 {margin: 0.0px 0.0px 0.0px 0.0px; font: 11.0px Helvetica; background-color: #fefefe}This ECG was texted to me:Computerized QRS is 114 msWhat do you think?There is an rSR ' in V1 and a qR in V2, suggesting incomplete RBBB. There is some concordant ST elevation (concordant to the R ' -wave) in both those leads and T-wave inversion in V5 and V6. But V3 is normal without any evidence of STEMI, and with a low voltage T-wave. And there is very large voltage in aVL that is diagnostic of LVH. LVH can produce a wide variety of pseudoSTEMI patterns.Here was my response: p.p1 {margin: 0.0px 0.0px 0...
Source: Dr. Smith's ECG Blog - May 6, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
A 60-something with Syncope, LVH, and convex ST Elevation
Note 2 other similar cases at the bottom that come from my book,The ECG in Acute MI.CaseWhile I was busy seeing patients, a resident brought me this ECG of a 60-something with a history of syncope only. There was no chest pain or SOB at the tim of the ECG:Computerized QTc is 464 msA previous ECG from 8 years prior wasnormal.What do you think?There is sinus rhythm at a rate of nearly 100 (nearly tachycardic)There is 2.5 mm STE in lead V1 and 3 mm in lead V2, withconvexity, and 1.5 mm in V3.This meets " STEMI criteria "However, there is very high voltage, with a very deep S-wave in V2 and tall R-wave in V4.This is ...
Source: Dr. Smith's ECG Blog - April 26, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
Research and Reviews in the Fastlane 177
This study has some frustrating findings: they looked at 318 patients who got a CTPA within 2 weeks of a negative CTPA and found a 5% positive rate. Is CTPA like a stress test, where we just can’t predict plaque rupture? Are people who get CTPAs people who other docs are also worried about PE? Or are we just ordering too many CTPAs? How many of these were false postives or negatives? Sadly, as with most clinical research on pulmonary embolism, I am let with more questions than answers (but we probably order too many CTPAs).
Recommended by: Seth Trueger
Pediatrics
Luck RP, et al. Cosmetic outcomes of absorbable ver...
Source: Life in the Fast Lane - March 30, 2017 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Clinical Case Education Emergency Medicine Infectious Disease Intensive Care Pediatrics R&R in the FASTLANE Radiology Respiratory Resuscitation critical care research and reviews Source Type: blogs
A young man with sudden chest pain
A 30-something with history of 2 pack per day smoking complained of sudden left arm and chest pain while working construction. It was very distressing for him. He presented by private transportation, stating that his pain was decreasing.At triage, he had this ECG recorded:The computer read that there is incomplete right bundle branch block.QRS duration 102 ms.What do you think?No significant abnormalities were seen in triage, and the patient had to wait 2 hours. By the time he was roomed, his pain was gone.A second ECG was recorded, pain free:If you didn ' t see anything wrong with the first one, maybe you c...
Source: Dr. Smith's ECG Blog - March 24, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
CMS Will Soon Unleash a New Appropriate Use Mandate
Cardiac imaging is in need of some wrangling. Professional medical associations and universities across the U.S. have developed appropriate use criteria (AUC) for physicians when determining if a patient should go through cardiac testing. However, a group of physicians believe that the AUC “is no longer an idealistic exercise” and a Centers for Medicare& Medicaid Services (CMS)-approved technique will soon be required when evaluating a patient ’s need for imaging procedures.AUC encourages physicians to utilize evidence or expert opinion when deciding if a patient should receive testing while using a three-fold ru...
Source: radRounds - March 15, 2017 Category: Radiology Authors: Julie Morse Source Type: blogs
Can a Genetic Test Tell You What Medication to Take For a Headache? The MyDNA Review
I was offered a genetic test by MyDNA that promises to let you know how your body metabolizes medications based on your genetic background. It might be crucial in the future when deciding about certain drugs for certain diseases. Here, I show you the results of my review.
Reading the secrets of your body with genetic testing
As a researcher with a PhD in genomics, it is fascinating for me to see how genetic tests work in action. The feeling of getting the results is similar to that if you could peek into a secret world, as if you could read the Rosetta Stone’s ancient old Egyptian hieroglyphs. The difference is that in t...
Source: The Medical Futurist - March 8, 2017 Category: Information Technology Authors: nora Tags: Genomics Personalized Medicine DNA dna testing dosing drug future gc3 Genetic testing genetics Genome Innovation pharma pharmacogenetics 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
