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Total 34927 results found since Jan 2013.

The LITFL Review 101
Conclusion: Imaging and repeat imaging in sciatic doesn’t really change the management..So why do it then! Focus Article: Early Imaging After Arrest Often Finds the Culprit. Bottom line from this study: The use of an early diagnosis protocol with immediate coronary angiography and/or CT scan provided the etiology of nearly two thirds of OHCA cases. ECG of the Week ECG of the Week – It looks bad and wide – whats going on! Ultrasound Podcast ULTRASOUND OF RADIUS FRACTURE! What? That’s right. Diagnose it and guide your reduction with US! TJdogma ICE 007 – another great ICE case, simple, sh...
Source: Life in the Fast Lane - April 8, 2013 Category: Emergency Medicine Doctors Authors: Kane Guthrie Tags: Education eLearning Emergency Medicine Featured Intensive Care LITFL review LITFL R/V Source Type: blogs

Research and Reviews in the Fastlane 097
This article looks at the role medicolegal concerns play in the management of patients with chest pain. The authors found that up to 30% of patients would not have been admitted if physicians had an established “acceptable miss-rate” or worked in a zero medicolegal risk environment. Maybe it’s time that we make some real headway in these areas in order to cut down on unnecessary healthcare spending. Recommended by: Anand Swaminathan Read More: Expunging “Zero-Miss” from Chest Pain Evaluations (EM Lit of Note) The Best of the Rest Emergency Medicine, PulmonaryHutchinson BD et al. Overdiagno...
Source: Life in the Fast Lane - August 26, 2015 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Cardiology Education Emergency Medicine Intensive Care Pediatrics Respiratory Resuscitation EBM literature R&R in the FASTLANE recommendations research and reviews urology Source Type: blogs

Derivation of a Clinical Decision Instrument to Identify Adult Patients With Mild Traumatic Intracranial Hemorrhage at Low Risk for Requiring ICU Admission
Conclusion: We derived a clinical decision instrument that identifies a subset of patients with mild traumatic intracranial hemorrhage who are at low risk for acute critical care intervention and thus may not require ICU admission. Physician clinical impression had test characteristics similar to those of the decision instrument. Because the results are based on single-center data without a validation cohort, external validation is required.
Source: Annals of Emergency Medicine - December 6, 2013 Category: Emergency Medicine Authors: Daniel K. Nishijima, Matthew Sena, Joseph M. Galante, Kiarash Shahlaie, Jason London, Joy Melnikow, James F. Holmes Tags: Trauma Source Type: research

"Meaningful Use" not so meaningul: Multiple medical specialty societies now go on record about hazards of EHR misdirection, mismanagement and sloppy hospital computing
The "Meaningful Use" program for EHRs is a mismanaged boondoggle causing critical issues of patient safety, EHR usability, etc. to be sidestepped.This is on top of the grossly mismanaged and unregulated U.S. boondoggle which should probably be called "the National Programme for IT in the HHS" - in recognition of the now-defunct multi-billion-pound debacle known as the National Programme for IT in the NHS (NPfIT), see my Sept. 2011 post "NPfIT Programme goes PfffT" at http://hcrenewal.blogspot.com/2011/09/npfit-programme-going-pffft.html.The complaints are not just coming from me now.As of January 21, 2015 in a letter to HH...
Source: Health Care Renewal - January 28, 2015 Category: Health Management Tags: AMIA healthcare IT safety Kaizen Event Karen De Salvo management mysticism MAUDE meaningful use Source Type: blogs

Pediatric Nuclear Medicine in Acute Care
This article focuses on the common applications used on a pediatric patient in acute care. To confirm the clinical diagnosis of brain death, brain scintigraphy is considered accurate and has been favorably compared with other methods of detecting the presence or absence of cerebral blood flow. Ventilation-perfusion lung scans are easy and safe to perform with less radiation exposure than computed tomography pulmonary angiography and remain an appropriate procedure to perform on children with suspected pulmonary embolism as a first imaging test in a hemodynamically stable patient with no history of lung disease and normal c...
Source: Seminars in Nuclear Medicine - February 18, 2013 Category: Radiology Authors: Amer Shammas, Reza Vali, Martin Charron Source Type: research

What ’s In A Word? The Evolution Of Effectiveness In Health Care
Discussions around value-based payment almost always involve paying for care that is necessary or appropriate, so a common understanding of those terms is needed to have a productive dialogue about what value means. Given the number of lives—and resources—at stake, coming to a common understanding of value-based care requires our immediate attention. But to do that work, we need to understand what constitutes value, to whom, and under what circumstances. A healthy debate can begin by bringing together diverse stakeholders and by understanding that as with beauty, effectiveness lies in the eye of the beholder. ...
Source: Health Affairs Blog - July 26, 2016 Category: Health Management Authors: Murray Ross Tags: Costs and Spending Featured Health Professionals Hospitals Insurance and Coverage Organization and Delivery Population Health Public Health Quality ACOs Alternative Payment Models Choosing Wisely value based care Source Type: blogs

Management of hemodynamically unstable pelvic trauma: results of the first Italian consensus conference (cooperative guidelines of the Italian Society of Surgery, the Italian Association of Hospital Surgeons, the Multi-specialist Italian Society of Young Surgeons, the Italian Society of Emergency Surgery and Trauma, the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care, the Italian Society of Orthopaedics and Traumatology, the Italian Society of Emergency Medicine, the Italian Society of Medical Radiology -Section of Vascular and Interventional Radiology- and the World Society of Emergency Surgery)
We present the results of the First Italian Consensus Conference on Pelvic Trauma which took place in Bergamo on April 13 2013. An extensive review of the literature has been undertaken by the Organizing Committee (OC) and forwarded to the Scientific Committee (SC) and the Panel (JP). Members of them were appointed by surgery, critical care, radiology, emergency medicine and orthopedics Italian and International societies: the Italian Society of Surgery, the Italian Association of Hospital Surgeons, the Multi-specialist Italian Society of Young Surgeons, the Italian Society of Emergency Surgery and Trauma, the Italian Soci...
Source: World Journal of Emergency Surgery - March 7, 2014 Category: Emergency Medicine Authors: Stefano MagnoneFederico CoccoliniRoberto ManfrediDario PiazzalungaRoberto AgazziClaudio AriciMarco BarozziGiovanni BellanovaAlberto BelluatiGiorgio BerlotWalter BifflStefania CamagniLuca CampanatiClaudio CastelliFausto CatenaOsvaldo ChiaraNicola Colaianni Source Type: research

SCAI Shock Stages A Through E
The Society for Cardiovascular Angiography and Intervention (SCAI) has classified cardiogenic shock into stages from A through E. This was developed by a multidisciplinary team from cardiology (interventional, advanced heart failure and noninvasive), emergency medicine, critical care and cardiac nursing. Stage A: “At risk” for cardiogenic shock – large myocardial infarction or heart failure, but not yet in shock, with normal mentation and systolic blood pressure of 100 mm Hg or more. Stage B: “Beginning” shock – hypotension or tachycardia without features of hypoperfusion (normal mentation). Systo...
Source: Cardiophile MD - December 16, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs

Prediction of urinary dickkopf-3 for AKI, sepsis-associated AKI, and PICU mortality in children
CONCLUSION: Urinary DKK3 was independently associated with an increased risk for AKI, SA-AKI, and PICU mortality and may be predictive of the aforementioned issues in critically ill children.IMPACT: Urinary dickkopf-3 (DKK3) has been identified as a preoperative biomarker for the prediction of acute kidney injury (AKI) following cardiac surgery or coronary angiography in adult patients. However, little is known about the clinical utility of urinary DKK3 in pediatric cohorts. This study demonstrated that urinary DKK3 is capable of early predicting AKI and pediatric intensive care unit (PICU) mortality and discriminating sep...
Source: Pediatric Research - August 25, 2022 Category: Pediatrics Authors: Junlong Hu Yueying Zhou Hui Huang Yuxian Kuai Jiao Chen Zhenjiang Bai Xiaozhong Li Yanhong Li Source Type: research

Comparison of Clinician Suspicion Versus a Clinical Prediction Rule in Identifying Children at Risk for Intra‐abdominal Injuries After Blunt Torso Trauma
ConclusionsThe derived clinical prediction rule had a significantly higher sensitivity, but lower specificity, than clinician suspicion for identifying children with intra‐abdominal injuries undergoing acute intervention. The higher specificity of clinician suspicion, however, did not translate into clinical practice, as clinicians frequently obtained abdominal CT scans in patients they considered very low risk. If validated, this prediction rule can assist in clinical decision‐making around abdominal CT use in children with blunt torso trauma. Resumen Comparación de la Sospecha Clínica Frente a una Regla de Predic...
Source: Academic Emergency Medicine - August 20, 2015 Category: Emergency Medicine Authors: Prashant Mahajan, Nathan Kuppermann, Michael Tunik, Kenneth Yen, Shireen M. Atabaki, Lois K. Lee, Angela M. Ellison, Bema K. Bonsu, Cody S. Olsen, Larry Cook, Maria Y. Kwok, Kathleen Lillis, James F. Holmes, Tags: Original Contribution Source Type: research

Transcatheter Interventions in Adults with Congenital Heart Disease: Surveys from the Society for Cardiovascular Angiography and Interventions to identify current patterns of care and perception on training requirements
Conclusions: ACHD management remains underdeveloped in relative terms, particularly in the United States. Significant gaps in interventional standards of practice and future training needs were recognized by this study. Our survey should serve as an impetus to establish training guidelines for physicians who seek to perform ACHD interventions. This article is protected by copyright. All rights reserved.
Source: Catheterization and Cardiovascular Interventions - May 11, 2017 Category: Cardiovascular & Thoracic Surgery Authors: Subeer K. Wadia, Michael J. Accavitti, Gareth J. Morgan, Damien Kenny, Ziyad M. Hijazi, Thomas K. Jones, Allison K. Cabalka, Doff B. McElhinney, Clifford J. Kavinsky Tags: PED ‐CHD ‐ Pediatric and Congenital Heart Disease Source Type: research

A prospective randomized controlled trial using propofol or dexmedetomidine for conscious sedation in pediatric patients undergoing sclerotherapy
Conclusion: Both propofol and dexmedetomidine can be used for administering sedation in pediatric patients undergoing sclerotherapy for superficial venous malformations in DSA suite. Although propofol provides a rapid onset and reduced duration of action, dexmedetomidine provides reduced episodes of arterial desaturation and respiratory depression.
Source: Journal of Pediatric Neurosciences - January 19, 2021 Category: Neuroscience Authors: Rajeev Chauhan Ankur Luthra Sameer Sethi Nidhi Panda Shyam Charan Meena Vikas Bhatia Summit D Bloria Source Type: research

The syndrome of vanishing ACS : Who activates spontaneous thrombolysis doctor ?
Background “Your husband was really lucky, his heart attack got spontaneously aborted. His ECG is near normal now. The angiogram is normal.No stent, no lysis. He secreted his own Tpa and got rid of the clot. We will discharge him to tomorrow.” Thank you very much, Doctor. How did this happen, doctor? Don’t thank me. Definitely, I don’t have an answer. Spontaneous successful thrombolysis (Ref 4) happens up to 15 % of ACS. All I can say is he has a very disciplined mast cell network and fibrinolytic system. Vascular events: Pathobiology Vascular highway accidents that happen with sudden freezing...
Source: Dr.S.Venkatesan MD - October 8, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized anti fibrinolytic system thrombolysis Source Type: blogs

The syndrome of vanishing ACS : Who activates spontaneous thrombolysis ?
Background “Your husband was really lucky, his heart attack got spontaneously aborted. His ECG is near normal now. The angiogram is normal.No stent, no lysis. He secreted his own Tpa and got rid of the clot. We will discharge him to tomorrow.” Thank you very much, Doctor. How did this happen, doctor? Don’t thank me. Definitely, I don’t have an answer. Spontaneous successful thrombolysis (Ref 4) happens up to 15 % of ACS. All I can say is he has a very disciplined mast cell network and fibrinolytic system. Vascular events: Pathobiology Vascular highway accidents that happen due to the sudden fr...
Source: Dr.S.Venkatesan MD - October 8, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized anti fibrinolytic system thrombolysis Source Type: blogs