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 tribute to the pharmacist
Dear pharmacist,
You just paged me and, I must admit, I’m not feeling excited to call back. I estimate that I probably get paged, called, texted or stopped in person by you exactly X·102 per day, where “X” is the number of days I’ve been on service. Despite all of the interactions over the years, I have never stopped to really consider our relationship. Here are a few of our most memorable moments:
You once paged me while I was driving home from clinic. I had just finished a hellish day filled with overbooked patients, prior authorization requests and last minute walk-ins. I was relieved just to make it to the end...
Source: Kevin, M.D. - Medical Weblog - March 24, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/taison-bell" rel="tag" > Taison Bell, MD < /a > Tags: Physician Hospital Medications Source Type: blogs
Adherence to the Surviving Sepsis Campaign bundles and outcome in severe sepsis and septic shock
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - March 9, 2017 Category: Internal Medicine Tags: critical care Source Type: blogs
Physicians must stop losing their own
In the past few weeks, we have lost two female physician colleagues tragically to suicide, a pediatrician and psychiatrist. In the general population, males take their lives at four times the rate of females. However, for physicians specifically, the suicide rate is evenly distributed between genders; making our occupation the one with the highest relative risk for women to die by suicide. This is what I wish would change about being a female physician; we must stop losing our own. We need to support each other, love one another, and face our challenges together.
Fifteen years ago, a surgeon called me in to evaluate ...
Source: Kevin, M.D. - Medical Weblog - March 5, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/niran-s-al-agba" rel="tag" > Niran S. Al-Agba, MD < /a > Tags: Physician Psychiatry Source Type: blogs
Research and Reviews in the Fastlane 174
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 174th edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.
This edition contains 5 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, JustiWelcome to the 173rd editi...
Source: Life in the Fast Lane - March 1, 2017 Category: Emergency Medicine Authors: Justin Morgenstern Tags: Education Emergency Medicine Infectious Disease Intensive Care R&R in the FASTLANE Resuscitation Toxicology and Toxinology EBM literature recommendations research and reviews Source Type: blogs
Bad bug, no drugs: The real end of antibiotics?
Follow me on Twitter @JohnRossMD
In September 2016, a woman in her 70s died of septic shock in Reno, Nevada, from an infection which was fully resistant to 26 different antibiotics. She had spent much of the previous two years in India, where she was treated for a hip fracture. The hip became infected, and after several more hospital stays, she returned to her home in Nevada.
Within weeks, she was desperately ill, and back in a hospital in Reno. A sample from her hip wound revealed a strain of the bacteria Klebsiella pneumoniae which was not sensitive to any antibiotics. It was even resistant to a drug called colistin, an ...
Source: Harvard Health Blog - February 27, 2017 Category: Consumer Health News Authors: John Ross, MD, FIDSA Tags: Drugs and Supplements Health Infectious diseases Source Type: blogs
Factors in delays in antibiotic administration in patients with septic shock
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - January 4, 2017 Category: Internal Medicine Tags: critical care infectious disease Source Type: blogs
Research and Reviews in the Fastlane 164
Welcome to the 164th edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.
This edition contains 6 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Justin Morgenstern and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R project or check o...
Source: Life in the Fast Lane - December 14, 2016 Category: Emergency Medicine Authors: Justin Morgenstern Tags: Emergency Medicine Intensive Care R&R in the FASTLANE Resuscitation EBM literature recommendations research and reviews 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 260
Welcome to the 260th 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
A seriously good survival guide for central venous access devices from new DFTB author, Amanda Ullman. Includes tips to salvage almost any line. [JS]
The Best of #FOAMed Emergency Medicine
Check out First 10 EM articles of the month for November...
Source: Life in the Fast Lane - December 4, 2016 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs
LITFL Review 256
Welcome to the 256th 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
Assessing oxygenation with an ABG has to be better than simple oxygen saturations, right? Well…Josh Farkas may make you think otherwise with this superb post. [SL]
The Best of #FOAMed Emergency Medicine
Another excellent list of top arti...
Source: Life in the Fast Lane - November 6, 2016 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs
Sepsis bundles – why sensitivity and specificity matter
Graham Walker(@grahamwalker) tweeted this in response to yesterday’s blog post:
Agree w @medrants on Abx usage. Sepsis guidelines mandating Abx for anything that COULD be sepsis is the problem
I responded that his example is brilliant. Let’s dissect the problem.
Sepsis is a severe problem that responds better to early aggressive treatment.
Those invested in diagnosing sepsis desire bundles that have a high sensitivity. In case you forgot the definition of sensitivity, it is the true positive rate. Sensitivity here represents the percentage of sepsis patients that you treat promptly. Sounds good –...
Source: DB's Medical Rants - November 3, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Cases: Use of Steroids as Adjuvants for Pain Management
Conclusion:Although there is no definitive, absolute proof that use of dexamethasone as an adjuvant agent for symptom management does not confer a potential increased risk of infection, we do have literature indicating that steroids are used to help manage and treat certain infections, and that there has not been evidence of increased new infections when used in a single dose post-operatively. The clinical take away here is that it okay to consider the use of a steroid, especially in a low dose for a short period of time, in managing pain of an inflammatory etiology (such as pleurisy), and when compared to the potential ri...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 31, 2016 Category: Palliative Care Tags: cancer hematology opioids pain riegel steroids Source Type: blogs
The yoga of surgery
Early on a random Tuesday morning, I walked into the burn unit and found my 87-year-old patient, Mr. Gray, in septic shock. While Mr. Gray’s burn injury was small by our standards, it appeared that the sequelae of the injury might prove fatal. I called Mr. Gray’s wife to obtain consent for a vascular catheter through which I planned to begin continuous dialysis and was surprised when she declared, “No more lines.”
The rest of my day was a blur of rounds, surgeries, and bedside procedures. I was able to temporarily stabilize Mr. Gray with antibiotics, fluids, and pressors. When his wife arrived at 3 p.m., she explai...
Source: Kevin, M.D. - Medical Weblog - September 24, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/red-hoffman" rel="tag" > Red Hoffman, MD, ND < /a > Tags: Physician Surgery Source Type: blogs
