Research & Reviews in the Fastlane 104
Welcome to the 104th 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, Anand Swaminathan 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 ou...
Source: Life in the Fast Lane - October 15, 2015 Category: Emergency Medicine Authors: Soren Rudolph Tags: Airway Anaesthetics Education Emergency Medicine Emergency Medicine Update Haematology Immunology Infectious Disease Intensive Care Pre-hospital / Retrieval R&R in the FASTLANE Resuscitation Trauma critical care Review Source Type: blogs
Dengue circulatory shock : What is the mechanism ?
Dengue is a global infectious disease caused by Flavivirus (RNA) transmitted by day biting mosquitoes Ades aegypti .It is primarily a tropical or sub tropical disease , India is marked among the epicentre . 75% of dengue infections are asymptomatic. Among the remaining 25 % only 5 % develop severe dengue and a fraction of them go for a dreaded circulatory and bleeding complication leading to a likely fatality.Severe hypotension is the hall-mark in dengue shock .
The mechanism of shock
The sine-qua non of dengue shock is the capillary leak syndrome .This is due to some unknown vascular toxins acting in micro cir...
Source: Dr.S.Venkatesan MD - October 1, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology -Therapeutic dilemma cardiology -Therapeutics Cardiology -unresolved questions dengue myocarditis mechanism of dengue shock myocardial involvement in dengue Source Type: blogs
New Futility Case: Siner v. Kindred Hospital Indianapolis
The Court of Appeals of Indiana issued a decision that allows a family to proceed with its medical malpractice action alleging that a hospital's unilateral DNR order caused the patient's death.
Facts"October 26, 2007, eighty-six-year old Geraldine Siner became a patient at Kindred Hospital. Geraldine suffered from advanced dementia caused by Alzheimer’s disease and as a result could no longer care for herself. Geraldine’s son, John Siner, was designated as her health care representative and had power of attorney."
"Upon Geraldine’s admission to Kindred, and several times thereafter, John inform...
Source: blog.bioethics.net - August 30, 2015 Category: Medical Ethics Authors: Thaddeus Mason Pope Tags: Health Care medical futility blog syndicated Source Type: blogs
Research and Reviews in the Fastlane 094
This article has significant implications for clinicians translating evidence into practice.
7 decreasing mortality
Noninvasive ventilation (NIV) for specific population with acute respiratory failure
Mild hypothermia after cardiac arrest
Prone positioning
Low tidal volume ventilation in acute respiratory distress syndrome (ARDS)
Tranexamic acid in patients with or at high risk of traumatic hemorrhagic shock
Daily interruption of sedatives in critically ill patients
Albumin administration in cirrhotic patients with spontaneous bacterial peritonitis
And 8 shown to increase mortality including hydroxyethy...
Source: Life in the Fast Lane - August 5, 2015 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Education Emergency Medicine Infectious Disease Intensive Care Orthopedics Pediatrics Pre-hospital / Retrieval Resuscitation Trauma critical care EBM literature R&R in the FASTLANE recommendations research and reviews Source Type: blogs
Research and Reviews in the Fastlane 093
This study of 50 volunteers suggests that three commonly taught methods for finding the cricothyroid membrane (general palpation, four-finger, skin crease) are relatively inaccurate, using ultrasonography as the gold standard. I conclude:1. The landmark techniques are inaccurate for finding the CTM *and that’s okay.* Make your best guess using general palpation and if you feel nothing, use four-finger or skin crease **and then make a long vertical incision.** Once you get through the skin you are very likely to be able to feel the CTM, and even if you still can’t at that point, that’s fine too, cut to air...
Source: Life in the Fast Lane - July 29, 2015 Category: Emergency Medicine Authors: Jeremy Fried Tags: Airway Education Emergency Medicine Intensive Care R&R in the FASTLANE Trauma critical care EBM literature recommendations research and reviews Source Type: blogs
The dilemma of treating patients, based on their contributions to society
During my third-year internal medicine rotation, I was introduced to and helped care for a patient named Casey (name changed to protect privacy). I identified with Casey because we were the same age, and I felt empathetic toward her situation.
Casey was very sick, a direct result of her risky behavior. She was admitted for infective endocarditis secondary to intravenous opioid abuse. She had her second heart valve replacement eight days prior with the first replacement done nine months before. The valve replacement was done at another area hospital, and she was discharged to a skilled nursing facility for extended antibiot...
Source: Kevin, M.D. - Medical Weblog - July 28, 2015 Category: Journals (General) Authors: Kelsey Childress Tags: Physician Hospital Source Type: blogs
Red Dust, dingoes, trauma and Sepsis
Guest post by Dr Chris Edwards of EMJourney recounts his time as a remote retrieval registrar based in Alice Springs – @EMtraveller
I’ve had the privilege to work as a Retrieval Registrar for the Alice Springs Hospital Retrieval Service in Central Australia for the last 6 months. How to describe it – words that spring to mind include:
Challenging (unlike many other retrieval jobs, you often are intimately involved in the logistics planning)
Satisfying (providing ICU level care to the most remote parts of Australia)
Scary (providing ICU level care to the most remote parts of Australia!)
Clinical character formi...
Source: Life in the Fast Lane - July 25, 2015 Category: Emergency Medicine Authors: Mike Cadogan Tags: Pre-hospital / Retrieval Alice Springs chris edwards Retrieval Medicine Source Type: blogs
Research and Reviews in the Fastlane 090
This study prospectively looks at 106 patients with either DVT or PE who were identified as low risk based on the Hestia criteria. All of the patients were started on rivaroxaban (a Factor Xa inhibitor) and none had VTE recurrence (while on anticoagulation), major bleeding events or death due to VTE. This study further supports outpatient management for low risk VTE but a randomized controlled trial is needed (keep your eye out for the MERCURY-PE study)
Recommended by Anand Swaminathan
Further reading: SGEM #126: Take me to the Rivaroxaban — Outpatient treatment of VTE (The Skeptics Guide to EM)
Research and critic...
Source: Life in the Fast Lane - July 9, 2015 Category: Emergency Medicine Authors: Jeremy Fried Tags: Airway Clinical Research Emergency Medicine Intensive Care Neurology R&R in the FASTLANE Respiratory Review critical care EBM Education recommendations research and reviews Source Type: blogs
Research and Reviews in the Fastlane 087
Welcome to the 87th 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, Anand Swaminathan 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 out...
Source: Life in the Fast Lane - June 10, 2015 Category: Emergency Medicine Authors: Soren Rudolph Tags: R&R in the FASTLANE critical care Education Emergency Medicine Intensive Care recommendations Review Source Type: blogs
LITFL Review 181
Welcome to the 181st 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 chuck of FOAM.The Most Fair Dinkum Ripper Beauts of the Week Mel Herbert discusses “Why We Do Emergency Medicine” from Essentials of Emergency Medicine 2014. Powerful talk about what we do every day. [AS]The Intensive Care Network has a must-listen update from the legendary John Myburgh on fluid resuscita...
Source: Life in the Fast Lane - May 10, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs
Politico: Electronic record errors growing issue in lawsuits
The indefatigable Arthur Allen of Politico.com has authored a nice piece on the issue of EHRs being a cause of medical malpractice, with resultant litigation. I was a contributor:Electronic record errors growing issue in lawsuitsBy Arthur Allen5/4/15 6:40 AM EDThttp://www.politico.com/story/2015/05/electronic-record-errors-growing-issue-in-lawsuits-117591.htmlMedical errors that can be traced to the automation of the U.S. health care system are increasingly an issue in medical malpractice lawsuits.Some of the doctors, attorneys and health IT experts involved in the litigation fear that safety and data integrity probl...
Source: Health Care Renewal - May 6, 2015 Category: Health Management Tags: Arthur Allen healthcare IT litigation healthcare IT risk Politico Source Type: blogs
Pulseless ventricular tachycardia – why did the AED not advise a shock?
This case was submitted by my friend Dr. Victoria Stephens. She is a third year Emergency Medicine Registrar from at the University of the Witwatersrand in Johannesburg, South Africa, and a great asset to FOAMed. Follow her on Twitter: @EMcardiac.CaseA 71 year old man was admitted to the ICU with neutropenic sepsis complicated by septic shock. He was intubated and ventilated and was started on an adrenaline infusion to maintain his blood pressure. The admission ECG was normal. Thirty-six hours into his ICU stay he went into a cardiac arrest. The monitor showed a wide complex tachycardia. CPR was commenced...
Source: Dr. Smith's ECG Blog - April 10, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
Research and Reviews in the Fastlane 076
This study is important to confirm what many of us already do, use ETCO2 as a marker of CPR quality. While limited by the manner in which the data was collected, and multiple potential confounders such as lack of medication administration and ventilation details, the authors provide us with a positive correlation between chest compression depth and ETCO2 levels. For every 10mm increase in depth, there was a 1.4mm Hg increase in ETCO2. While statistically significant, there is likely limited clinical importance of such a small difference. Nevertheless, as quality of CPR is the known most important factor in resuscitation, a...
Source: Life in the Fast Lane - March 26, 2015 Category: Emergency Medicine Authors: Jeremy Fried Tags: Cardiology Emergency Medicine Gastroenterology Infectious Disease R&R in the FASTLANE Respiratory Resuscitation critical care recommendations research and reviews Source Type: blogs
Ease the transition to hospital medicine
I came to hospital medicine from the land of pulmonary-critical care. I had spent ten years dealing with septic shock, respiratory failure, and acute renal failure. I had intubated, withdrawn life support, placed central lines, performed thoracenteses, and even placed a couple of chest tubes. I had changed tracheostomy tubes; I ran codes. In short I was a critical care bad ass. I thought I was hot stuff. But I tired of critical care, so I went to hospital medicine.
And died. Just died on the vine.
Continue reading ...
Your patients are rating you online: How to respond. Manage your online reputation: A social media guide....
Source: Kevin, M.D. - Medical Weblog - March 11, 2015 Category: Journals (General) Authors: Tracy Cardin, ACNP Tags: Physician Hospital Hospitalist Source Type: blogs
What can we learn about palliative care from Indian physicians?
Early on in my career I called an Indian internist in the middle of the night to admit a patient to him.
The patient was an 88-year-old female with advanced dementia, a terminal brain disease. She had aspiration pneumonia, which is often the final common pathway of this illness. She was in respiratory failure, in septic shock and was a “full code.”
I can still recall our 4 a.m. conversation:
“Hi, Dr. M this is Monica Murphy in the ER. I have an 88-year-old female with advanced dementia who has pneumonia and is septic. I intubated her; she’s got a central line with antibiotics and pressors hanging, so we need to adm...
Source: Kevin, M.D. - Medical Weblog - February 24, 2015 Category: Journals (General) Authors: Monica Williams-Murphy, MD Tags: Physician Palliative care Source Type: blogs
