Dying with Dignity in the Intensive Care Unit – NEJM Poll
The New England Journal of Medicine is conducting a poll on an ICU case. Read the case below and decide how decisions should be made about this patient’s further treatment. Participate in the poll and, if you like, submit a comment supporting your choice. The editors’ recommendations will appear on the NEJM site along with a link to the related review article, on June 26.
Presentation of CaseA 77-year-old man whose medical history includes treated hypertension and hypercholesterolemia, previous heavy alcohol intake, and mild cognitive impairment required 15 days ...
Source: blog.bioethics.net - June 12, 2014 Category: Medical Ethics Authors: Thaddeus Mason Pope Tags: Health Care medical futility blog syndicated Source Type: blogs
Single Bout of Binge Drinking Linked to Immune System Effects
The hazards of a leaky gut. Biology for $1000, Alex: An integral part of the cell walls of Gram-negative bacteria, these toxic compounds can trigger inflammation and other immunological responses after a single episode of heavy drinking. Answer: What are endotoxins? The outer membranes of gram-negative bacteria contain toxic elements known as endotoxins, or lipopolysaccharides. An endotoxin is released when a bacterial cell wall is breached, allowing virulent proteins to enter the bloodstream. When endotoxins engage with the immune system, the result is inflammation—a necessary part of healing, yet potentially damaging t...
Source: Addiction Inbox - May 22, 2014 Category: Addiction Authors: Dirk Hanson Source Type: blogs
Top stories in health and medicine, March 19, 2014
From MedPage Today:
Is Belphen the Next Blockbuster Diet Drug? Even though there are scant data, obesity researchers and patients have already put a name to a potential new weight-loss craze: Belphen, a combination of lorcaserin (Belviq) and phentermine.
Does COPD Dull the Mind? Mild cognitive impairment was more likely in patients with chronic obstructive pulmonary disease (COPD), particularly the longer it went on.
Panel Urges Higher Bar for Cancer Trials. Oncology clinical trials should be designed so that the primary endpoint of overall survival benefit is a more meaningful one, and patients should expect no less.
Se...
Source: Kevin, M.D. - Medical Weblog - March 19, 2014 Category: Family Physicians Tags: News Cancer Endocrinology Pulmonology Source Type: blogs
Pathogenic Neisseria
John K. Davies and Charlene M. Kahler present a new book on Pathogenic Neisseria: Genomics, Molecular Biology and Disease Intervention The human pathogens, Neisseria meningitidis and Neisseria gonorrhoeae are exquisitely adapted to life within the human mucosa, their only natural niche. N. meningitidis is the causative agent of rapidly transmissible meningitis and septic shock. Vaccines developed to control this pathogen can be rendered ineffective by the pathogen’s ability to undergo antigenic variation. In contrast, there are no current vaccination prospects for N. gonorrhoeae, the causative agent of sexually transm...
Source: Microbiology Blog: The weblog for microbiologists. - January 31, 2014 Category: Microbiology Source Type: blogs
Inspiration for Living a Grateful Life
In 2011 writer and artist Anne O. Kubitsky printed out 500 invitation cards asking people to share what they’re grateful for in a postcard (and mail it back to her). She left these cards in various places, everywhere from post offices to parks to college cafeterias to libraries.
Within three weeks she received handmade postcards from all over the world – from Oregon to Alaska to Australia to Germany. Today, she’s received thousands of responses in many different forms: letters, emails and even phone calls.
People also have submitted postcards made from leather and clay. One person submitted a 12-year Alcoholics Anony...
Source: World of Psychology - December 1, 2013 Category: Psychiatrists and Psychologists Authors: Margarita Tartakovsky, M.S. Tags: Books General Holiday Coping Mental Health and Wellness Motivation and Inspiration Self-Help Anne O. Kubitsky grateful Gratefulness Gratitude Holidays life Source Type: blogs
The LITFL Review 115
The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the best and brightest from the blogosphere, the podcast video/audiosphere and the rest of the Web 2.0 social media jungle to find the most fantastic EM/CC FOAM (Free Open Access Meducation) around.
Welcome to the 114th edition, brought to you by:
Kane Guthrie [KG] from LITFL
Tessa Davis [TRD] from LITFL and Don’t Forget The Bubbles
Brent Thoma [BT] from BoringEM, and
Chris Nickson [C...
Source: Life in the Fast Lane - November 11, 2013 Category: Emergency Medicine Doctors Authors: Kane Guthrie Tags: Education eLearning Emergency Medicine Featured Intensive Care LITFL review LITFL R/V Source Type: blogs
Combining esmolol and nor epi in septic shock?
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - October 30, 2013 Category: Internists and Doctors of Medicine Tags: cardiovascular critical care infectious disease Source Type: blogs
EMA Journal August 2013
From Andrew Gosbell & Tony Brown
Issue 4 (Vol. 25) of Emergency Medicine Australasia published online on 2 August 2013
First Do No Harm. In Fact, First Do Nothing, at Least not a Cannula (#FOAMed)
This thought provoking editorial considers the potential cascade of over-investigation, diagnosis and treatment that may be initiated in the ED. Using the example of peripheral intravenous catheters (PIVC), where a recent study (Pain With No Gain?) demonstrated that 50% of PIVCs inserted in adult patients went unused, Egerton-Warburton (@First_do_noharm) one of that article’s authors, and Ieraci (@SueIeraci) conten...
Source: Life in the Fast Lane - October 15, 2013 Category: Emergency Medicine Doctors Authors: Mike Cadogan Tags: Education EMA Emergency Medicine Featured Journal ADAPT ADP Egerton-Warburton EMA Journal First Do No Harm NEAT Pain With No Gain? Sue Ieraci Source Type: blogs
Alzheimer's Like Symptoms After Leaving the Hospital
As medical care is improving patients are surviving critical illness more often; but, if they are surviving their critical illness with disabling forms of cognitive impairment like Alzheimer's something has to be done.
+Alzheimer's Reading Room
Patients treated in intensive care with no evidence of cognitive impairment often leave with deficits similar to those like mild Alzheimer’s disease (AD).
These symptoms or deficits often persist for at least a year, according to a Vanderbilt University Medical Center study published today in the New England Journal of Medicine.
Subscribe to the Alzheimer's Readin...
Source: Alzheimer's Reading Room, The - October 5, 2013 Category: Dementia Authors: Bob DeMarco Source Type: blogs
Book of Nurses: Ally.
I’m Ally; I’m 23 and work as a Critical Care Nurse in Newy.
My parents pushed me into nursing. That sounds weird. But it’s really, very strangely, true. I nailed my HSC, had always been an academic achiever, and if I had gone with my gut or my guidance councilor’s advice, I probably would have become an economist. But my parents told me for as long as I can really recall, that I should do nursing, despite my personal interest in writing, economics, politics and the humanities.
As a profound sufferer of ‘middle child syndrome’ I felt my parents didn’t believe that I could achieve anything more…you kn...
Source: impactEDnurse - September 17, 2013 Category: Nurses Authors: impactEDnurse Tags: ectopics Source Type: blogs
The LITFL Review 109
The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the best and brightest from the blogosphere, the podcast video/audiosphere and the rest of the Web 2.0 social media jungle to find the most fantastic EM/CC FOAM (Free Open Access Meducation) around.
Welcome to the 109th edition, brought to you by:
Kane Guthrie [KG] from LITFL
Tessa Davis [TD] from LITFL and Don’t Forget The Bubbles
Brent Thoma [BT] from BoringEM, and
Chris Nickson [CN] ...
Source: Life in the Fast Lane - September 16, 2013 Category: Emergency Medicine Doctors Authors: Kane Guthrie Tags: Education eLearning Emergency Medicine Featured Health Intensive Care LITFL review LITFL R/V Source Type: blogs
Study Explains Errors Caused by EHR Default Values - With Only Four Reports of "Temporary" (By the Grace of God) Patient Harm
From Health Data Management and the Pennsylvania Patient Safety Authority:Study Explains Errors Caused by EHR Default ValueJoseph Goedert Sept. 5, 2013 A new study analyzes errors related to “default values” which are standardized medication order sets in electronic health records and computerized physician order entry systems.The Pennsylvania Patient Safety Authority, an independent state agency, conducted the study. “Default values are often used to add standardization and efficiency to hospital information systems,” says Erin Sparnon, an analyst with the authority and study author. “For example, a...
Source: Health Care Renewal - September 5, 2013 Category: Health Medicine and Bioethics Commentators Tags: Erin Sparnon healthcare IT risk Health Data Management default values Pennsylvania Patient Safety Authority HIT Policy Committee Source Type: blogs
SMACC: The Dark Art of IVC Ultrasound
Thanks to plenty of people for their input, but especially Kylie Baker and Adrian Goudie
When I was first taught about sonographic assessment of the Inferior Vena Cava (IVC), the following table was unveiled with great solemnity:
IVC diameter (cm)
IVCCI
Estimated RA pressure (mm Hg)
<1.7
>50%
0-5
>1.7
>50%
6-10
>1.7
<50%
11-15
‘dilated’
none
>15
We were told to learn these measurements, take them to the bedside and use them on our critically ill patients to guide resuscitation. We were commanded to use M-mode assessment in the subxiphoid ling axis, and ideally a sniff test.
IVC ultra...
Source: Life in the Fast Lane - July 26, 2013 Category: Emergency Medicine Doctors Authors: Justin Bowra Tags: Emergency Medicine Featured Intensive Care SMACC inferior vena cava ivc justin bowra Ultrasound Source Type: blogs
Fever, Friend or Foe?
The audio and slides for this SMACC talk are at the bottom of this blog post
Fever is so hot right now…
‘Humanity has but three great enemies: fever, famine and war; of these by far the greatest, by far the most terrible, is fever’
— William Osler1
Fever is one of the cardinal signs of infection and — nearly 120 years after William Osler’s statement in his address to the 47th annual meeting of the American Medical Association on The Study of the Fevers of the South1 — infectious diseases remain a major cause of morbidity and mortality2. Despite this, it is unclear whether fever itself is truly the enemy or w...
Source: Life in the Fast Lane - July 10, 2013 Category: Emergency Medicine Doctors Authors: Paul Young Tags: Emergency Medicine Featured Infectious Disease Intensive Care critical care Fever Friend or Foe ICU paul young SEPSIS SMACC Source Type: blogs
