Is the end of football coming? This doctor says it can’t come fast enough.
Evan Murray was a 17-year-old high school senior, honor student, and three-sport athlete who died recently as a direct result of injuries sustained playing quarterback for his school football team. On the last play of his life, he got drilled by a defender with a clean hit to the midsection. He gathered himself, rose, and walked off the field on his own. Shortly thereafter, however, he collapsed on the sideline and the on-site ambulance transported him to the hospital. It’s unclear what happened next, whether he died en route to the hospital or in the ER or during emergency surgery. He died, though. That ...
Source: Kevin, M.D. - Medical Weblog - October 17, 2015 Category: Journals (General) Authors: Jeffrey Parks, MD Tags: Conditions Neurology Source Type: blogs
Patient autonomy is held to be sacrosanct. A doctor reconsiders this view.
The refusal of blood products by the Jehovah’s witnesses has often been cited as a great example of patient religious freedom triumphing over the traditional paternalism of medicine. Patients are free to refuse transfusion even at the risk of death. Many hospital-based physicians have, at one time or another, been witness to the demise of a patient refusing blood products, perhaps a preventable demise. Patient autonomy is held to be sacrosanct. My recent experiences, however, have led me to reconsider this view.
A 21-year-old male of African-American descent, a Jehovah’s Witness, with a history of sickle cell anemia pr...
Source: Kevin, M.D. - Medical Weblog - September 26, 2015 Category: Journals (General) Authors: Anonymous Tags: Conditions Hematology Intensive care Source Type: blogs
The Sale of Fetal Tissue
TUESDAYS WITH ROSEMARY AND MYRAVirtually everyone is familiar with Mitch Albom’s book, Tuesdays With Morrie. Myra Christopher (Foley Chair at the Center and former Center CEO) and Rosemary Flanigan (Retired Center Program Staff) have decided to regularly contribute to the Center for Practical Bioethics’ blog and call it “Tuesdays with Rosemary and Myra” (even though it won’t necessarily be published on a Tuesday). Read more about Rosemary and Myra at the bottom of this post. The Sale of Fetal Tissue M: Rosemary, you know all the hub-bub about the video of the executive from Planned Paren...
Source: blog.bioethics.net - August 26, 2015 Category: Medical Ethics Authors: Practical Bioethics Tags: Health Care syndicated Tuesdays with Rosemary & Myra Source Type: blogs
LITFL Review 194
Welcome to the 194th 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
When is ST elevation not ACS? Read Stephen Smith’s blog for a great case demonstrating that ST elevation = ischemia but not necessarily coronary occlusion. [AS]
The Best of #FOAMed Emergency Medicine
A primer on xanthochromia from Boring EM. [A...
Source: Life in the Fast Lane - August 23, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs
Doctors now diagnose in code. ICD code, that is.
“Hi, it’s Dr. Smith, are you taking consults today?” the voice on the other side of my short-range hospital phone said. I recognized the caller’s name as one of the new hospital doctors, known as hospitalists.
“Of course,” I said, “What have you got?” I guess some groups have a specific doctor for the day “take” the consults. If I am in the hospital, I am always taking consults.
“Great,” the hospitalist says. “I have a 67-year-old female with chronic systolic heart failure and diabetes type 2 (uncontrolled) who presents with acute blood loss anemia likely from upper GI bleed. She was giv...
Source: Kevin, M.D. - Medical Weblog - August 16, 2015 Category: Journals (General) Authors: Frederick Gandolfo, MD Tags: Physician GI Hospital Hospitalist Source Type: blogs
A Step Toward a Cultural Transformation in the Way Pain is Perceived, Judged and Treated
The following blog post is the executive summary of the June 29-30, 2015, PAINS Collaborators Meeting in Washington, DC, held in response to Department of Health and Human Services’ publication of the National Pain Strategy Report. BACKGROUNDIn anticipation of publication of the National Pain Strategy (NPS) Report, in June 2015 the Pain Action Alliance to Implement a National Strategy (PAINS), a coalition of national leaders and organizations committed to advancing the sixteen recommendations made in the Institutes of Medicine’s report, Relieving Pain in America: A Blueprint for Transforming Prevention, C...
Source: blog.bioethics.net - July 23, 2015 Category: Medical Ethics Authors: Practical Bioethics Tags: Health Care syndicated Source Type: blogs
Something I learned during AS level revision - sickle cell anaemia
Not my revision, as such, but helping my elder son revise for his AS level history exams. One of the things he studied was the Civil Rights Movement in the United States. And one of the things within that was the role of the Black Panthers in raising awareness and action about sickle cell anaemia (sickle cell disease).The Black Panthers were set up in 1966 to protect residents of African American neighbourhoods from police brutality. But they did more than that, including setting up breakfast clubs and other community programmes.There is more about the Black Panthers in general on Britannica but it does n...
Source: Browsing - July 1, 2015 Category: Databases & Libraries Tags: civil rights sickle cell Source Type: blogs
Pain Management with Low-Dose Ketamine Infusions
Ketamine is a fascinating drug with multiple potential applications in the emergency department, but emergency physicians should consider this phencyclidine-like dissociative agent for pain management.
Pain, as we know, has complex mechanisms and pathways. Peripheral and central sensitization of pain pathways are recognized as part of the process of chronic and subacute pain syndromes. The NMDA receptor is central to the sensation of pain, and ketamine’s ability to centrally block the NMDA receptor is widely recognized and accepted as the mechanism for pain relief.
Ketamine is rapidly distributed into the brain...
Source: M2E Too! Mellick's Multimedia EduBlog - July 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Pain Management with Low-Dose Ketamine Infusions
Ketamine is a fascinating drug with multiple potential applications in the emergency department, but emergency physicians should consider this phencyclidine-like dissociative agent for pain management.
Pain, as we know, has complex mechanisms and pathways. Peripheral and central sensitization of pain pathways are recognized as part of the process of chronic and subacute pain syndromes. The NMDA receptor is central to the sensation of pain, and ketamine’s ability to centrally block the NMDA receptor is widely recognized and accepted as the mechanism for pain relief.
Ketamine is rapidly distributed into the brain and...
Source: M2E Too! Mellick's Multimedia EduBlog - July 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Proactive Psychiatric Consultation For Hospitalized Patients, A Plan for the Future
The Yale Behavioral Intervention Team (BIT) is a proactive, multi-disciplinary psychiatric consultation service for all internal medicine inpatients at Yale-New Haven Hospital. The goal of the team, which includes nurses, social workers, and psychiatrists, is to shift from a “reactive” to a “proactive” paradigm of psychiatric consultations on hospital inpatient medical floors.
The team screens for, identifies, and removes/mitigates behavioral barriers to the effective receipt of health care among hospitalized medical patients, especially among those with co-occurring mental illness and/or substance abuse. To facili...
Source: Health Affairs Blog - May 28, 2015 Category: Health Management Authors: William H. Sledge and Hochang Ben Lee Tags: Hospitals Innovations in Care Delivery Organization and Delivery Behavioral Health Behavioral Intervention Team Mental Health Nursing Patient Care Psychiatry Social Work Source Type: blogs
Global Life Expectancy Has Risen by Six Years Since 1990
This study confirms other work that shows the ballpark growth in life expectancy at birth is something like one year with every four calendar years. Adult life expectancy is also climbing, but more slowly - perhaps one year each decade. This present pace will change as the research community starts to deliberately target aging for treatment, which has not previously been the case. Past gains in life expectancy at age 30 or 60 due to improvements in medicine have been somewhat incidental, side-effects rather than deliberately obtained results.
Global life expectancy for both sexes increased from 65.3 years in 1990, to 71.5...
Source: Fight Aging! - December 18, 2014 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
Hydroxyurea and HbF in sickle cell disease
var gaJsHost = (("https:" == document.location.protocol) ? "https://ssl." : "http://www."); document.write(unescape("%3Cscript src='" + gaJsHost + "google-analytics.com/ga.js' type='text/javascript'%3E%3C/script%3E")); Steinberg MH et al. Effect of hydroxyurea on mortality and morbidity in adult sickle cell anemia. Risks and benefits up to 9 years of treatment. JAMA 1003; 289: 1645-51. Weiner DL, et al. editorial: hydroxyurea and sickle cell disease. A chance for every patient.HbF is inversely related to mortality in SCD, and can be increased with hydroxyurea. Also cite Multicenter Study of hy...
Source: neurologyminutiae - October 9, 2014 Category: Neurologists Source Type: blogs
Stay Off the Admit Train
A man in his mid-50s with intermittent nosebleeds was sent in by his primary doctor for “abnormal labs.” The CBC sent from the office revealed a hemoglobin of 5.9 mg/dL. He had no past medical history and no sites of bleeding except for nosebleeds. Labs were sent to confirm the anemia as well as for potential admission.
His lab results were WBC 5.5; HGB 5.0; platelets 160; NA 124; K 3.4; Cl 99; CO2 23; BUN 16; Cr 1.8; glucose 71; anion gap 2; calcium 9.3; and albumin 2.1.
What is his diagnosis?
With the pressure on wait times and length of stay, I think much more often we put patients on the "admit train&...
Source: Lions and Tigers and Bears - August 20, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Stay Off the Admit Train
A man in his mid-50s with intermittent nosebleeds was sent in by his primary doctor for “abnormal labs.” The CBC sent from the office revealed a hemoglobin of 5.9 mg/dL. He had no past medical history and no sites of bleeding except for nosebleeds. Labs were sent to confirm the anemia as well as for potential admission.
His lab results were WBC 5.5; HGB 5.0; platelets 160; NA 124; K 3.4; Cl 99; CO2 23; BUN 16; Cr 1.8; glucose 71; anion gap 2; calcium 9.3; and albumin 2.1.
What is his diagnosis?
With the pressure on wait times and length of stay, I think much more often we put patients on the "admit ...
Source: Lions and Tigers and Bears - August 20, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Outbreaks of Non-tubercuous Mycobacterial Infection in the United States
The following chronology of nosocomial mycobacteriosis outbreaks in the United States is abstracted from Gideon www.GideonOnline.com and the Gideon e-book series. [1,2] Primary references available on request.
1987 – An outbreak (17 cases) of Mycobacterium chelonae otitis media was caused by contaminated water used by an ENT practice in Louisiana.
1988 – An outbreak (8 cases) of foot infections due to Mycobacterium chelonae subspecies abscessus infections were associated with a jet injector used in a podiatric office.
1989 to 1990 – An outbreak (16 cases) of sputum colonization by Mycobacterium fortuitum...
Source: GIDEON blog - July 23, 2014 Category: Databases & Libraries Authors: Dr. Stephen Berger Tags: Ebooks Epidemiology Microbiology Outbreaks ProMED Non-tuberculous Mycobacteria Source Type: blogs
