Research and Reviews in the Fastlane 133
This study certainly suggests a benefit to using Dexmedetomidine in these patients.
Recommended by: Nudrat Rashid
The Best of the Rest
Emergency Medicine
Beadle KL et al. Isopropyl alcohol nasal inhalation for nausea in the Emergency Department: A randomized controlled trial. Ann Emerg Med. 2015. PMID: 26679977
This is a small double-blinded RCT comparing inhaled isopropyl alcohol to saline placebo for short-term relief of nausea in the ED. Although it is hard to believe patients (and possibly investigators) were truly blinded to the odor of isopropanol, this study found isopropanol superior to placebo for improvement...
Source: Life in the Fast Lane - May 4, 2016 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Education Emergency Medicine Intensive Care Neurology Neurosurgery critical care examination R&R in the FASTLANE recommendations research and reviews Resuscitation Source Type: blogs
Research and Reviews in the Fastlane 126
This article is a well done, RDCT comparing non-dissociative dose intravenous ketamine (0.3 mg/kg) to intravenous morphine (0.1 mg/kg). The authors found no statistically significant difference between the two at 30 minutes. This data gives further credence to the use of ketamine for acute pain relief in the ED though it does not demonstrate superiority.
Recommended by Anand Swaminathan
Cardiology
Kim S, et al. Searching for answers to clinical questions using google versus evidence-based summary resources: a randomized controlled crossover study. Academic medicine : journal of the Association of American Medical Coll...
Source: Life in the Fast Lane - March 16, 2016 Category: Emergency Medicine Authors: Jeremy Fried Tags: Airway Cardiology Emergency Medicine R&R in the FASTLANE EBM Education literature recommendations research and reviews Source Type: blogs
What Do We Know About Medical Errors Associated With Electronic Medical Records?
By ROSS KOPPEL
Recently, the Journal of Patient Safety published a powerful and important article on the role of EHRs in patient harm, errors and malpractice claims. The article is open access. Electronic Health Record–Related Events in Medical Malpractice Claims by Mark L. Graber, Dana Siegal, Heather Riah, Doug Johnston, and Kathy Kenyon.
The article is remarkable for several reasons:
Considerably over 80% of the reported errors involve horrific patient harm: many deaths, strokes, missed and significantly delayed cancer diagnoses, massive hemorrhage, 10-fold overdoses, ignored or lost critical lab results, ...
Source: The Health Care Blog - January 11, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
Giant T wave inversion
Brief Review
ECG showing deep T wave inversion in anterior wall myocardial infarction
(Click on the image for an enlarged view)
Giant T wave inversion can be broad and deep or just deep T inversions. A depth of T wave of 10 mm or above is generally considered as deep T inversion [1]. Giant T wave inversions with depth of 35 mm have also been described in literature [2]. Deep T inversions without gross increase in width can occur in ischemia and hypertrophic cardiomyopathy. In a study involving 864 patients with hypertrophic cardiomyopathy, 15% had giant T wave inversion [3]. While giant T inversions occurred in about one ...
Source: Cardiophile MD - November 18, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: ECG / Electrophysiology ECG Library deep T inversion giant T inversion Large T wave inversion Source Type: blogs
Care of the dying adult: draft guideline for consultation
National Institute for Health and Care Excellence (NICE) -This guideline applies to all adults who are potentially entering the last days of their lives in any setting that is covered by NHS services. It includes those who may be dying from chronic diseases and it also includes people who have deteriorated after a subacute event such as a stroke, subarachnoid haemorrhage or myocardial infarction. It would not apply to people who are near to death within hours of major trauma or attempted suicide. The consultation closes on 9 September 2015.
Draft guideline
Appendices
NICE - consultations (Source: Health Management Specialist Library)
Source: Health Management Specialist Library - July 30, 2015 Category: UK Health Authors: The King's Fund Information & Knowledge Service Tags: Consultations Source Type: blogs
A neurosurgery case that this medical student won’t forget
After the last elective case of the day, the neurosurgeon I was shadowing told me that he was on overnight call that evening, and that I could stick around to observe more surgeries if I wanted to. “Yes,” I responded. “Absolutely yes.”
My fascination with surgery stems from its ability to provide immediate results to a patient by cutting out, repairing, reshaping, or bypassing the problem. It’s exciting and tactile, and I find that very appealing. What’s more thrilling is emergency surgery, when an operation becomes the last-ditch intervention that hopefully saves someone from imminent death.
The first case of ...
Source: Kevin, M.D. - Medical Weblog - July 10, 2015 Category: Journals (General) Authors: Basheer Elsolh Tags: Education Medical school Surgery Source Type: blogs
Research and Reviews in the Fastlane 081
This article reviewed 17,583 adult ED intubations over 10 years at 13 different centers. The study found 95% of intubations were performed by ED physicians with good results: 99% of intubations were successful within 3 attempts.Orotracheal intubation with RSI was, of course, the most common technique, with 85% first pass success rate with this technique. And first pass success rates increased over time during the 10 year period, showing that we are continuing to get better!Interestingly, senior residents had 85% first pass rate, compared to just 72% for attendings.For drugs, etomidate was overwhelmingly the most commonly u...
Source: Life in the Fast Lane - April 30, 2015 Category: Emergency Medicine Authors: Anand Swaminathan Tags: R&R in the FASTLANE critical care Education Emergency Medicine Intensive Care literature recommendations research and reviews Source Type: blogs
Giant Inverted T waves in an Elderly Patient
This is another contribution from Victoria Stephen. Victoria is a third year EM Registrar from at the University of the Witwatersrand in Johannesburg, South Africa, and a great asset to FOAMed. Follow her on Twitter: @EMcardiac.Here is her previous contribution: Pulseless ventricular tachycardia – why did the AED not advise a shock? CaseA 91 year old presented to the ED of a small hospital with a history of sudden onset syncope. A family member thought she was having a seizure. She reported no chest pain or dyspnoea when conscious. The patient had a history of hypertension which was po...
Source: Dr. Smith's ECG Blog - April 15, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
Emergency Department Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.....
Conclusions: Many unnecessary tests are obtained to evaluate syncope. Selecting tests based on history and examination and prioritizing less expensive and higher yield tests would ensure a more informed and cost-effective approach to evaluating older patients with syncope._____________________________________________________________________________4) Reed MJ. The ROSE (Risk Stratification of syncope in the emergency department) Study. J Am Coll Cardiol, 2010; 55:713-721, doi:10.1016/j.jacc.2009.09.049 Objectives: The aim of this study was to develop and validate a clinical deci...
Source: Dr. Smith's ECG Blog - April 8, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
ED Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.....
Conclusions: Many unnecessary tests are obtained to evaluate syncope. Selecting tests based on history and examination and prioritizing less expensive and higher yield tests would ensure a more informed and cost-effective approach to evaluating older patients with syncope._____________________________________________________________________________4) Reed MJ. The ROSE (Risk Stratification of syncope in the emergency department) Study. J Am Coll Cardiol, 2010; 55:713-721, doi:10.1016/j.jacc.2009.09.049 Objectives: The aim of this study was to develop and validate a clinical deci...
Source: Dr. Smith's ECG Blog - April 8, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
Research and Reviews in the Fastlane 074
This study is further evidence that the HEART pathway is a safe approach to the management of low risk chest pain and decreases unnecessary health care utilization.Recommended by Anand SwaminathanThe Best of the Rest Resuscitation Sanghavi BS et al. Outcomes After Out-of-Hospital Cardiac Arrest Treated by Basic vs Advanced Life Support. JAMA Intern Med. 2015;175(2):196-204. PMID: 25419698The OPALS trial, published in 2004, demonstrated the lack of added benefit of ACLS over BLS in out-of-hospital cardiac arrest (OHCA). ACLS continues to be standard care despite repeatedly demonstrating improved ROSC without improved ...
Source: Life in the Fast Lane - March 11, 2015 Category: Emergency Medicine Authors: Jeremy Fried Tags: Clinical Research Emergency Medicine LITFL R&R in the FASTLANE critical care literature recommendations research and reviews Trauma Source Type: blogs
LITFL Review 172
Welcome to the 172nd 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 WeekDi McMath writes a touching post reminding us all to build and maintain our resilience in “caring for the invisible wounds”. Thanks to Minh Le Cong for the tip! [SO]The Best of #FOAMed Emergency MedicineNice review of core content on skin and sof...
Source: Life in the Fast Lane - March 8, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs
EMA Journal December 2014
Issue 6 (Vol. 26) of EMA Journal for 2014 was published online on 1st December. Editorial overview by Andrew Gosbell & Geoff HughesRuling out subarachnoid haemorrhage (Abstract)Although uncommon, subarachnoid haemorrhage (SAH) is a potentially life-threatening cause of headache presentations to ED. For neurologically intact patients investigation for possible SAH is time consuming and has associated risks, so three clinical decision rules (CDRs) have been proposed to identify those patients with headache at high risk of SAH. This retrospective cohort study, from AM Kelly and colleagues, of 59 c...
Source: Life in the Fast Lane - February 2, 2015 Category: Emergency Medicine Authors: Mike Cadogan Tags: Education EMA Journal LITFL Source Type: blogs
Cardiac arrest, severe acidosis, and a bizarre ECG
A middle aged male had an unwitnessed PEA arrest associated with cocaine use. Whether there was a shockable rhythm prior to PEA is unknown, but he was never defibrillated. He received chest compressions with LUCAS and 3 doses of epinephrine, and was intubated by prehospital providers. He had intermittent pulses. Here is his initial ECG, with a pH of 6.50:The rhythm is uncertain: probably an accelerated junctional rhythm with RBBB and PVCs, but it could be an accelerated rhythm initiated in the left bundle, mimicking RBBB. It is important to ascertain the end of the QRS, which I attempt to do b...
Source: Dr. Smith's ECG Blog - January 14, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
CCC Update 009
Here is a quick overview of the major updates and revisions to the LITFL Critical Care Compendium since CCC Update 008.Check these out:Airway and cervical spine injuriesPeople can get pretty twitchy about intubating patients with suspected cervical spine injuries. Apply MILS, use a bougie and perform rapid sequence intubation. What’s so hard about that?… Airway management in Major TraumaAn overview of the issues affecting airway management in major trauma, including the indications for intubation the possible causes of airway compromise in this setting.Antimicrobial stewardshipUpdated with a recent systematic rev...
Source: Life in the Fast Lane - December 15, 2014 Category: Emergency Medicine Authors: Chris Nickson Tags: Critical Care Compendium Emergency Medicine FCICM Fellowship Intensive Care CCC update FCICM exam Source Type: blogs
