LITFL Review 159
Welcome to the 159th 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 WeekThis Will Revolutionize Education is a much-watch video for all educators at any level, on the role of innovation and the role of the teacher. [AS]The Best of #FOAMed Emergency MedicineAmal Mattu reviews a case of a 17-year-old with a wide irregular ...
Source: Life in the Fast Lane - December 9, 2014 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review LITFL R/V Source Type: blogs
Lumbar Puncture: Golden Rules
We feel it is extremely important to highlight some golden rules and additional pearls after our recent lumbar puncture series. (Read the first two articles about positioning and technique at http://bit.ly/1zRSOdC and http://bit.ly/1wY8MiJ.) These tips will help you ensure the best outcome for your patients.
Be Prepared
§ Be aware that patients will be anxious.
□ Spend dedicated time reviewing the procedure and informed consent.
□ Make sure that they feel only the lidocaine injection.
□ Most patients will do better with Versed as long as there are no contraindications.
§ Be prepared for pa...
Source: The Procedural Pause - December 5, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Lumbar Puncture: Golden Rules
We feel it is extremely important to highlight some golden rules and additional pearls after our recent lumbar puncture series. (Read the first two articles about positioning and technique at http://bit.ly/1zRSOdC and http://bit.ly/1wY8MiJ.) These tips will help you ensure the best outcome for your patients.
Be Prepared
§ Be aware that patients will be anxious.
□ Spend dedicated time reviewing the procedure and informed consent.
□ Make sure that they feel only the lidocaine injection.
□ Most patients will do better with Versed as long as there are no contraindications.
§ Be prepared for patients ...
Source: The Procedural Pause - December 5, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Research and Reviews in the Fastlane 059
This study looked at national survey data from 2009-2010 of patients >18 y/o presenting to the ED (n=44,448 visits) and found that cardiac enzyme testing was performed in 16.9% of visits, including in 8.2% of visits lacking ACS-related symptoms (which includes things like nausea, vomiting, abdominal pain, dyspnea, etc). This begs the question, why then, was a troponin (or ck-mb) ordered? It’s probably not changing management. In an era in which we’re discovering that there are harms to downstream testing, this study calls out just how trigger happy we may be. As more sensitive cardiac assays are used, this m...
Source: Life in the Fast Lane - November 26, 2014 Category: Emergency Medicine Authors: Jeremy Fried Tags: R&R in the FASTLANE airway brain failure critical care Emergency Medicine General Surgery hypothermia Intensive Care prehospital recommendations Review Trauma Source Type: blogs
We Still Don’t Know What’s Wrong
A few years ago, I was talking with a medical student who had just finished a shift in the ED. He was an excellent student, but today he had a string of patients who left him frustrated. The 40 year-old woman who presented with abdominal pain left the ED with a diagnosis of “abdominal pain.” We discharged the 35 year-old man who presented with a severe headache with a diagnosis of “possible tension headache.” A five year-old girl with a fever left with “fever of probable viral etiology.” We had gotten blood tests and a CT scan on the woman with abdominal pain, the results of which were normal. We had treated th...
Source: Academic Medicine Blog - November 17, 2014 Category: Universities & Medical Training Authors: David P. Sklar, M.D. Tags: Featured From the Editor ambiguity specialty choice tolerance for ambiguity Source Type: blogs
Lumbar Puncture Made Simple
Part 2 of a Three-Part Mini-Series on Lumbar Puncture
This month we are back (no pun intended) with the second part of our mini-series focused on perfect patient positioning and lumbar puncture (LP). Part one can be found at http://bit.ly/ProceduralPause.
Now that you have the proper skills to position your patient for an LP, the procedure should be pretty simple, right? The answer is yes! We want you all to be experts. We know that you can and will master an LP after reading these short and sweet LP guidelines and clinical pearls.
Lumbar puncture in the emergency department.
Manual of Clinical Anesthesiology;...
Source: The Procedural Pause - November 3, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Lumbar Puncture Made Simple
Part 2 of a Three-Part Mini-Series on Lumbar Puncture
This month we are back (no pun intended) with the second part of our mini-series focused on perfect patient positioning and lumbar puncture (LP). Part one can be found at http://bit.ly/ProceduralPause.
Now that you have the proper skills to position your patient for an LP, the procedure should be pretty simple, right? The answer is yes! We want you all to be experts. We know that you can and will master an LP after reading these short and sweet LP guidelines and clinical pearls.
Lumbar puncture in the emergency department.
Manual of Clinical Anesth...
Source: The Procedural Pause - November 3, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Research and Reviews in the Fastlane 054
Conclusions Wrong? (emlitofnote)
Critical Care, CardiologyGuyton AC. Regulation of cardiac output. Anesthesiology. 1968; 29(2): 314-26. PMID: 5635884
The modern emphasis on echo might make you think that the heart determines cardiac output. This classic paper by Guyton shows that unless the heart is failing, it has a permissive role in determining cardiac output. The real determinants are (1) the degree of vasodilation of the peripheral vasculature, especially veins, and (2) the filling of the circulatory system, indicated by the mean systemic filling pressure. Gotta love those Guyton curves!
Recommended by: Chris Nick...
Source: Life in the Fast Lane - October 20, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Cardiology Clinical Research Education Emergency Medicine Infectious Disease Intensive Care Neurology Neurosurgery Obstetrics / Gynecology Orthopedics Pediatrics Trauma critical care literature R&R in the FASTLANE recommendat Source Type: blogs
India Holds Bill Gates Accountable For His Vaccine Crimes
Conclusion
It is difficult to believe that, despite the mounting evidence outlining the many crimes against humanity that have been committed by the Gates Foundation, GAVI, UNICEF and PATH, Bill Gates is portrayed as a hero among many.
However, according to the definition of hero in the Oxford Dictionary, the word hero means:
“A person, typically a man, who is admired or idealized for courage, outstanding achievements, or noble qualities.” [12]
The dictionary I used said nothing about vaccinating innocent, vulnerable children with untested and unsafe vaccinations, causing them to suffer agonizing, untimely deaths.
&nbs...
Source: vactruth.com - October 5, 2014 Category: Allergy & Immunology Authors: Christina England Tags: Christina England Top Stories Bill and Melinda Gates Foundation Gardasil Death Global Alliance for Vaccines and Immunization (GAVI) MenAfriVac Source Type: blogs
Research and Reviews in the Fastlane 050
This study compared bedside US by EPs vs radiology US vs CT as the INITIAL test in patients expected with nephrolithiasis. It found there was no difference in serious outcomes between the groups, but the rate of serious outcomes was overall very low.
Obviously patients that got only an US had lower radiation exposure and lengths of stay. But what is interesting is that 40% of patients with an initial ED US went on to get a CT also.
This study does not state that patients should ONLY undergo US, just that it should be the INITIAL test. If it cuts down on our CT ordering, it sounds like a good start. (Zack Repanshek)
Recomme...
Source: Life in the Fast Lane - September 29, 2014 Category: Emergency Medicine Authors: Jeremy Fried Tags: Cardiology Clinical Research Emergency Medicine Infectious Disease R&R in the FASTLANE Radiology Resuscitation critical care Education Intensive Care literature recommendations Research and Review Source Type: blogs
Research and Reviews in the Fastlane 043
This study claimed a sensitivity and specificity of 100% in this group of patients questioning the traditional “CT, LP” approach to managing patients with clinical suspicion for SAH. However, the study has flaws and we eagerly await external validation.
Recommended by: Salim R. Rezaie
Emergency Medicine
Williams CM, Maher CG, Latimer J et al. Efficacy of paracetamol for acute low-back pain: a double-blind, randomised controlled trial. Lancet. 2014 Jul 23. pii: S0140-6736(14)60805-9. doi: 10.1016/S0140-6736(14)60805-9. PMID 25064594
Should we continue to give paracetamol for lower back pain? In this Austral...
Source: Life in the Fast Lane - August 12, 2014 Category: Emergency Medicine Authors: Jeremy Fried Tags: Anaesthetics Emergency Medicine Infectious Disease Intensive Care Neurology Pediatrics Pre-hospital / Retrieval R&R in the FASTLANE Radiology Toxicology and Toxinology critical care literature recommendations research and reviews Source Type: blogs
Respiratory Failure and ST Depression: Is there Posterior STEMI?
The ultrasound in this case was recorded by Dr. Robert F. (Rob) Reardon, one of my partners here at Hennepin County Medical Center (HCMC) in Minneapolis, and one of the world leaders in emergency ultrasound. He is also an editor of this great new textbook of emergency ultrasound (Ma, Mateer, Reardon, Joing, eds.), and one of the authors of the Cardiac Ultrasound chapter (other authors of this chapter are Dr. Andrew Laudenbach (also of HCMC) and Dr. Scott Joing (also of HCMC, and the creator of the outstanding FOAMed site, www.hqmeded.com).CaseA middle-age woman with a history of emphysema presented in severe res...
Source: Dr. Smith's ECG Blog - June 24, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
Notes to myself – 2
Pentobarb coma – BIS should be 10-20 and SR (suppression ratio) should be 70-80
Consider lev albuterol
Should give vaccines after coiling of spleen or before if possible
No calcium channel blockers post MI definitely and post op in general
Toradol inhibits spine healing
Don’t do endoscopes with patients in supine position
don’t ambulate patients with known dvt’s. wait 2-3 days until clots get stuck.
dvt’s even with filter get heparin as much as possible for post phlebitic syndrome and to retard new clot formation
diffuse alveolar hemorrhage – secondary to chemo, goodpasture’s, wege...
Source: Inside Surgery - December 31, 2013 Category: Surgeons Authors: Editor Tags: General Source Type: blogs
Managing the flow: a review of the care received by patients who were diagnosed with an aneurysmal subarachnoid haemorrhage
This report highlights the process of care for patients who are admitted with with aneurysmal subarachnoid haemorrhage, looking both at patients that underwent an interventional procedure and those managed conservatively. It takes a critical look at areas where the care of patients might have been improved. Remediable factors have also been identified in the clinical and the organisational care of these patients.
Full report
Executive summary
Audit toolkit
NCEPOD - publications (Source: Health Management Specialist Library)
Source: Health Management Specialist Library - November 22, 2013 Category: UK Health Authors: The King's Fund Information & Knowledge Service Tags: Quality of care and clinical outcomes Source Type: blogs
