Critical Care Compendium update
LITFL’s Critical Care Compendium is a comprehensive collection of pages concisely covering the core topics and controversies of critical care.
Currently there are almost 1,500 entries with more in the works… Some pages are more developed than others, and all the pages are being constantly revised and improved. Links to new references and online resources are added daily, with an emphasis on those that are free and open access (FOAM!).
These pages originated from the FCICM exam study notes created by Dr Jeremy Fernando in 2011, and have been updated, modified and added to since. As such will be particularly us...
Source: Life in the Fast Lane - November 17, 2013 Category: Emergency Medicine Doctors Authors: Chris Nickson Tags: Critical Care Compendium Education eLearning Emergency Medicine Featured CCC LITFL collection Source Type: blogs
Healthcare Update Satellite – 10-21-2013
Setting the record straight about EMS myths. Well … really one myth … going to an emergency department by ambulance doesn’t mean you’ll go to the front of the line. The places that I work will frequently have patients who come by ambulance go directly to the waiting room. Other times when it isn’t as busy, the patients would have gone straight to a bed regardless of how they arrived. Calling an ambulance to try to game the system isn’t worth the expense.
One of the things people don’t think about when filing a lawsuit is called “subrogation.” If insurance has paid for care that is related to your lawsuit,...
Source: WhiteCoat's Call Room - October 21, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
Middle Aged Woman with Asystolic Cardiac Arrest, Resuscitated: Cath Lab?
Conclusions: Head CT is common in NT-OHCA. Cerebral edema is more common in patients presenting with an initial rhythm of PEA/asystole than in VT/VF and is associated with higher mortality. Management is rarely affected by routine use of early head CT. In those who required urgent PCI, CT was associated with a (non-statistically significant) 21 minute longer mean DBT. Kurkciyan et al., abstracthttp://www.sciencedirect.com/science/article/pii/S0300957201003811Objective: Spontaneous subarachnoid haemorrhage as a cause of out-of-hospital cardiac arrest is poorly evaluated. We analyse disease-specific and emergen...
Source: Dr. Smith's ECG Blog - October 20, 2013 Category: Cardiology Authors: Steve Smith Source Type: blogs
One incompetent regulator, the Professional Standards Authority, approves another, the CNHC
Jump to follow-up
The consistent failure of ‘regulators’ to do their job has been a constant theme on this blog. There is a synopsis of dozens of them at Regulation of alternative medicine: why it doesn’t work, and never can. And it isn’t only quackery where this happens. The ineptitude (and extravagance) of the Quality Assurance Agency (QAA) was revealed starkly when the University of Wales’ accreditation of external degrees was revealed (by me and by BBC TV Wales, not by the QAA) to be so bad that the University had to shut down.
Here is another example that you couldn’t make up.
...
Source: DC's goodscience - October 13, 2013 Category: Professors and Educators Authors: David Colquhoun Tags: Anti-science antiscience badscience CNHC NOS Professional Standards Authority Quality assessment regulation alternative medicine CAM Complementary and Natural Healthcare Council Harry Cayton National Occupational Stardards Ofquac Source Type: blogs
Dx of neurologic emergencies in pregnancy/postpartum
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")); Edlow JA, Caplan LR, Obrien K, Tibbles CD. Diagnosis of acute neurological emergencies in pregnant and post-partum women. Lancet Neurology 2013; 12: 175-185This is a review article that is nicely written. I am blogging some of the minutiae of the article, not necessarily the major points, that might escape otherwise. Here are a few pearls from the article:1. There is 8-39 % overlap be...
Source: neurologyminutiae - October 1, 2013 Category: Neurologists Source Type: blogs
Journal Alert: Neuropsychology - Online First Publications & Volume 27, Issue 5
APA Journal alerts for: Neuropsychology Online First Publications The following articles have been published online this week before they appear in a final print and online issue of Neuropsychology: Decision-Making Deficits Persist After Aneurysmal Subarachnoid Hemorrhage. Al-Khindi, Timour; Macdonald, R. Loch; Schweizer, Tom A. doi: 10.1037/neu0000003 Neuropsychological Deficits Associated With Heavy Prenatal Alcohol Exposure Are Not Exacerbated by ADHD. Glass, Leila; War...
Source: Intelligent Insights on Intelligence Theories and Tests (aka IQ's Corner) - September 17, 2013 Category: Neurologists Source Type: blogs
The Art of Resurrection
Resurrection, Raffaellino del Garbo (1510)In the world outside of Christianity, horror, and science fiction, the dead cannot be brought back to life. Or can they? A feature in the The Observer from earlier this year profiled Dr. Sam Parnia, critical care physician and author of Erasing Death: The Science That Is Rewriting the Boundaries Between Life and Death (called The Lazarus Effect in the UK). The article begins in a dramatic fashion:Sam Parnia – the man who could bring you back from the deadSam Parnia MD has a highly sought after medical speciality: resurrection. His patients can be dead for several hours before t...
Source: The Neurocritic - August 25, 2013 Category: Psychiatrists and Psychologists Authors: The Neurocritic 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
Hopefully we can now stop doing LP ’ s to rule out SAH if CT scan performed within 6 hours of onset
The Canadian study by Perry et al just published in the BMJ studied 3132 patients with worst ever headache across 11 ED’s between 2000-2009 of which 240 (7.7%) had subarachnoid haemorrhage.
CT scanning overall had a sensitivity of 93% for detecting SAH, but if done within 6 hours of onset of headache and interpreted by an experienced radiologist, the sensitivity rose to 100% picking up ALL 121 patients with SAH of the 953 patients scanned within 6 hours.
Looks like its time to modify our practices as long as we have access to experienced radiologists – overnight may be an issue when such access may not be readi...
Source: Oz E Medicine - emergency medicine in Australia - July 19, 2011 Category: Emergency Medicine Authors: admin Tags: tips and guidelines headache subarachnoid haemorrhage Source Type: blogs
