The ICU experience that changed a young doctor ’ s perspective forever
As a healthy 30-year-old intern with an infant, I never expected to land in the ICU on a random Thursday at 10 a.m. As I prepared to start my first precepted thoracentesis at the VA, I suddenly began to experience double vision. Assuming it to be a weird manifestation of anxiety, I politely stepped out
Read more…
The ICU experience that changed a young doctor’s perspective forever originally appeared in KevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - February 24, 2023 Category: General Medicine Authors: Olivia Tomasco, MD Tags: Conditions Critical Care Source Type: blogs
A story of a good death
Just over seven years ago, on April 22nd, my father heralded his 88th birthday with a thoracentesis to drain the fluid from his lungs. On May 3rd, less than two weeks later, he died, due to a blockage in his abdomen leading to sepsis, most likely from two 20-plus-year-old sarcoma surgeries. Between these events, heRead more …A story of a good death originally appeared inKevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - May 27, 2022 Category: General Medicine Authors: < span itemprop="author" > < a href="https://www.kevinmd.com/post-author/carol-ewig" rel="tag" data-wpel-link="internal" > Carol Ewig < /a > < /span > Tags: Patient Hospital-Based Medicine Palliative Care Source Type: blogs
It Is A Pity That We Don ’t See More Balanced Views On Clinical Software Errors.
This appeared las week: Medical software blamed for fatal anticoagulant double-dosing error Hospital doctors relying on the Cerner system accidentally prescribed an additional dose of apixaban 11th March 2021 By Antony Scholefield A hospital software system has been blamed for a fatal anticoagulant double-dosing error after it displayed a prescribing icon so small that it could not be seen on a standard computer screen. In 2019, Ian Fraser was admitted to the Sunshine Hospital in Melbourne with an exacerbation of his congestive cardiac failure as well as community-acquired pneumonia. He had a comp...
Source: Australian Health Information Technology - March 17, 2021 Category: Information Technology Authors: Dr David G More MB PhD Source Type: blogs
Is Practicing on a Cadaver the Best Way to Develop Ultrasound Skills?
Medical students and radiology residents at the University of Arkansas for Medical Sciences are turning to lightly embalmed cadavers to fine tune and master their ultrasound-guided procedure skills.In their  studypublished inAcademic Radiology, the group of researchers led by Mary E. Meek, MD, associate professor of radiology, had first-year medical students practice placing the needle and dilating the tissues on cadavers that had been deceased for three days. The bodies were threaded with wires and catheters on both access points. The cadavers were arranged in the seated positions and had been injected with Lidocaine. Ra...
Source: radRounds - July 27, 2018 Category: Radiology Authors: Julie Morse Source Type: blogs
LITFL Review 305
LITFL • Life in the Fast Lane Medical Blog
LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog
Welcome to the 305th 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 chunk of FOAM.
The Most Fair Dinkum Ripper Beauts of the Week
What’s on the Trauma Professional’s blog this week? Lots as usual! Learn about bucket...
Source: Life in the Fast Lane - November 5, 2017 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: LITFL review Source Type: blogs
What a radiologist learned about a thoracentesis from a pulmonologist
It was 1989. While alternating between NCAA basketball tournament games on broadcast television, reruns of an older version of the game show Wipeout on cable, and the 8-bit Nintendo game Top Gun, a child sat in a hospital bed in the middle of rural America wondering why he was there. All he knew was that he had a sharp pain in the left side of his chest and that couldn’t breathe very well. If you looked at him, however, you would be able to tell that his face was masked in pallor, and he had lost about 17 pounds over the course of a week. He was too weak to walk very far.
Having no pediatric lung specialist in town, ...
Source: Kevin, M.D. - Medical Weblog - January 10, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/cory-michael" rel="tag" > Cory Michael, MD < /a > Tags: Physician Radiology Source Type: blogs
MKSAP: 57-year-old man with a right-sided pleural effusion
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 57-year-old man is evaluated in follow-up for a right-sided pleural effusion. He initially presented with increasing dyspnea and a constant dull ache on his right side. He also has lost 9.1 kg (20.0 lb) over the last 6 months. Medical history is otherwise unremarkable, and he takes no medications. He has never smoked and is employed as an auto mechanic.
Initial chest radiograph showed a moderate-sized, free-flowing pleural effusion on the right; the left lung field was unremarkable. Thoracentesis showed 3500/Â...
Source: Kevin, M.D. - Medical Weblog - November 12, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Cancer Pulmonology Source Type: blogs
Doctors must preserve their empathy at all costs
It was several years ago. I was a first-year internal medicine resident. Keen, tired, overworked, and still idealistic. Mr. Smith was a 45-year-old lawyer who rolled into St. Paul’s Hospital Emergency room, while our medicine team was on intake. He was a healthy appearing lawyer who noted that for the past month he had become more short of breath performing his regular exercise. Things were especially bad for him during his morning treadmill workout, so he came in for evaluation. The ED started the standard work-up including blood work and a chest x-ray.
The x-ray came back showing a large right-sided pleural effusion. A...
Source: Kevin, M.D. - Medical Weblog - September 23, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/michael-levy" rel="tag" > Michael Levy, MD < /a > Tags: Physician Cancer Source Type: blogs
Faculty Procedural Supervision and Expertise: An Endangered Species
Editor’s Note: This post is one of two pieces on the topic of procedural competency. Check back next week for the other piece.
A few days ago I was working with a new resident and she came to me for help with a procedure. She had a patient with a severe headache and fever and she wanted to do a spinal tap. We had previously discussed the differential diagnosis and the possibility of meningitis. Now it was clear the resident was not at all confident in her ability to do the procedure and that I might have to do it. I took a deep breath. Although there had been a time when I was confident about doing a spinal tap, that was...
Source: Academic Medicine Blog - September 6, 2016 Category: Universities & Medical Training Authors: David P. Sklar, M.D. Tags: Featured From the Editor Editor in Chief faculty procedural competency resident Source Type: blogs
LITFL Review 239
Welcome to the 239th 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
Josh Farkas weaves an elegant web around the NINDS Trial, not debating the therapy, but explaining Fragility Index and introducing the Instability Index. This is truly critical appraisal 2.0. [JS, AS, SO]
The Best of #FOAMed Emergency Medicine
...
Source: Life in the Fast Lane - July 10, 2016 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Education LITFL review Source Type: blogs
Solving the Problem of Delivering Oxygen during Needle Cricothyroidotomy
BY RICAURTE A. SOLIS, DO
Â
When faced with a "can't intubate, can't oxygenate" crisis, the decision to move to a surgical airway must be made rapidly and deliberately. A surgical cricothyroidotomy is debatably the better approach in these situations, but a needle cricothyroidotomy may sometimes be indicated. It may be easier to perform in a very small child, for example, and although it is probably less than ideal in an adult, a rapid needle cricothyroidotomy may provide an oxygenation bridge that will prevent a critically hypoxic patient from arresting until a more definitive airway is secured.
Â
Cricothyroido...
Source: M2E Too! Mellick's Multimedia EduBlog - August 3, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Solving the Problem of Delivering Oxygen during Needle Cricothyroidotomy
BY RICAURTE A. SOLIS, DO
Â
When faced with a "can't intubate, can't oxygenate" crisis, the decision to move to a surgical airway must be made rapidly and deliberately. A surgical cricothyroidotomy is debatably the better approach in these situations, but a needle cricothyroidotomy may sometimes be indicated. It may be easier to perform in a very small child, for example, and although it is probably less than ideal in an adult, a rapid needle cricothyroidotomy may provide an oxygenation bridge that will prevent a critically hypoxic patient from arresting until a more definitive airway is secured.
Â
Cricothyr...
Source: M2E Too! Mellick's Multimedia EduBlog - August 3, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
MKSAP: 54-year-old woman with shortness of breath
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 54-year-old woman is evaluated for shortness of breath of 3 months’ duration and a 4.5-kg (10-lb) weight loss over the preceding 2 months. She has a 35-pack-year smoking history.
On physical examination, temperature is 36.9 °C (98.4 °F), blood pressure is 145/82 mm Hg, and pulse rate is 108/min. Oxygen saturation is 92% with the patient breathing ambient air. No palpable lymphadenopathy is noted. The patient has clubbing of the fingertips. The lung fields are clear on the left, with diminished breath s...
Source: Kevin, M.D. - Medical Weblog - April 12, 2015 Category: Journals (General) Authors: mksap Tags: Conditions Cancer Source Type: blogs
Tension pneumothorax – time to change the old mantra?
Here is your ATMIST handover in resus: 28 year old male, injured 25 minutes ago, penetrating chest trauma, Asherman seal on anterior chest, RR 35, clearly deteriorating, high flow O2 administered.Initial observations: A – moaning, distressed, mask fogging, B – RR is now more like 40, with reduced expansion on the right, and absent breath soundsAre his neck veins distended? Trachea deviated? You are swift, brave and decisive – in goes the 14G cannula, 2nd intercostal space, mid clavicular line and…nothing happens. In fact, the patient continues to deteriorate…What is your next option?Following the recent ...
Source: Life in the Fast Lane - December 2, 2014 Category: Emergency Medicine Authors: Fraser Brims Tags: Education Respiratory 2nd ICS 5th ICS Ian Duffus tension tension pneumothorax Source Type: blogs
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
