A resident ’s dream turns into cold reality
It’s every emergency resident’s dream to be part of a big procedure: The rush of a heart-pounding, adrenaline-filled moment of slamming in a chest tube, “criching” someone or being part of the big show — a thoracotomy. The holy grail. Cracking a chest, performing intracardiac massage, cross-clamping the aorta. A last-ditch effort to pull a patient away from the clutches of the grim reaper. A typical level-one center hums to life when a paramedic call comes in of a penetrating trauma to the box.
Everyone and their mothers run down to the ED. There is, of course, the ED team, the trauma surgery team, pharma...
Source: Kevin, M.D. - Medical Weblog - October 31, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/zahir-basrai" rel="tag" > Zahir Basrai, MD < /a > Tags: Physician Emergency Medicine Residency Source Type: blogs
Today, I hugged a stranger
.
And I didn’t know his name.
We had just operated on a young man, probably in his late teens. He sustained multiple gunshot wounds to the chest and abdomen, and was in critical condition. When he lost pulses in the trauma bay, we cut his chest open and spread his ribs. His lifeless body laid there as we held his heart in the palm of our hands, and pumped it — over and over again — to mimic life. We placed a clamp on his aorta to minimize blood loss, and to ensure that blood preferentially travels to the brain.
We pumped his heart tirelessly, afraid to let go, afraid to give up, afraid to say “...
Source: Kevin, M.D. - Medical Weblog - August 14, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/edwin-acevedo" rel="tag" > Edwin Acevedo, Jr., MD < /a > Tags: Physician Cardiology Emergency Surgery Source Type: blogs
Emergency physicians have to build emotional walls. Sometimes they break.
We emergency physicians are often thrust into the frontline battles raging in society. The pain, blood, and emotions are so real, so thick and ever present, creating an undertone that is difficult to deny. We walk the corridors of our departments actively involved in life or death, where the span of mere millimeters might as well be miles as we explore wounds, clinical scenarios and presentations. How do we do this on a day-to-day basis? How does active involvement in tragedy and triumph of others become a career? How do we leave the trauma bays, resuscitation rooms and bereavement rooms and continue our lives with familie...
Source: Kevin, M.D. - Medical Weblog - July 24, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/jeffrey-mcwilliams" rel="tag" > Jeffrey McWilliams, MD < /a > Tags: Physician Emergency Source Type: blogs
The Procedures Course
LITFL • Life in the Fast Lane Medical Blog
LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog
This week I participated as a learner in The Procedure Course. The course is run as a collaboration between The Alfred Trauma Unit, Alfred Emergency & Trauma Centre, National Trauma Research Institute and Monash University. It is a cadaver-based ‘hands on’ procedures course designed to enable emergency and critical care physicians to develop the mastery necessary to perform life-sight-and-limb-saving procedures when the time comes.
I’ve been involved i...
Source: Life in the Fast Lane - July 21, 2017 Category: Emergency Medicine Authors: Chris Nickson Tags: Education alfred course emergency procedures Resuscitation Source Type: blogs
Fight Aging! Newsletter, April 17th 2017
This study assessed the prevalence of grey hair in patients with coronary artery disease and whether it was an independent risk marker of disease.
This was a prospective, observational study which included 545 adult men who underwent multi-slice computed tomography (CT) coronary angiography for suspected coronary artery disease. Patients were divided into subgroups according to the presence or absence of coronary artery disease, and the amount of grey/white hair. The amount of grey hair was graded using the hair whitening score: 1 = pure black hair, 2 = black more than white, 3 = black equals white, 4 = white more t...
Source: Fight Aging! - April 16, 2017 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
Promising Results from an Early Trial of a Stem Cell Heart Patch
Heart patches are one manifestation of the tissue engineering approach to regenerative medicine. Cells delivered to the patient are usually combined with a biodegradable scaffold material that provides support to help the cells survive and undertake beneficial signaling actions. A heart patch is some amount of this combined material applied to the exterior of the heart, in some cases simply by injection since the scaffold can be made to be a viscous fluid. The researchers here claim better results by abandoning the scaffolds, however, and implanting thin sheets of engineered cells. This paper reports on the results of an e...
Source: Fight Aging! - April 10, 2017 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
Research and Reviews in the Fastlane 151
This study takes data from a trauma registry and shows a survival rate for resuscitative thoracotomy (RT) of 9.7% vs. 37.5% for REBOA. There are a number of issues with this study due to the retrospective design. Additionally, the RT group was more likely to be dead on presentation in comparison to the REBOA group (71% vs. 38% without vital signs). While this data supports REBOA use, a prospective study should be undertaken to gauge the benefit of this modality.
Recommended by: Anand Swaminathan
Retrieval, Pre-hospital and Disaster
Sadek S, et al. Resuscitative endovascular balloon occlusion of the aorta (REBOA) in the ...
Source: Life in the Fast Lane - September 14, 2016 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Cardiology Disaster Education Emergency Medicine Intensive Care Pre-hospital / Retrieval Trauma critical care examination literature R&R in the FASTLANE recommendations research and reviews Resuscitation Source Type: blogs
Research and Reviews in the Fastlane 147
In this report two cases where a new method for removing encircling objects from the penis using a ordinary condom was applied. The article in danish with a short abstract, but sufficient self explanatory images are provided.
Recommended by Soren Rudolph
Resuscitation
Laina A et al. Amiodarone and cardiac arrest: Systematic review and meta-analysis. Internat J Cardiol 2016; 221: 780-8. PMID: 27434349
Amiodarone is dead in the dead! The recent ALPs trial in the NEJM grabbed headlines showing that there was no difference in survival to discharge in OHCA patients who got amiodarone versus lidocaine versus placebo. This s...
Source: Life in the Fast Lane - August 17, 2016 Category: Emergency Medicine Authors: Justin Morgenstern Tags: Education Emergency Medicine R&R in the FASTLANE Resuscitation Toxicology and Toxinology Trauma EBM literature recommendations research and reviews Source Type: blogs
Research and Reviews in the Fastlane 140
In this study of 187 traumatic arrest patients, the survival rate was 3.2%. The authors found that if the patient had no cardiac motion AND no pericardial effusion, the mortality was 100%. This potentially identifies a group in which providers should not be subjected to the risks of thoracotomy.
Recommended by Anand Swaminathan
The Best of the Rest
Emergency medicine
Cheng YJ et al. The Role of Macrolide Antibiotics in Increasing Cardiovascular Risk. J Am Coll Cardiol. 2015. PMID 26564594
The harm is small – 1 in ~25,000 prescriptions – but this is another call to avoid unnecessary use of macrolide antibiotics w...
Source: Life in the Fast Lane - June 30, 2016 Category: Emergency Medicine Authors: Soren Rudolph Tags: Clinical Research Education Emergency Medicine Intensive Care LITFL Pre-hospital / Retrieval R&R in the FASTLANE Resuscitation Review Trauma critical care Source Type: blogs
What is our goal in pain management?
One of the cool things about having worked in chronic pain management since the mid-1980’s is that I’ve seen a few things come and a few things go. Some things remain, of course, and the things that seem most long-lived are debates about pain reduction vs living with pain. On one hand, there’s an enormous industry set up to help people reduce their pain experience through pharmacology, injection procedures, surgery, hands-on therapy, movement practice, and novel approaches like brain stimulation and even mirror therapy. On the other hand, there’s a smaller but equally well-established industry est...
Source: HealthSkills Weblog - June 19, 2016 Category: Anesthesiology Authors: adiemusfree Tags: ACT - Acceptance & Commitment Therapy Chronic pain Clinical reasoning Coping Skills Coping strategies Pain conditions Professional topics Research Resilience/Health pain management Therapeutic approaches treatment values Source Type: blogs
Funtabulously Frivolous Friday Five 135
Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old fashioned medical trivia…introducing Funtabulously Frivolous Friday Five 135
Question 1
What was the cause for the most fatalities at Pearl Harbour?
+ Reveal the Funtabulous Answer
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NOT Thiopental (but the initial trauma or delayed hemorrhagic shock)
It has been a popular myth that Thiopental caused more deaths than the initial trauma but of the 344 patients admitted to the Tripler Army Hospi...
Source: Life in the Fast Lane - February 12, 2016 Category: Emergency Medicine Authors: Neil Long Tags: Frivolous Friday Five Aluminium Anaesthetics Buddy Ebsen FFFF Heidelberg Electric Belt impotence Kehr's sign pearl harbour Princess Diana pulmonary vein splenic rupture thiopental thoracotomy Source Type: blogs
LITFL Review – Best of 2015
Welcome to the Best of 2015 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 Year
SMACC Podcast: Crack the Chest Get Crucified (John Hinds)
John’s talk from the opening plenary at SMACC Chicago had a furious battle with David Newman’s talk for the number one spot. Both were clear front runners given the shear numb...
Source: Life in the Fast Lane - January 8, 2016 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Education LITFL review Source Type: blogs
Robotic repair of mitral valve
Brief Review
Abstract: Robotic repair of mitral valve is a promising minimally invasive surgical approach for both simple and complex mitral valve regurgitation, with excellent results.
Robotic repair of mitral valve is a minimally invasive approach compared to conventional mitral valve repair, which itself is an option against mitral valve replacement. Robotic and conventional mitral valve repairs are considered mostly for degenerative mitral valve disease as opposed to rheumatic mitral valve disease in which scarring often precludes a good repair and replacement is often the only option available. Mitral valve repair gi...
Source: Cardiophile MD - November 24, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiac Surgery minimally invasive valve repair robotic cardiac surgery robotic mitral valve repair Source Type: blogs
Extracorporeal CPR
Conventional cardiopulmonary resuscitation (CPR) involves chest compressions and respiratory support with either mouth to mouth respiration or bag and mask ventilation. Extracorporeal CPR (ECPR) means supporting the heart and lung function using extracorporeal method of venoarterial perfusion during cardiac arrest [1]. Extracorporeal membrane oxygenator (ECMO) circuits are used in extracorporeal CPR. The recently published 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care [2] discusses the use of ECPR for cardiac arrest and also the potential ethical i...
Source: Cardiophile MD - October 27, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology CPR ECPR ROSC Source Type: blogs
