The tricky thing about asthma
In mid-January, health headlines announced that nearly one-third of adults diagnosed with asthma don’t actually have this respiratory condition at all. This announcement appeared everywhere from Fox News Health to the Chicago Tribune.
As a primary care doc, a medical writer, and an asthma sufferer, I was very skeptical of these dramatic announcements, and with good reason. An editorial that accompanied this study provides important perspective that suggests the news headlines were exaggerated and misleading.
Taking a closer look at the study
Let’s talk about the study, which is a good one, and has merit. Canadian resea...
Source: Harvard Health Blog - March 6, 2017 Category: Consumer Health News Authors: Monique Tello, MD, MPH Tags: Asthma and Allergies Lung disease Source Type: blogs
MKSAP: 67-year-old man with worsening exertional dyspnea
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 67-year-old man is evaluated for a 6-month history of worsening exertional dyspnea. He has a history of severe COPD diagnosed 4 years ago and previously had minimal exertional symptoms. However, he now notes shortness of breath when walking short distances that is limiting his activity level. He does not have chest pain, gastrointestinal symptoms, or sleep-related symptoms. Medical history is otherwise unremarkable. Medications are a twice-daily fluticasone/salmeterol inhaler and an as-needed albuterol/ipratro...
Source: Kevin, M.D. - Medical Weblog - February 11, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Pulmonology 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, 2016 Category: Surgery Authors: Editor Tags: General Source Type: blogs
Decision Making at the End of Life: Joint #patientpref and #hpm Tweetchat
By Meredith MacMartinFred was a sick guy. He had been diagnosed with COPD years ago, and more recently developed heart failure, and although he and his wife Nancy tried to stick with his medication regimen and monitor his salt intake, his shortness of breath had been making it harder and harder to even get around the house. He followed regularly with his primary care doctor, and talked about what he would want in terms of medical care if and when he got sicker. His wife knew that he didn ’t want to go to the hospital if it could be avoided, and that he definitely did not want to end up in an ICU on a ventilator, or getti...
Source: Pallimed: A Hospice and Palliative Medicine Blog - December 7, 2016 Category: Palliative Care Source Type: blogs
When a cough just won ’t go away
Who has never had a cough? I bet no one can raise their hand. We see this in clinic all the time. But chronic cough— one that lasts at least eight weeks — can be hard for patients to deal with and difficult for doctors to figure out.
In the October 20, 2016 issue of the New England Journal of Medicine, lung experts describe a step-by-step approach doctors can use to help treat patients with chronic cough. Most often a prolonged cough is due to one of the “usual suspects.” But when it’s not, we have a long list of increasingly rarer conditions that we should run through and rule out. If it isn’t due to any of th...
Source: Harvard Health Blog - November 7, 2016 Category: Consumer Health News Authors: Monique Tello, MD, MPH Tags: Cold and Flu Health Lung disease Source Type: blogs
MKSAP: 62-year-old man is evaluated for declining exercise capacity
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 62-year-old man is evaluated for declining exercise capacity over the past year. He was diagnosed with moderate COPD 3 years ago. His symptoms had previously been well controlled with tiotropium and as-needed albuterol. He has not had any hospitalizations. He is adherent to his medication regimen, and his inhaler technique is good. He quit smoking 2 years ago. All immunizations are up to date, including influenza and pneumococcal vaccination. A chest radiograph performed 3 months ago for increased cough and sp...
Source: Kevin, M.D. - Medical Weblog - August 13, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Pulmonology Source Type: blogs
ST Elevation. What is it?
< div dir= " ltr " style= " text-align: left; " trbidi= " on " > < span class= " s1 " > A young woman was < /span > & nbsp;found down, unresponsive, with legs crossed. & nbsp;She was intubated by medics. & nbsp;A prehospital EKG (not found, but reportedly identical to the first ED ECG below) was read as ***STEMI*** and after prehospital cath lab activation, the patient was transported to the ED. < br / > < div class= " p1 " > < br / > < /div > < div class= " p1 " > On arrival, she was mechanically ventilated and < u > not < /u > in apparent shock. & nbsp;Here is the ED ECG: < /div > < table align= " center " cellpaddin...
Source: Dr. Smith's ECG Blog - July 23, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
MKSAP: 66-year-old man with polyuria and polydipsia
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 66-year-old man is evaluated in the office after being treated in the emergency department for an exacerbation of chronic obstructive pulmonary disease. While in the emergency department, he was noted to have a random blood glucose level of 211 mg/dL (11.7 mmol/L). His HbA1c was 7.8% at the time. A repeat random fingerstick blood glucose level in office is 204 mg/dL (11.3 mmol/L).
The patient reports recent polyuria and polydipsia. He has lost 6 kg (13.2 lb) over the last 3 months. He has chronic epigastric pa...
Source: Kevin, M.D. - Medical Weblog - July 23, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Diabetes Endocrinology Source Type: blogs
Research and Reviews in the Fastlane 141
This study showed that while it’s feasible to acutely lower systolic blood pressure < 140 mm Hg, there’s no benefit to death or disability. Additionally, patients in the aggressive blood pressure treatment arm were more likely to have adverse renal events at 7 days. These results mirror those seen in the INTERACT-2 trial (prior to the statistical shenanigans used to spin the results positively). Based on the best available evidence, we can confidently say that it should not be standard care to aggressively drop blood pressure in these patients.
Recommended by Anand Swaminathan
Further reading The case of ...
Source: Life in the Fast Lane - July 7, 2016 Category: Emergency Medicine Authors: Jeremy Fried Tags: Airway Clinical Research Emergency Medicine Neurology Neurosurgery Pediatrics R&R in the FASTLANE Resuscitation critical care EBM Education literature recommendations research and reviews Source Type: blogs
No Pea'ce in the Pods
Discussion of Recent Literature. Pediatr Emerg Care 2013;29(6):743.Davis MG, Casavant MJ, et al. Pediatric Exposures to Laundry and Dishwasher Detergents in the United States: 2013-2014. Pediatrics 2016;137(5):e20154529.Russell JL, Wiles DA, et al. Significant Chemical Burns Associated with Dermal Exposure to Laundry Pod Detergent. J Med Toxicol 2014;10(3):292.Tags: detergent pod, laundry detergent, vomiting, poisoning, erythema, decontaminationPublished: 7/2/2016 10:06:00 AM (Source: The Tox Cave)
Source: The Tox Cave - July 2, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
LITFL Review 232
Welcome to the 232nd 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
Cliff Reid offers an amazing reflection on training, stress exposure and pushing one self to achieve even in the face of defeat. [AS]
Nadim Lalani writes one of the most incredible pieces I have ever read on courageous collegiality in medicine, a...
Source: Life in the Fast Lane - May 22, 2016 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review LITFL R/V Source Type: blogs
What medications have you been able to stop on the Wheat Belly lifestyle?
I posed this question on the Wheat Belly Facebook page recently and received an overwhelming response. Here, I share a partial list of the responses: medications people have been able to stop by following the Wheat Belly lifestyle.
Just take a look at this incredible list: these represent medications prescribed by doctors to, in effect, “treat” the consequences of consuming wheat and grains. They prescribe drugs to treat the inflammation, swelling, skin rashes, gastrointestinal irritation, high blood sugars, airway allergy, and other abnormal effects all caused by wheat and grains.
The list includes anti-inf...
Source: Wheat Belly Blog - October 6, 2015 Category: Cardiology Authors: Dr. Davis Tags: Wheat Belly Lifestyle asthma cholesterol diabetes drugs gluten grains hypertension prescription medication reflux Source Type: blogs
Extreme Bradycardia after Diarrhea and Dehydration. Best ED treatment?
A patient presented with weakness. He was found to be bradycardic, so this ECG was recorded:There is atrial flutter with 3rd degree AV block and Left ventricular escape. Why is it not slow AV conduction with RBBB? The QRS occurs at different points on the flutter wave. There is complete dissociation due to complete AV block.More historyThe patient has a history of congenital heart disease repaired as a child. He reports having had an extra pacemaker transiently but this was removed at a very young age. The patient describes a history of progressive bradycardia. In recent years, the patient states th...
Source: Dr. Smith's ECG Blog - October 2, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
Rising Cost Of Drugs: Where Do We Go From Here?
The trends are clear: patients and institutions across the nation are concerned about skyrocketing drug prices. This post offers some information about drug pricing, explores the notion of market intervention, and proposes a series of responses to high pharmaceutical costs.
A few jaw-dropping facts quickly illustrate the pattern of rising drug costs. The average annual cost of cancer drugs increased from roughly $10,000 before 2000 to over $100,000 by 2012, according to a recent study in Mayo Clinic Proceedings. Several breakthrough specialty medications and orphan drugs recently approved by the Food and Drug Administratio...
Source: Health Affairs Blog - August 31, 2015 Category: Health Management Authors: Ifrad Islam Tags: Costs and Spending Drugs and Medical Technology Featured Medicaid and CHIP Payment Policy Public Health Big Pharma CMS FDA Gilead Sciences hepatitis C Pricewaterhouse Coopers Source Type: blogs
