Research and Reviews in the Fastlane 080
This study calls into question the current guidelines and will hopefully lead to more evidence-based recommendations in the future.Recommended by: Zack RepanshekRead More: Antibiotics for community-acquired pneumonia: Is azithromycin out? (Pulm CCM)The Best of the RestOphthalmology, Ultrasound Vrablik ME et al. The diagnostic accuracy of bedside ocular ultrasonography for the diagnosis of retinal detachment: a systematic review and meta-analysis. Ann Emerg Med 2015; 65(2):199-203. PMID: 24680547Nice meta-analysis of bedside US for retinal detachment in Annals of EM showing 97-100% sensitivity, 83-100% specificity, base...
Source: Life in the Fast Lane - April 23, 2015 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Cardiology Education Emergency Medicine Infectious Disease Intensive Care Ophthalmology Psychiatry and Mental Health Resuscitation Trauma critical care R&R in the FASTLANE recommendations research and reviews Source Type: blogs
Why don’t people ask their doctors more questions?
I do not get it. Day in and day out, I ask patients why they take a medicine. Many do not know. “My doctor put me on it,” goes the common response.
Take statin drugs, for example. I often ask a person why they are taking the drug? With rare exception, the person says it is to lower cholesterol.
That’s not the right answer–and herein lies much of the problem with preventative medicine. A statin drug does indeed lower cholesterol but its main purpose is to reduce the risk of heart attack, stroke or death in the future. Cholesterol is just a number. It’s a surrogate that we can measure but itR...
Source: Dr John M - April 22, 2015 Category: Cardiology Authors: Dr John Source Type: blogs
Interpreting the new sore throat article
First, this study required the work of a large team. The main work happened in two places – a research microbiology laboratory and our college health clinic. They took an idea and translated it into an opportunity to collect and analyze data.
Second, the accompanying editorial (written by a friend and excellent researcher Dr. Jeffrey Linder) raises some questions that I will work to answer. He writes that we do not have enough evidence to change practice yet. He postulates that Fusobacterium necrophorum might not actually cause pharyngitis and that linking positive PCR testing to the risk of suppurative complicat...
Source: DB's Medical Rants - February 23, 2015 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Healthcare Update Satellite — 01-19-2015
Penicillin allergy? It’s associated with increased bad outcomes, but not for the reasons you think. The allergies themselves are mostly not allergies. And no, “my mother said I had a rash when I was a baby” isn’t an allergy. However, when compared with patients who don’t have penicillin “allergies”, patients with penicillin allergies have longer hospital stays and are between 14% and 30% more likely to get resistant infections while in the hospitals – possibly because the penicillin “allergic” patients are being treated with much stronger antibiotics that kill of...
Source: WhiteCoat's Call Room - January 19, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
How Can You Be Sure?
“How can you be sure?”
That question stopped our discussion for a second.
During some down time, several nurses and I were talking about childhood coughs. Her 6 month old child had just started daycare 2 weeks ago and has been coughing ever since. The child was put on amoxicillin and then Zithromax by her pediatrician but … [GASP] … her cough wasn’t getting any better. The nurse thought her child had pneumonia.
“What should she be taking now?”
I was in a particularly snarky mood, so, with a smirk, I said “probably vancomycin … maybe add gentamycin just for the gram nega...
Source: WhiteCoat's Call Room - January 13, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Random Thoughts Source Type: blogs
EHRs and Ebola in the Texas Health Presbyterian Hospital ED: the ED physician finally speaks out
At my Oct. 2, 2014 post "Did Electronic Medical Record-mediated problems contribute to or cause the current Dallas Ebola scare?" (http://hcrenewal.blogspot.com/2014/10/did-electronic-medical-record-mediated.html) I had written:While I have no evidence as to any role of EHRs in this seemingly strange, cavalier and incomprehensible medical decision to send this man home, resulting in potential exposure of numerous other individuals to Ebola (and I am certainly not in a position to have such evidence), I believe this possibility [that is, an EHR-related information snafu - ed.] needs to be investigated fully. I then ...
Source: Health Care Renewal - December 15, 2014 Category: Health Management Tags: AHRQ Ebola virus EPIC healthcare IT risk Joseph Howard Meier Silverstein EHR principle Texas Health Presbyterian Hospital Source Type: blogs
Top stories in health and medicine, September 11, 2014
From MedPage Today:
Azithromycin Linked to Belly Blockage in Infants. Infants who received azithromycin (Zithromax) in the early days of life were at an increased risk for developing infantile hypertrophic pyloric stenosis (IHPS).
Singulair Doesn’t Ease Wheeze in Most Kids. Intermittent montelukast (Singulair) didn’t alleviate wheezing in children, except possibly for those with a specific genetic mutation.
Single-Pill HIV Therapy Proves Less Toxic. An investigational single-pill regimen for HIV — the first to be based on a protease inhibitor — was less toxic than a similar regimen using separate ...
Source: Kevin, M.D. - Medical Weblog - September 11, 2014 Category: Journals (General) Authors: MedPage Today Tags: News Infectious disease Pulmonology Source Type: blogs
Increased Heart Risk Linked To Popular Antibiotic
Acute use of the popular macrolide antibiotic clarithromycin has been linked to a small but significant increase in cardiac death. In a report in the BMJ, researchers in Denmark analyzed the effects over a 14-year period of the acute use of penicillin V, roxithromycin, and clarithromycin. Earlier research raised concerns that marcrolide antibiotics in general, and erythromycin and azithromycin in particular, might prolong the QT interval and increase the risk for fatal arrhythmias. In the new study, clarithromycin was associated with a significant increase in the rate of sudden cardiac death compared with the other...
Source: CardioBrief - August 20, 2014 Category: Cardiology Authors: Larry Husten Tags: Heart Rhythms Policy & Ethics Prevention, Epidemiology & Outcomes antibiotics arrhythmias clarithromycin QT interval Source Type: blogs
Feeling a Little Better
Still in the hospital. My temperature seems to have stabilized near normal, I'm coughing a little less, and blood oxygen (without supplemental oxygen) is up in the 94% range. However, pulse rate and respiration rate are unchanged and much higher than normal, so the jury is still out.
For the medically inclined: I was started on a Z-Pak (azithromycin) Monday, then in the hospital they added a cephalosporin IV antibiotic Tuesday. By today (Thursday) we didn't see much progress, so the hospital doctor finally talked me into oral Levaquin, dropping both of the others. That dose was this noon , so it's ...
Source: Myeloma Hope - August 1, 2014 Category: Cancer Tags: pneumonia Source Type: blogs
Stop Expecting Antibiotics to Be Handed Out Routinely: Here’s Why
For years, my colleagues on the Prepared Patient site have preached the importance of being an advocate for your own care. And they’ve noted that at times it is necessary to push back against doctors’ recommendations if a suggested treatment does not seem right. I just returned from a visit to the U.K., which drove home the importance of that advice. Coming down with a common cold gave me a chance to experience differences in how British and American doctors approach the nasty symptoms of an all-too-common medical problem.
Let’s face it. Most of us have been given too many antibiotics for sore throats, co...
Source: Disruptive Women in Health Care - June 16, 2014 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Access Consumer Health Care Policy Source Type: blogs
Top stories in health and medicine, June 9, 2014
From MedPage Today:
Surgeons Not Very Involved in ACOs, Survey Says. Accountable Care Organizations have given little attention to surgery in the early years of the Medicare program, choosing to focus instead on managing chronic conditions and reducing hospital readmissions.
Early Allergen Exposure Cuts Wheeze Risk. A new study confirmed that when inner-city kids were exposed to allergens they had an increased risk of recurrent wheezing and sensitivity to allergens.
Death Risk Down With Pneumonia Antibiotic. Taking into account both death and myocardial infarction (MI), use of antibiotic regimens that included azithromyc...
Source: Kevin, M.D. - Medical Weblog - June 9, 2014 Category: Journals (General) Authors: MedPage Today Tags: News Diabetes Endocrinology Infectious disease Surgery Source Type: blogs
Long QT: Do not trust the computerized QT interval when the QT is long
A middle-aged male with h/o DM was found down. He was hypoglycemic (mild, 45 mg/dl) and had pneumonia with hypoxia. He had this ECG recorded:Sinus rhythm with slight right axis deviation and non-diagnostic T-wave inversionsHe received azithromycin and ceftriaxone for community acquired pneumonia. Then he became very agitated in spite of correction of hypoglycemia, and was given a total of 15 mg of haloperidol. His K returned at 2.8 mEq/L and ionized Calcium at 3.82 mEq/L (normal, 4.4 -5.2). Magnesium was 1.5 mEq/L (normal, 1.3 - 2.0)A troponin returned slightly elevated, so another ECG was rec...
Source: Dr. Smith's ECG Blog - June 3, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
The LITFL Review 130
The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the best and brightest from the blogosphere, the podcast video/audiosphere and the rest of the Web 2.0 social media jungle to find the most fantastic EM/CC FOAM (Free Open Access Meducation) around.
Welcome to the 130th edition, brought to you by:
Kane Guthrie [KG] from LITFL
Tessa Davis [TRD] from LITFL and Don’t Forget The Bubbles
Brent Thoma [BT] from BoringEM, and ALiEM
Chris Ni...
Source: Life in the Fast Lane - March 25, 2014 Category: Emergency Medicine Doctors Authors: Kane Guthrie Tags: Education eLearning Emergency Medicine Featured Health Intensive Care LITFL review Toxicology LITFL R/V Source Type: blogs
Top stories in health and medicine, March 12, 2014
From MedPage Today:
Docs Unprepared for Payment Reform. A pair of recent reports call into question the ability of physician practices to embrace health reform efforts.
Even a Few Drinks Tied to Poor Birth Outcomes. Women who consumed low levels of alcohol before conception and during pregnancy were more likely to have adverse birth outcomes such as low birth centile, low birth weight, and premature birth than nondrinkers.
Can Antibiotics Trigger Arrhythmias?. Azithromycin and levofloxacin were both associated with elevated risks of death and serious cardiac arrhythmias during standard lengths of prescription.
HIV: More ...
Source: Kevin, M.D. - Medical Weblog - March 12, 2014 Category: Family Physicians Tags: News Heart Infectious disease OB/GYN Source Type: blogs
Oops - Intensive Care
Saturday, February 8, 2014, Breaking News
My sweeties and I ran a lovely marathon in New Orleans last Sunday. On Monday we flew home, and by Tuesday morning I felt a scratchy throat. That came on fast, knocked me flat (weak, fever, aches, severe cough, nausea), and by Thursday it was diagnosed at Mayo as Influenza Type A. Yes, I did get the flu shot, last November. By Friday morning I was having trouble breathing and my local doc found pneumonia. He checked me into the ICU in Lakeview Hospital in Stillwater, MN.
The hospital staff treat me with respect, lots of smiles, but they put on gowns, masks, and ...
Source: Myeloma Hope - February 9, 2014 Category: Cancer Source Type: blogs
