Hospitals run on much more than doctors and nurses, so spread the love
As a hospitalist in Minnesota, my colleagues and I are busy preparing for the coming viral storm. It is starting to rain. We read the harrowing front line stories from overwhelmed hospitals in China, Italy, and now here in the U.S., and reach for a sublingual Zofran tablet to calm the nauseous dread. The smart […]Find jobs at  Careers by KevinMD.com.  Search thousands of physician, PA, NP, and CRNA jobs now.  Learn more. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - March 23, 2020 Category: General Medicine Authors: < span itemprop="author" > < a href="https://www.kevinmd.com/blog/post-author/craig-bowron" rel="tag" > Craig Bowron, MD < /a > < /span > Tags: Conditions COVID-19 coronavirus Infectious Disease Source Type: blogs

Chest pain in high risk patient. Are these Hyperacute T-waves? What is going on here?
A 40-something woman with h/o obesity, hyperlipidemia, smoking, as well as cocaine and alcohol abuse presented with intermittent chest pain for 2-3 weeks that became constant in the last day.  There is also some generalized weakness.  There is some associated SOB, but no nausea and vomiting.Here is the initial EKG:What do you think?There is sinus rhythm, a bit of ST depression (II, aVF, III, V2-V6) and apparently very wide and large T-waves.  However, if one looks closely, one sees a distinct and prominent U-wave in leads II, III, aVF.  Whether a T-wave or a U-wave, the interval (QT or QU) is very ...
Source: Dr. Smith's ECG Blog - December 18, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs

Acute Angle Closure: Mastering Tonometry
​Identifying and managing disease often requires the delicate and skillful use of temperamental emergency department machinery. The ability to apply these may appropriately help determine a difficult diagnosis.Glaucoma, we all know, can cause blindness, and acute narrow angle glaucoma refers to the angles within the eye that are not as wide and open as normal. People with acute angle glaucoma have abnormal anatomy within the eye where the angle changes as the eye is dilated. This can cause blockages of fluid drainage from the anterior to posterior changes resulting in increased intraocular pressure. It ca lead to acute a...
Source: The Procedural Pause - November 9, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Alcohol Pad = Aromatherapy = Nausea Relief?
by Bob Arnold (@rabob)In general, I am a cynic and a nihilist. That means when reviewing the literature, I find most glasses half empty rather than half full (OK, probably this is true in life, but that is TMI). I am very unlikely to try a new treatment based on one study.For every rule, however, there is an exception. I am completely enthralled with aromatherapy and thus found anarticle in the Annals of Emergency Medicine by Beadle on isopropyl alcohol nasal inhalation for nausea in the emergency department. It was a randomized controlled trial which made it swoon-worthy. The only problem was it was a placebo trial and so...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 24, 2018 Category: Palliative Care Tags: arnold emergency department journal article nausea ondansetron pallimed writing group research vomiting Source Type: blogs

Double Trouble: Both-Bone Fractures
​Both-bone forearm fractures may make you feel a little nervous. A completely crooked forearm is definitely a disturbing sight. Both-bone forearm fractures (especially of the midshaft) typically require surgical intervention, but relocation of bony injuries, regardless of site or complexity, is an important and necessary skill you need to know. Plus, you will be required to assist with sedation, reduction, and splinting when the orthopedic team is involved.​Correcting and stabilizing two bones (instead of one) may seem tricky, but we are going to help you do it right. This complex procedure should be done with orthoped...
Source: The Procedural Pause - August 31, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

A Balancing Act: Diet Selection for Older Adults
This study highlights that, beyond the detrimental effects of tube feeding on quality of life, there could be detrimental effects from non-oral feeding on the health of our patients. This is obviously not the case for all patients, so each individual case needs to be considered, but these studies comparing outcomes are important to consider. Participant: When using the IDDSI (International Dysphagia Diet Standardization Initiative), are there at least two numbers included in a diet order: one for foods and one for liquids? Are dietary departments fully onboard? Rogus-Pulia: My understanding of IDDSI is that, yes,...
Source: American Speech-Language-Hearing Association (ASHA) Press Releases - June 18, 2018 Category: Speech-Language Pathology Authors: Jillian Kornak Tags: Academia & Research Health Care Private Practice Slider Speech-Language Pathology Dysphagia Feeding Disorders nutrition Speech Disorders Swallowing Disorders Source Type: blogs

A female in her 60s who was lucky to get expert ECG interpretation
Submitted and written by Alex Bracey, with edits by Pendell Meyers and Steve Smith:I was walking through the critical care section of the ED when I overheard a discussion about the following ECG. I had no history on the case and no prior ECG for comparison.What do you think?Here are inferior leads, and aVL, magnified:A closer inspection of the inferior leads and aVLSinus bradycardia. The T-wave in lead III is slightly tall and broad (increased area under the curve) compared to its QRS complex. In isolation, this probably could not be called a hyperacute T-wave, but you may suspect it.  There is T-wave invers...
Source: Dr. Smith's ECG Blog - February 15, 2018 Category: Cardiology Authors: Pendell Source Type: blogs

Research and Reviews in the Fastlane 191
This article has spawned a lot of controversy. It is worth reading to understand why. Recommended by: Justin Morgenstern Emergency Medicine Samuels EA, et al. “Sometimes You Feel Like the Freak Show”: A Qualitative Assessment of Emergency Care Experiences Among Transgender and Gender-Nonconforming Patients. Annals of emergency medicine. 2017. PMID: 28712604 This is a qualitative study of transgender patients who visited an ED in the US. This article is a must read as providers often lack insight into the complexities of caring for transgender patients and systemic barriers to conscientious care. T...
Source: Life in the Fast Lane - January 10, 2018 Category: Emergency Medicine Authors: Justin Morgenstern Tags: Emergency Medicine Gastroenterology R&R in the FASTLANE Respiratory Resuscitation EBM Education recommendations research and reviews Source Type: blogs

So I ’m a fellow now
I always “knew” that I was going to be the nice fellow. Partly because I’ve had some terrible experiences with fellows during residency (which I’m still salty about, by the way. I mean, listen, there is never a scenario where I, as an intern, am ‘deciding’ to consult you. The intern is just doing what they were damn well told) – but mostly because I figured I didn’t know anywhere near enough about pediatric neurology to be mean or even a wee bit testy. … I was perhaps wrong. This gradual realization reminds me of being an intern and “knowing” that I was goi...
Source: Action Potential - December 16, 2017 Category: Universities & Medical Training Authors: Action Potential Tags: Uncategorized Source Type: blogs

An August Appendectomy
In August, (one month ago today)I had an appendectomy. There was very little drama involved, the doctors office visit led straight to a same day CT scan and an emergency review with the radiologist who informed me the appendix couldn't be seen but the colon was most definitely inflamed and I should go to the ER if it got worse. To the ER I went that night, to a hospital where the D Care is very good (had that going for it). They admitted me under observation, coursing enough pain medications through me to make me sick for the next 14 hours. The plan was to do another CT the next day. In observation, as I was trying not to ...
Source: The D-Log Cabin - September 20, 2017 Category: Endocrinology Authors: HVS Source Type: blogs

As US Attorney, Labor Secretary Nominee Enabled Drug and Biotechnology Executives' Impunity
The new Trump administration nominee for US Secretary of Labor is a former US Attorney for the southern district of Florida.  In that role, he seemed to uphold the ideas that certain big corporations, particularly big pharmaceutical and biotechnology corporations, are too big to jail, and that top executives of big corporations should not be held accountable for their corporations'actions.He had central involvement in three bigsettlements of charges of corporate misbehavior which held no individuals accountable for enabling, authorizing, directing or implementing the bad behavior.  The settlements imposed only mo...
Source: Health Care Renewal - February 21, 2017 Category: Health Management Tags: bribery Bristol-Myers-Squibb deception Donald Trump Genzyme GlaxoSmithKline impunity kickbacks legal settlements manipulating clinical research Sanofi-Aventis Source Type: blogs

Another Case of Vomiting
​A 26-year-old man presented to the emergency department with nausea, vomiting, and abdominal pain. He said he had had the pain, which he said encompassed his entire abdomen, for three days.​He had been unable to tolerate anything by mouth. His vitals on presentation included a heart rate of 115 bpm, blood pressure of 126/70 mm Hg, respiratory rate of 22 bpm, and pulse oximetry of 100% on room air.Physical examination revealed dry mucus membranes, dry skin, tachycardia without murmurs, and clear lungs. Abdominal examination demonstrates hyperactive bowel sounds without pain on palpation or hepatosplenomegaly. The patie...
Source: The Tox Cave - December 1, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Lieutenant Lumpy: An Update.
Another year, another clean set of scans and a pristine checkup with Dr. Crane and his Irrepressibly Cheerful Staff. (They always seem happy to see me? I guess because I don't look like Frankenstein's Monster?)Next year, because the lung nodule I have has not changed in six years, I can start getting annual chest x-rays rather than an annual chest CT, along with my usual head/neck/orbits MR. I'll have to get all that every year for the foreseeable future, because (as Dr. Crane said), " These stupid salivary gland tumors have a really long fuse. " And they tend to recur in both the original spot and met to really ...
Source: Head Nurse - October 6, 2016 Category: Nursing Authors: Jo Source Type: blogs

What truly palliates? Do we choose or do we allow the patient to choose?
The day I met Mr. Lightfoot, he was a medical curiosity on teaching rounds, “a great example of a Sister Mary Joseph’s Nodule,” a sign of metastatic stomach cancer. Earl was lying in a hospital bed in the cancer unit of the hospital, his stomach completely distended, nauseous and vomiting, unable to eat anything. He had undergone a cycle of chemotherapy only days before. I organized Mr. Lightfoot into a problem list: 1. Nausea / vomiting. Zofran and Compazine 2. Diet. IV fluids, PO intake as tolerated 3. Gastric cancer. Status post cycle of chemotherapy, hold for now. The plan seemed simple. Continue read...
Source: Kevin, M.D. - Medical Weblog - September 21, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/divya-yerramilli" rel="tag" > Divya Yerramilli, MD < /a > Tags: Physician Cancer Source Type: blogs

On the Worst Healthcare Experience of My Life
By JESS JACOBS This has been a very sad weekend for me personally, the wider health care community and for anyone who knew Jess Jacobs, who died on Saturday. She was only 29 years old, and was smart, funny, enthusiastic, and brave well beyond her years. She suffered from two very rare diseases, but was also working to push health policy forward at ONC, FDA and Aetna, and she really knew her stuff. Jess was a marvel and a rarity in more ways than one. She was #UnicornJess. (That link will take you to the twitter memorial on Sunday night, but also check out remembrances from Ted Eytan & Carl...
Source: The Health Care Blog - August 15, 2016 Category: Consumer Health News Authors: Matthew Holt Tags: THCB #UnicornJess Hospital Care Jess Jacobs Source Type: blogs

Research and Reviews in the Fastlane 142
This study demonstrated that very early administration (pre-hospital) did not change outcomes in terms of infarct size. There was also no reduction in ventricular dysrhythmias. Once again we see that earlier is not always better. Recommended by Anand Swaminathan The R&R iconoclastic sneak peek icon key The list of contributors The R&R ARCHIVE R&R Hall of famer You simply MUST READ this! R&R Hot stuff! Everyone’s going to be talking about this R&R Landmark paper A paper that made a difference R&R Game Changer? Might change your clinical practice R&R ...
Source: Life in the Fast Lane - July 13, 2016 Category: Emergency Medicine Authors: Jeremy Fried Tags: Cardiology Clinical Research Education Emergency Medicine Pediatrics R&R in the FASTLANE critical care EBM literature recommendations research and reviews Source Type: blogs

Research and Reviews in the Fastlane 133
This study certainly suggests a benefit to using Dexmedetomidine in these patients. Recommended by: Nudrat Rashid The Best of the Rest Emergency Medicine Beadle KL et al. Isopropyl alcohol nasal inhalation for nausea in the Emergency Department: A randomized controlled trial. Ann Emerg Med. 2015. PMID: 26679977 This is a small double-blinded RCT comparing inhaled isopropyl alcohol to saline placebo for short-term relief of nausea in the ED. Although it is hard to believe patients (and possibly investigators) were truly blinded to the odor of isopropanol, this study found isopropanol superior to placebo for improve...
Source: Life in the Fast Lane - May 5, 2016 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Education Emergency Medicine Intensive Care Neurology Neurosurgery critical care examination R&R in the FASTLANE recommendations research and reviews Resuscitation Source Type: blogs

Research and Reviews in the Fastlane 131
This study only shows an association and not causality and will need further prospective studies to elucidate the truth. However, in the absence of better evidence, either agent appears reasonable as the first line but rocuronium has a number of advantages (absence of contraindications, longer paralysis). Recommended by: Anand Swaminathan Read More: Does Succinylcholine Increase Mortality in Severe TBI Patients? (UMEM Education Pearls), Rocuronium vs. Succinycholine (Core EM) The R&R iconoclastic sneak peek icon key The list of contributors The R&R ARCHIVE R&R Hall of famer You simply ...
Source: Life in the Fast Lane - April 20, 2016 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Cardiology Education Emergency Medicine Gastroenterology Intensive Care LITFL Neurology Pre-hospital / Retrieval Resuscitation EBM literature R&R in the FASTLANE recommendations research and reviews Source Type: blogs

T-wave inversion in a young woman with hyperventilation and carpopedal spasm
This case is another good one contributed by Brooks Walsh, with an excellent review.A 24 year-old African-American female presented to the ED with nausea and vomiting for 1 day. She also complained of paresthesias and cramping in her hands and wrists, as well as perioral paresthesias. She had no significant  personal or family medical history. Vitals signs and exam were remarkable only for hyperventilation with clear lungs, and bilateral carpopedal spasms.An ECG was obtained to assess the QTc prior to administering ondansetron:A bedside focused echocardiogram did not demonstrate overt septal or concentric hypertrophy....
Source: Dr. Smith's ECG Blog - January 13, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs

LITFL Review #208
Welcome to the 208th 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 Tim Leeuwenburg’s talk from SMACC US, Coping with Isolation, speaks to those physicians who practice “all alone” in a rural environment. The take-home message: vulnerability is OK; be kind to each other; and we are never alone w...
Source: Life in the Fast Lane - November 30, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

LITFL Review 185
Welcome to the 185th 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 Incredible reenactment videos of the Elaine Bromiley case, “a routine operation that went horribly awry.” From EMCrit, where Nicholas Chrimes’s videos show how things go wrong and how they can go right. [AS]   The Best of #...
Source: Life in the Fast Lane - June 8, 2015 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

She took Zofran and her son had a heart defect. Here’s why she’s not suing.
I suffered from extreme nausea during my pregnancy; I had triplets, and I’m pretty sure I had a triple dose. I never threw up, but you know how your mouth salivates the moment right before you vomit, that sensation that sends you running to the bathroom? I had that. All. Day. Long. For four weeks. By day four or five I was beside myself. I was drooling on my knees into a trash can or a toilet almost constantly. I kept a kidney basin beside me as I charted in the office, and my colleagues knew to leave a bathroom free. Just in case. If I could have been off work I would have, except I knew I would have to stop working...
Source: Kevin, M.D. - Medical Weblog - May 15, 2015 Category: Journals (General) Authors: Tags: Conditions Medications OB/GYN Source Type: blogs

First Time Mother Shows Up In ER With Complaints of Bilateral Symmetrical Breast Swelling.
Jackson, MS  - In what ER doctors are calling one of the strangest cases of Failure To Parent ever, 20 year-old first time mother Tanya Jameson called 911 demanding to be transported  back to Jackson Memorial Hospital by ambulance with complaints of severe, progressive, bilateral breast swelling three days after delivering a bouncy 10 pound 2 ounce baby boy.Paramedics arrived at the scene to find Tanya's mother in a panic consoling her daughter writhing in pain.  "You've got to take my daughter to the ER.  Those damn doctors let her out too soon. Something is terribly wrong!" said her anxiety ...
Source: The Happy Hospitalist - May 11, 2015 Category: Internal Medicine Authors: Tamer Mahrous Source Type: blogs

Just how much “healthcare” do you need minus grains?
Jamilyn shared her early experience with this lifestyle: “I started Wheat Belly February 9th, 2015. I have lost 20 pounds in just over 2 months and 10 on my own in the 9 months prior to WB–30 pounds difference from the first picture to the 3rd picture. “I have eliminated all of the many medications I was taking for migraines, IBS, gastroparesis, chronic sinusitis, and joint pain. I haven’t taken Allegra or Flonase (which I have taken everyday since I was in my 20’s) since the second day of Wheat Belly. I no longer need my Protonix, Reglan, Carafate, or Zofran for my gastroparesis either. No m...
Source: Wheat Belly Blog - April 15, 2015 Category: Cardiology Authors: Dr. Davis Tags: Wheat Belly Success Stories gastroparesis grains IBS joint pain sinusitis Source Type: blogs

Cases: Second-Line Anti-emetic Therapies for Refractory Chemotherapy-Induced Nausea and Vomiting (CINV)
Discussion:Nausea and vomiting (NV) are commonly reported side effects with chemotherapy.1 The primary pathway for NV involves the chemotherapy drugs directly stimulating the chemoreceptor trigger zone (CTZ), in the area postrema at the base of the fourth ventricle. Activated receptors in the CTZ transmit signals to the vomiting center in the brainstem to produce NV. Receptors in the CTZ include serotonergic receptor 5-hydroxytryptamine type 3 (5-HT3), dopaminergic (D2) and neurokinin type 1 (NK-1) receptors. In addition, chemotherapy can damage GI mucosa causing local release of 5-HT3 neurotransmitters by gut enterochrom...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 25, 2014 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Gastroparesis Awareness Month: A Day In The Life
This is my second post for Gastroparesis Awareness Month.  Read my first post, Tube Love, here.  My first post was a love poem to my feeding tube.  :-)  My second one is a little more serious and a lot longer.  I apologize for the length.  I have trouble reading lengthy posts myself.  But sometimes I’m incapable of summarizing myself, so I have to write posts that are too long for even me to read.  I hope you’ll at least be able to skim through the important parts.  I’ve tried to break up the text with lots of photos, to see if that helps any. A DAY IN THE LIFE...
Source: Ballastexistenz - August 24, 2014 Category: Autism Authors: Mel Baggs Tags: Adrenal insufficiency Aspiration pneumonia Bronchiectasis Education Feeding tube Food Gastroparesis Life Skills Medical Medical stuff Personal history Treatment adult tubie adult tubies awareness awareness months bipap ce Source Type: blogs

Healthcare Update Satellite — 07-2-2014
Ve have vays of keeping you qviet. Halt den mund! Government-contracted security force who actually call themselves the “Brown Shirts” … threatens to arrest medical providers if they leak any information to media about all of the medical illnesses that are being seen at an illegal alien refugee camp in Lackland Air Force Base. By the way, this story is from FoxNews, so everyone should just ignore it until you or your family members sit next to one of them on a bus or in a movie theater. Combine these kids on playgrounds with anti-vax kids? What could go wrong? Nothing to worry about. Nothing at all. New ...
Source: WhiteCoat's Call Room - July 2, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Research and Reviews in the Fastlane 035
This study suggests that antiemetics are not nearly as potent as widely believed. These drugs have been shown to be effective in preventing nausea (i.e. pretreatment for chemo) but it’s appears that the mechanism for halting nausea is different than that for preventing it. Recommended by: Anand Swaminathan Read More: Nausea? We’ve Got Placebo for That The Best of the Rest Emergency Medicine, Pulmonary 1. Kew KM, Kirtchuk L, Michell C. Intravenous magnesium sulfate for treating adults with acute asthma in the emergency department. Cochrane Database Syst Rev. 2014 May 28;5 PubMed ID: 24865...
Source: Life in the Fast Lane - June 18, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Anaesthetics Cardiology Emergency Medicine Evidence Based Medicine General Surgery Intensive Care Palliative care Pediatrics Respiratory Resuscitation Trauma critical care literature R&R in the FASTLANE recommendations resear Source Type: blogs

Research and Reviews in the Fastlane 035
This study suggests that antiemetics are not nearly as potent as widely believed. These drugs have been shown to be effective in preventing nausea (i.e. pretreatment for chemo) but it’s appears that the mechanism for halting nausea is different than that for preventing it. Recommended by: Anand Swaminathan Read More: Nausea? We’ve Got Placebo for That The Best of the Rest Emergency Medicine, Pulmonary 1. Kew KM, Kirtchuk L, Michell C. Intravenous magnesium sulfate for treating adults with acute asthma in the emergency department. Cochrane Database Syst Rev. 2014 May 28;5 PubMed ID: 24865...
Source: Life in the Fast Lane - June 18, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Anaesthetics Cardiology Emergency Medicine Evidence Based Medicine Featured General Surgery Intensive Care Palliative care Pediatrics Respiratory Resuscitation Trauma critical care literature R&R in the FASTLANE recommendatio Source Type: blogs

Fat people and feeding tubes.
This isn’t a post I like to write.  The idea to write it always comes after someone, who is not communicating with me in good faith, approaches me and makes snide remarks about how I can possibly need a feeding tube if I’m fat.  Except they usually go beyond calling me fat.  They usually make some reference to my weight that makes it sound like I’m unusually fat, just to make things worse.  In one case, a known repeat cyber-bully (he has made threatening phone calls to a friend of mine — if I’d recognized him on sight I’d have deleted his comment unread) even tol...
Source: Ballastexistenz - May 15, 2014 Category: Autism Authors: Mel Baggs Tags: Abuse Bullying Death Ethics Ethics, justice, etc. Food Medical Medical stuff Prejudice Rumors Stereotypes Treatment Trolls Discrimination fat fat and health fat health fatphobia feeding tube feeding tubes gastropare Source Type: blogs

Cases: "Am I really going to have to live like this?": The Role of Octreotide in Patients with Persistent Nausea and Vomiting after Venting Gastrostomy
Discussion:Malignant bowel obstruction can occur with any cancer but is most commonly associated with advanced ovarian cancer, where it occurs in up to 50% of patients. It generally indicates a poor prognosis and carries a heavy symptom burden predominated by nausea, vomiting and abdominal pain. Patients with carcinomatosis, like Ms BB, are generally not candidates for surgical correction of the obstruction or endoscopic stenting. Fortunately, medical management can be very effective. Abdominal pain is treated with opioids and nausea is treated with metoclopramide in partial obstructions and haloperidol in complete obstruc...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 10, 2014 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Acamprosate For Alcohol: Why the Research Might Be Wrong
Calcium may be curbing the urge to drink. “Occasionally,” reads the opening sentence of a commentary published online last month in Neuropsychopharmacology, “a paper comes along that fundamentally challenges what we thought we knew about a drug mechanism.” The drug in question is acamprosate, and the mechanism of action under scrutiny is the drug’s ability to promote abstinence in alcoholics. The author of the unusual commentary is Markus Heilig, Chief of the Laboratory of Clinical and Translational Studies at the National Institute on Alcohol Abuse and Alcoholism (NIAAA).Acamprosate, in use w...
Source: Addiction Inbox - February 17, 2014 Category: Addiction Authors: Dirk Hanson Source Type: blogs

Give and Take Medicine (Good Doctor and Nurse Humor).
Being a great doctor or nurse means learning how to give and take.  Healthcare professionals are not dictators and patients are not entitled to whatever they read on the internet.   Nursing and doctoring are an art of skillful negotiation with patients and their families.  As professionals, doctors and nurses have an obligation to seek out the care plan that is in the best interests of their patients.  The Happy Hospitalists wants all patients to know that your doctor and nurse are there for you.  They are ALWAYS thinking about how to make you the most satisfied patient.  They have to because ...
Source: The Happy Hospitalist - January 26, 2014 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs

Merry Christmas Big Pharma, from PharmaGossip and Sid Wolfe
Escalating criminal and civil violations: pharma has corporate integrity? Not reallySidney M Wolfe looks at the system that should, but does not, deter drug companies from breaking the lawAre criminal and civil penalties of hundreds of millions of dollars an important deterrent to law breaking by international drug companies?Further, would external monitoring in the form of US government mandated corporate integrity agreements (CIA)1 to prevent recurrences of such illegal activities, lasting five years after being signed, be an additional deterrent? Yes in both cases, but only if the size of the penalties outweig...
Source: PharmaGossip - December 24, 2013 Category: Pharma Commentators Authors: insider Source Type: blogs

Anchors Aweigh!
An otherwise healthy 38 year old patient was brought in by her family with vomiting and mental status changes from her pain medications. She had repair of a tibial plateau fracture performed four days earlier and was having a lot of pain. She didn’t like taking the Percocets that she was prescribed because they made her nauseous. She took one of them the day after her surgery and she was nauseous the rest of the day, so she vowed not to take any additional Percocets. However, her knee pain was worse that morning to the point that she couldn’t stand it any longer, so she took two Percocets … on an empty s...
Source: WhiteCoat's Call Room - December 10, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Medical Topics Patient Encounters Source Type: blogs

Cannabinoid Hyperemesis Syndrome
Thankfully, cannabinoid hyperemesis syndrome isn’t a life- or limb-threatening condition. Malpractice attorneys would be having a field day if it were. I have been attuned to this condition only for the past several years, but it’s apparent that this condition remains diagnostically elusive.   Every new case I pick up has presented previously to my or another community emergency department multiple times without anyone making the diagnosis. And the patient almost always has a trail of CT scans, abdominal ultrasounds, and other imaging studies as well as hundreds of dollars in laboratory testing. It’s...
Source: M2E Too! Mellick's Multimedia EduBlog - December 3, 2013 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Cannabinoid Hyperemesis Syndrome
Thankfully, cannabinoid hyperemesis syndrome isn’t a life- or limb-threatening condition. Malpractice attorneys would be having a field day if it were. I have been attuned to this condition only for the past several years, but it’s apparent that this condition remains diagnostically elusive.   Every new case I pick up has presented previously to my or another community emergency department multiple times without anyone making the diagnosis. And the patient almost always has a trail of CT scans, abdominal ultrasounds, and other imaging studies as well as hundreds of dollars in laboratory testing. It&rsquo...
Source: M2E Too! Mellick's Multimedia EduBlog - December 3, 2013 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Worst Smells In The Hospital? There's a List For That!
I recently asked my thousands of Facebook readers to describe the worst smell in the hospital in their own words.  They did not disappoint.  The hospital setting provides the perfect opportunity to experience a crisis of unimaginable olfactory proportions.  Some people thought the smell of rotting flesh was the most intolerable smell in the hospital.  Other folks said the unmistakeable smell of melena was the worst.  Walking off an elevator onto a floor or unit and experiencing the smells of nasal suicide is a sure fire way to create interesting conversation.  Simply ask anyone who's job is st...
Source: The Happy Hospitalist - October 19, 2013 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs

Medical Mispronunciations and Misspelled Words: The Definitive List.
Hearing medical mispronunciations and seeing misspelled words are an under appreciated  joy of working in healthcare.  Physicians often forget just how alien the language of medicine is to people who don't live it everyday.  The best part about being a physician is not helping people recover from critical illness. The best part is not  about  listening and understanding with compassion and empathy.  Nope, the best part about being a physician is hearing patients and other healthcare providers butcher the language of medicine and experiencing great entertainment in the process.   Doctors c...
Source: The Happy Hospitalist - October 2, 2013 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs

Post #39 Vomiting and Diarrhea (Gastroenteritis) in Children: A Practical Guide
It certainly looks, sounds and smells awful, but vomiting and diarrhea are rarely dangerous.Vomiting, not to be confused with spitting up, is the expulsion of food from the stomach.  Spitting up is more of a laundry problem than a medical problem, and kids who spit up do not become dehydrated.  Diarrhea is a little harder to define, because watery stools are fairly common and most healthy individuals will experience it from time to time for reasons which do not qualify as diarrhea.Frequent stools can be normal too, especially in breast-fed babies, who might dirty the diaper every time they feed, up to 12 times a ...
Source: A Pediatrician's Blog - July 13, 2013 Category: Pediatricians Source Type: blogs

Feeding tubes and weird ideas
My favorie BADD post: Tube-ageddon. I haven't had much time to write anything here about the hell I went through getting my GJ tube. I had every indication for a GJ tube. I had gastroparesis so bad it was starting to affect my breathing, in a way that doctors said was likely to result in infection after infection until I died. From the emergency room onward, doctors were saying my best hope was to get a feeding tube. Yet the pressure I got from doctors, while in the hospital for one of those infections, was to just keep getting infections, go home, wait to die. Most of them wouldn't say that outright. But som...
Source: Ballastexistenz - May 2, 2013 Category: Autism Authors: Amanda Tags: Abuse Autism Bullying Cognitive disability Degradation Developmental disability Disability Rights Discrimination Ethics Ethics, justice, etc. Food Hatred Medical Medical stuff Outside Perceptions Physical disability Power Source Type: blogs

Transdermal Granisetron for Refractory Nausea and Vomiting
Discussion: There were many factors that likely contributed to the dramatic improvement in Ms Emma N’s refractory nausea and vomiting. Better psychiatric care through the palliative care psychologist and psychiatrist almost certainly played a role in her overall clinical turn-around. The close attention, serial visits and supportive counseling she received in the Palliative Care clinic could also have been therapeutic. Up-titration of her olanzapine also likely was helpful. Olanzapine is an atypical antipsychotic that works on multiple receptors including dopaminergic, serotonergic, adrenergic, histaminergic and musc...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 1, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Cases: Transdermal Granisetron for Refractory Nausea and Vomiting
Discussion: There were many factors that likely contributed to the dramatic improvement in Ms Emma N’s refractory nausea and vomiting. Better psychiatric care through the palliative care psychologist and psychiatrist almost certainly played a role in her overall clinical turn-around. The close attention, serial visits and supportive counseling she received in the Palliative Care clinic could also have been therapeutic. Up-titration of her olanzapine also likely was helpful. Olanzapine is an atypical antipsychotic that works on multiple receptors including dopaminergic, serotonergic, adrenergic, histaminergic and musc...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 1, 2013 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs

Dear Diary
My gosh. I actually get angst when I haven’t posted for a few days. Actually, I have angst for other reasons, but not posting just adds to the angst. So what’s been happening lately? First, the poor WhiteCoat children are having trying times in their love lives. Oldest daughter WhiteCoat found out from a member of her track team that her boyfriend of 6 months was cheating on her. Another member of her track team was apparently going around and telling everyone that she had a “secret boyfriend” and was also telling everyone the sordid details of the interactions she was having with her “secret ...
Source: WhiteCoat's Call Room - April 1, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Random Thoughts Source Type: blogs

The LITFL Review 094
Welcome to the awesome 94th edition! 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. The Most Fair Dinkum Ripper Beaut of the Week StEmylns Top spot this week has been smashed by two great post from the StEmylns team! First up we h...
Source: Life in the Fast Lane - February 12, 2013 Category: Emergency Medicine Doctors Authors: Kane Guthrie Tags: Education eLearning Emergency Medicine Featured Health Intensive Care LITFL review LITFL R/V Source Type: blogs

Gray Days
It's been a rough 1.2 weeks. Begun,of course, with a sore throat & a mild cough,moved to the runny nose, followed by the 101 degree fevers & the addition of some hard core throat pain, losing my taste on Super Bowl Sunday,(I did not go to the party & how sad is that,when the whole of Baltimore was stark Raven mad?Methinks it may never happen again ) The cough set in & Sunday night I probably got two hours of sleep. Monday I went to the doc & they gave me codeine syrup & an antibiotic for my "sinus infection." Sinus infection-really? Yep,within a day my head felt like a literal bomb & t...
Source: The D-Log Cabin - February 7, 2013 Category: Diabetes Authors: HVS Source Type: blogs

Hey GSK - what's a weekend boondoggle?
Louisiana attorney general files second suit against GlaxoSmithKline over off-label drug use GlaxoSmithKline allegedly marketed nine drugs illegally for uses that have not been approved by the Food and Drug Administration and provided doctors with "consulting fees," expensive meals and "weekend boondoggles" to convince them to prescribe those brands, according to a lawsuit filed this week by Louisiana Attorney General Buddy Caldwell. These practices cost the state's Medicaid and medical assistance programs millions of dollars and subjected patients to "non-approved, ineffective and unsafe uses&quo...
Source: PharmaGossip - February 7, 2013 Category: Pharma Commentators Authors: insider Source Type: blogs

The LITFL Review 091
Welcome to the in-depth 91st edition! 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. The Most Fair Dinkum Ripper Beaut of the Week  EKG Videos This weeks ripper is taken out by the master of ECG’s Amal Mattu. Each week he puts out...
Source: Life in the Fast Lane - January 15, 2013 Category: Emergency Medicine Doctors Authors: Kane Guthrie Tags: Education eLearning Emergency Medicine Featured Health Intensive Care LITFL review LITFL R/V Source Type: blogs