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This page shows you the most recent publications within this specialty of the MedWorm directory.

Split Decision
These days I divide my time between clinical and consulting work.   in my consulting job I work as a medical command physician for ambulances, helicopters and airlines needing advice and direction on all sorts of medical emergencies. For the past several months I have been fielding several calls a day regarding screening for *possible* Ebola patients wanting to board a plane or currently in the air and suddenly developing symptoms. Of all of those phone calls…only one of them had recent travel in Liberia and originated from a West African airport.  All of the rest were from random passengers that vomited, or had di...
Source: Mr. Hassle's Long Underpants - October 30, 2014 Category: Emergency Medicine Authors: Doc Shazam Tags: Uncategorized Ebola Source Type: blogs

Pulse Dose Pressors for Children and Adults
The three videos presented this month demonstrate the technique for mixing and administering pulse dose epinephrine with actual patients. Particularly helpful is the one that demonstrates the administration of pulse dose epinephrine to a pediatric patient. What I really like about the demonstrated pediatric technique (first discussed in my Emergency Medicine News blog on anaphylaxis: http://bit.ly/1CHsX6h) is that it uses the same 1:100,000 concentration used for adults. And, the 0.1 mL/kg is easily remembered because it is the same mL/kg recommendation for the ACLS concentration of epinephrine. There is essentially nothin...
Source: M2E Too! Mellick's Multimedia EduBlog - October 30, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Health Affairs Web First: Vietnam’s Health Care System, Explained By Its Minister Of Health
In August, Vietnam’s Minister of Health, Nguyen Thi Kim Tien, was interviewed for Health Affairs by Tsung-Mei Cheng, recently released as a Health Affairs Web First. Among the topics discussed was an overview of the unique characteristics of Vietnam’s health system; its strengths and weaknesses; health financing reform aimed at reaching the goal of universal health coverage; the prevention and control of infectious diseases; and how Vietnam has performed in achieving the Millennium Development Goals. Cheng is a health policy research analyst at the Woodrow Wilson School of Public and International Affairs, Princeton U...
Source: Health Affairs Blog - October 30, 2014 Category: Health Management Authors: Chris Fleming Tags: All Categories Global Health Public Health Source Type: blogs

Stay Safe This Halloween
Halloween is a time when ghosts and goblins of all ages go out to play. Before your night turns dark and stormy, keep this in mind:  Stick with apple cider and soda or pop. Binge drinking alcohol can lead to lead to some very scary outcomes. Alcohol in any amount is dangerous for teens to drink because it can change the developing brain (which is why it is illegal). But binge drinking—five or more drinks for guys and four or more for girls—has the potential for more immediate terrors—it contributes to alcohol poisoning and car crashes. Need some stats? In 2010, approximately 189,000 emergency rooms visits were for...
Source: NIDA Drugs and Health Blog - October 30, 2014 Category: Addiction Authors: The NIDA Blog Team Source Type: blogs

Grad Student Invents Flying Ambulance Drone To Deliver Emergency Shocks
Drones have been used to kill people in war zones and to spy on people. Now a sharp young  graduate student in the Netherlands has come up with an innovative new use for drones that could one day help save thousands of lives. Click here to read the full post on Forbes. [youtubevid id="y-rEI4bezWc"]       (Source: CardioBrief)
Source: CardioBrief - October 29, 2014 Category: Cardiology Authors: Larry Husten Tags: Heart Rhythms People, Places & Events Policy & Ethics AEDs Cardiac arrest defibrillators drones sudden cardiac death Source Type: blogs

The Ebola quarantine: Is 21 days enough?
A few weeks ago an emergency room doctor called our infectious disease physician group concerning a patient who had returned from Liberia and was having nausea and vomiting. Several of the patient’s family members had died of Ebola. As panic struck us, our decisive question was: When did he return from Liberia? The Centers for Disease Control and Prevention guidelines for screening and isolating patients for possible Ebola infection are clear: Any person who is presenting with symptoms (which include fever, headache, vomiting and stomach pain) along with a history of travel to West African countries including Liberia, G...
Source: Kevin, M.D. - Medical Weblog - October 29, 2014 Category: Journals (General) Authors: Tags: Conditions Infectious disease Source Type: blogs

Health Affairs Briefing: Collaborating For Community Health
Policymakers are paying increasing attention to the relationship between the characteristics of communities and the health of the people living in them. The November 2014 issue of Health Affairs, “Collaborating For Community Health,” examines new possibilities created by alignment of the fields of health and community development. These possibilities come from both sides, including recent changes in the community development field that have set the stage for the new focus on improving health, as well as new approaches to health care financing that create incentives for improving health outcomes. You are invited...
Source: Health Affairs Blog - October 29, 2014 Category: Health Management Authors: Chris Fleming Tags: All Categories Health Philanthropy Nonmedical Determinants Public Health Source Type: blogs

Grand-Aides And Health Policy: Reducing Readmissions Cost-Effectively
Hospital readmissions for the same condition within 30 days likely should not occur, and most often indicate system failure. Readmitted patients are either discharged too early, should be placed into palliative care or hospice, or most often are victims of a failure in transition of care from hospital to home. Most hospitals and physicians would like to eliminate such readmissions, particularly now that payers like Medicare are penalizing hospitals for high rates of readmission. Numerous approaches have been tried to reduce readmissions, with recent published improvements between a 2 percent and 26 percent reduction. The G...
Source: Health Affairs Blog - October 29, 2014 Category: Health Management Authors: Arthur Garson Tags: Access All Categories Health Care Costs Health Care Delivery Hospitals Payment Quality Workforce Source Type: blogs

SMACC Chicago Registration is coming…
The programme for SMACC Chicago is now online for all to see. It has been a real joy to work on this — the opportunity to bring together the best people in critical care, to talk about the best topics in critical care, is one to be relished. We have assembled an awesome lineup — both behind the scenes to build the fire, and front stage to light it… as you will see in the programme. Most importantly, registrations are opening very soon: 0800h November 6th (AEST). Check out the ICN post titled SMACC Chicago Rego Opens 5 November for equivalent opening times throughout the world’s time zones, and some importa...
Source: Life in the Fast Lane - October 29, 2014 Category: Emergency Medicine Authors: Chris Nickson Tags: Emergency Medicine Intensive Care SMACC Social Media programme registration smacc chicago Source Type: blogs

Ebola And EHRs: An Unfortunate And Critical Reminder
The Dallas hospital communication lapse that led to the discharge of a Liberian man with Ebola symptoms is an example of the failure of the American health care system to effectively share health information, even within single institutions. It is not possible to know whether a faster response would have saved Thomas Eric Duncan’s life or reduced risk to the community and health workers. What is clear is that rapid sharing of information is one of the elements critical to halting the spread of Ebola. Had all members of the initial care team known of the patient’s recent arrival from an Ebola-stricken country and acted ...
Source: Health Affairs Blog - October 28, 2014 Category: Health Management Authors: Lara Cartwright-Smith, Jane Hyatt Thorpe, and Sara Rosenbaum Tags: All Categories Emergency Medicine Global Health Health IT Hospitals Policy Public Health Technology Source Type: blogs

Lessons from Ebola: The Infectious Disease Era, And The Need To Prepare, Will Never Be Over
With the wall-to-wall news coverage of Ebola recently, it’s hard for many to distinguish fact from fiction and to really understand the risk the disease poses and how prepared we are to fight it. Fighting infectious diseases requires constant vigilance. Along with Ebola, health officials around the globe are closely watching other emerging threats: MERS-CoV, pandemic flu strains, Marburg, Chikungunya and Enterovirus D68. The best defense to all of these threats is a good offense — detecting, treating and containing as quickly and effectively as possible. And yet, we have consistently degraded our ability to respond...
Source: Health Affairs Blog - October 28, 2014 Category: Health Management Authors: Jeffrey Levi Tags: All Categories Global Health Hospitals Pharma Policy Prevention Public Health Research Workforce Source Type: blogs

The LITFL Review 154
The LITFL Review is 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. Welcome to the 154th edition, brought to you by: Anand Swaminathan [AS] (EM Lyceum, iTeachEM) Brent Thoma [BT] (BoringEM and Academic Life in EM) Chris Connolly [CC] Chris Nickson [CN] ( iTeachEM, RAGE, INTENSIVE and SMACC) Joe-Anthony Rotella [JAR] Kane Guthrie [KG] Mat Goebel [MG] Segun Olusany...
Source: Life in the Fast Lane - October 28, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Education LITFL R/V Source Type: blogs

Research and Reviews in the Fastlane 055
This study demonstrates a higher success rate (100% vs. 88%) and lower pneumothorax rate (0% vs. 5%) in comparing ultrasound guided versus landmark technique for placement. Although the ultrasound guided method may be technically difficult to learn and take some time investment, that time is repayed in the shorter time to accessing the vessel and lower complication rate. Recommended by: Anand Swaminathan Emergency medicineRosen P. The biology of emergency medicine. JACEP. 1979 Jul;8(7):280-3. PubMed PMID 449164 Peter Rosen has called this ‘the only good article I have ever written’. This is Rosen’s rati...
Source: Life in the Fast Lane - October 28, 2014 Category: Emergency Medicine Authors: Soren Rudolph Tags: Anaesthetics Clinical Research Emergency Medicine Intensive Care Neurology Resuscitation Trauma critical care Education literature R&R in the FASTLANE recommendations Research and Review Source Type: blogs

18 hours of intermittent chest pressure
A male in his 60's with no previous cardiac history complained of substernal chest pain intermittently for 18 hours.  It has more recently become constant.  He was diaphoretic.  He called 911 and had this prehospital ECG recorded:I saw this when he arrived, and was worried about the slight ST depression in V2 and the size of the T-waves in V5 and V6, as well as the minimal terminal T-wave inversion in aVL and a bit of ST depression there.We recorded this immediately:The same findings are here, without any evolution.BP was 140/80.His pain continued and would be relieved from 8/10 to 6/10 with sublingual nitro...
Source: Dr. Smith's ECG Blog - October 28, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs

Ordinary People
Cheryl loved to dance.  There wasn't a time in our house when the the kids weren't jumping up and down on the furniture, the radio blasting, and her body swaying in rhythm.  Ironically, we were dancing when it happened.  It was her fortieth birthday.  The kids laughed and clapped as I dipped her dramatically and she sprung back into my arms.  And then she crumpled.  Tony, my youngest, giggled hysterically thinking it was a ruse.  I clutched at her lifeless body, all muscle tone was lost.It was the emergency room physician who first used the word "stroke".  But what does a plumber kno...
Source: In My Humble Opinion - October 28, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs

Ebola and the psychology of contagious disease
A month ago I published a post predicting that paramedics, emergency nurses, and emergency physicians would be exposed to patients with Ebola and have difficulty picking out these patients from the many other patients who present to the ED with similar symptoms. In light of the events in Dallas, Texas, this seems prophetic, but it is really not so difficult to explain (despite the finger-pointing from a horde of outraged reporters and their experts); and it points to one reason why it may not be so easy to control Ebola as it migrates into the U.S. and other developed countries. I am not trying to hype the danger here,...
Source: Kevin, M.D. - Medical Weblog - October 27, 2014 Category: Journals (General) Authors: Tags: Physician Infectious disease Source Type: blogs

An Innovative Approach to Stroke & Aphasia Recovery: Part 1, Life Participation
Here’s the scenario:  A 51 year-old woman is having the worst headache she has ever experienced.  Let’s call her Linda.  She is concerned and decides to lie down to see if it subsides.  Alone in the bedroom, she experiences a stroke.  She is conscious but cannot move her right side and cannot call out for help.  Her husband, let’s call him Jim, finds her, recognizes that something is terribly wrong and calls 9-1-1. She is taken to the local hospital; the immediate question posed in the emergency room, “What time did symptoms occur?”  Jim does not know and Linda cannot answer.  She has been diagnosed as ha...
Source: Disruptive Women in Health Care - October 27, 2014 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Advocacy Women's Health Source Type: blogs

Be a Friend to Man’s Best Friend: Keep Marijuana Away from Your Dog
As more communities allow medical marijuana, or decriminalize illicit marijuana, veterinarians are seeing an alarming trend. More and more dogs are arriving in emergency animal hospitals with marijuana toxicosis, or marijuana poisoning. A recent study in Colorado showed that 4 times as many dogs were treated for marijuana poisoning in 2010 than in 2005. Sadly, two dogs identified in that study died. Similarly, from 2008 to 2013, the Pet Poison Helpline—a poison control hotline for animals—has seen a 200% increase in calls related to pets eating marijuana. Most times, dogs ingest marijuana accidentally by eating a marij...
Source: NIDA Drugs and Health Blog - October 27, 2014 Category: Addiction Authors: The NIDA Blog Team Source Type: blogs

Ebola presents a new paradigm from the ER
Ebola is frightening but not for the reason you may imagine. A little over a year ago Asiana Flight 214 crashed while landing at San Francisco International Airport resulting in 181 injuries and 3 deaths.  As an emergency medicine resident, this fast-forwarded my training as I took care of many of the patients arriving in our emergency department.  I left that day inspired that I had the education and training to provide great care to those in need and was proud to be part of a larger medical community that performs at the highest level.  But what became most reassuring was that the health care system largely worked.  ...
Source: Kevin, M.D. - Medical Weblog - October 26, 2014 Category: Journals (General) Authors: Tags: Physician Emergency Infectious disease Source Type: blogs

An interdisciplinary approach to hospital malnutrition
Hendersonville, North Carolina may not have a Mayo Clinic that is known for medical innovation, but it is making waves in solving a stubborn problem in health care: malnutrition. Pardee UNC Health Care is implementing a new nursing protocol that puts nutrition at the center of the care team and the locus for reducing readmissions, pressure ulcers and lengths of stay. Pardee’s efforts come as more and more studies document the seriousness of the malnutrition problem: One in three Americans is malnourished upon admission to the hospital. And that may be an underestimate. A new study in the Annals of Emergency Medicine find...
Source: Kevin, M.D. - Medical Weblog - October 25, 2014 Category: Journals (General) Authors: Tags: Conditions Hospital Source Type: blogs

Helicopter emergency services: A disparity between aviation and medical proficiency
As the helicopter emergency services (HEMS) industry enters its fifth decade, there is an 800-pound gorilla in the room and nobody is talking.  The average EMT, fireman and emergency physician too often make the flawed assumption that when it comes to HEMS, the industry is a uniform, high quality, strictly regulated entity.  They assume that all HEMS programs use state of the art aircraft flown by well trained, experienced pilots. They assume all medical crews are the best of the best in their vocations receiving recurrent specialty training in the ICUs, ORs and EDs of regional hospitals. Continue reading ... Your patie...
Source: Kevin, M.D. - Medical Weblog - October 25, 2014 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

Ebola virus arrives in New York City
This morning I received this email from President Lee Bollinger: Dear fellow members of the Columbia community: As you may have seen in the media, Dr. Craig Spencer is being treated for Ebola at Bellevue Hospital in Manhattan. Dr. Spencer, an emergency department physician at NewYork-Presbyterian/Columbia University Medical Center, recently returned from a humanitarian mission with Doctors Without Borders to one of the outbreak areas in Western Africa. We admire and appreciate all of those willing to do this vital and selfless public health work around the globe. It’s critical to bear in mind what our public health and i...
Source: virology blog - October 24, 2014 Category: Virology Authors: Vincent Racaniello Tags: Basic virology Information columbia university Ebola ebolavirus filovirus hemorrhagic fever New York City viral Source Type: blogs

Do Doctors Have a Duty to Treat Patients With Ebola?
[Huffington Post] Now that two nurses treating Ebola victim Thomas Eric Duncan have themselves been diagnosed with the disease, it is time to ask: Do doctors, nurses and other healthcare professionals have a duty to treat patients? What of the unsung healthcare “workers” — hazmat teams, EMTs, transporters who wheel stretchers, lab techs who test […] (Source: blog.bioethics.net)
Source: blog.bioethics.net - October 24, 2014 Category: Medical Ethics Authors: Brittany Rush Tags: Health Care Public Health ebola emergency preparedness Infectious Diseases Risk Exposure & Bioethics Social Matters syndicated World News - Home World News - News Source Type: blogs

Tax-Exempt Status For Nonprofit Hospitals Under The ACA: Where Are The Final Treasury/IRS Rules?
Months have now stretched into years, and there still remains no sign of final Treasury/IRS regulations interpreting the Affordable Care Act (ACA)’s provisions covering the expanded obligations of nonprofit hospitals that seek tax-exempt status under §501(c)(3) of the Internal Revenue Code. The ACA amendments do not depend on formal agency policy to take effect. Nonetheless, Congress directed the Treasury Secretary to issue regulations and guidance necessary to carry out the reforms (26 U.S.C. §501(r)(7)). To this end, two important sets of proposed rules were issued: the first in June, 2012; and the second, in April ...
Source: Health Affairs Blog - October 23, 2014 Category: Health Management Authors: Sara Rosenbaum Tags: All Categories Disparities Health Law Health Reform Hospitals Medicaid Nonmedical Determinants Policy Prevention Public Health States Source Type: blogs

Save a Life Makes Final Round in Challenge
Save a Life is a finalist in the Chicago Open Innovation Challenge, in which several people with innovative ideas are competing for $25,000 in grant funding.     Save a Life helps instructors verify CPR competency through Google Glass that guides and tracks proper technique based on visual and auditory prompts. The education tool also has a built-in tool that assists with calling for help, and provides objective metrics on compression rate, rhythm, and depth. The program works by accessing the wearable sensors (gyroscope/accelerometer) in Google Glass to help students achieve metrics through audio and visual feedback in ...
Source: Technology & Inventions - October 23, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Introduction to Special Series on Stroke: World Stroke Day, Women & Stroke, and the Stroke Comeback Center
Today, Disruptive Women in Health Care begins a special week-long series to raise awareness of stroke in recognition of World Stroke Day, providing opinion and actionable information, and joining in the celebration of 10 successful years of the Stroke Comeback Center in Vienna, VA. October 29, 2014 is World Stroke Day and the launch of a 2-year, world-wide campaign, I am woman: Stroke affects me, sponsored by the World Stroke Organization (WSO) and supported by national organizations like the American Stroke Association (ASA).  Women have a higher risk of stroke than men, a higher mortality rate from stroke than men, have...
Source: Disruptive Women in Health Care - October 23, 2014 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Advocacy Women's Health Source Type: blogs

Passport Stamped for the Land of Pain: Learning to Live in a Foreign Land
The following post originally ran on the Pain Action Alliance to Implement a National Strategy’s (PAINS) website. For many years, my passport was stamped in the land of the well, but a poor response to oral surgery in 2013 cancelled that document, leaving me in the land of the sick, the suffering, the other. While I was a well-one, I’d hear stories from that other country—and listen as best I could when others told tales of their visits– but I did not know what it truly meant to live there all the time. Learning to live in another country is hard work. There are unfamiliar customs to understand, a language to l...
Source: Disruptive Women in Health Care - October 22, 2014 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Chronic Conditions Consumer Health Care Women's Health Source Type: blogs

Healthcare Update Satellite — 10-21-2014
This study makes a good case for requiring orthopedic evaluation in the emergency department for every pediatric patient suffering from any type of bone or joint injury – regardless of the time of day or night. What no one is telling you about Ebola … from a Hazmat Trained Hospital Worker. The gear used to protect providers from Ebola is difficult to put on, difficult to remove, and can usually only be worn for 30 minutes at a time. The medical providers in Dallas who contracted Ebola had no protocols in place and this author believes that the “system failed them.” Patients apparently believe that b...
Source: WhiteCoat's Call Room - October 21, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Judy Faulkner and EPIC, Show us your EHR screens
At "Congressional committee releases timeline detailing how Presbyterian treated Ebola patient Thomas Eric Duncan", Dallas News, Oct. 17, 2014 there is a link that provides acccess to documents released by the U.S. House of Representatives' Energy and Commerce Committee.These documents address the EHR issues in the care of Ebola patient Thomas Duncan I wrote of 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) and others: Congressional committee releases timeline...
Source: Health Care Renewal - October 21, 2014 Category: Health Management Tags: Dallas News Ebola virus EPIC healthcare IT risk Robert Wilonsky Texas Health Presbyterian Hospital Source Type: blogs

When treating neo-Nazis, should physicians have a choice?
What I found most disturbing about the man’s arm was not the deep, stellate laceration on the underside of his biceps. It was the swastika tattoo next to it. “Sir,” I said, “we’ll have you fixed up in no time. I’m going to numb up the wound, irrigate it, then repair the laceration with sutures and send you home on antibiotics and pain medication. The nurse will update your tetanus shot. But before I start, I need to point out that I find your tattoo offensive.” Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source:...
Source: Kevin, M.D. - Medical Weblog - October 21, 2014 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

Quantified health and the great digital divide
Go into any hospital today and notice that between every great nurse and patient sits a computer terminal. The quantified health movement has created the great digital divide, between the patient and everyone else. The nurse of old used to actually touch the patient. No more. Now, they wheel in a computer console, sit down and record the digital output of the wired up patient, every vital sign, every drug order or scheduled procedure. It’s the same with doctors’ rounds. Groups of doctors place a mobile computer between themselves and the patient and stand around talking about the numbers. Continue reading ... Your p...
Source: Kevin, M.D. - Medical Weblog - October 21, 2014 Category: Journals (General) Authors: Tags: Physician Emergency Health IT Source Type: blogs

Research and Reviews in the Fastlane 054
Conclusions Wrong? (emlitofnote) Critical Care, CardiologyGuyton AC. Regulation of cardiac output. Anesthesiology. 1968; 29(2): 314-26. PMID: 5635884 The modern emphasis on echo might make you think that the heart determines cardiac output. This classic paper by Guyton shows that unless the heart is failing, it has a permissive role in determining cardiac output. The real determinants are (1) the degree of vasodilation of the peripheral vasculature, especially veins, and (2) the filling of the circulatory system, indicated by the mean systemic filling pressure. Gotta love those Guyton curves! Recommended by: Chris Nick...
Source: Life in the Fast Lane - October 20, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Cardiology Clinical Research Education Emergency Medicine Infectious Disease Intensive Care Neurology Neurosurgery Obstetrics / Gynecology Orthopedics Pediatrics Trauma critical care literature R&R in the FASTLANE recommendat Source Type: blogs

Enrolling College Students In Health Insurance: Lessons From California (Part 1)
Editor’s note: As we approach the beginning of the second open enrollment period under the Affordable Care Act, Walter Zelman describes an effort he led during last year’s initial open enrollment period to enroll students in the California State University (CSU) system in coverage. Part 1 below provides background on the CSU system and the enrollment effort, the CSU Health Insurance Education Project, as well as a discussion of what worked well. Part 2, which will appear tomorrow, addresses what worked less well, as well as project results, lessons and policy implications, and next steps. In addition to Zelman,...
Source: Health Affairs Blog - October 20, 2014 Category: Health Management Authors: Walter Zelman Tags: All Categories Consumers Coverage Health Reform Insurance Policy States Source Type: blogs

“@MDaware: common misnomer – most emergency “rooms” are actually peninsulas”
“@MDaware: common misnomer – most emergency “rooms” are actually peninsulas” Related posts: Did she see the jacket yet? “@MDaware: LittleAware is nonplussed about joining the Cobra Kai pic.twitter.com/QCZXc7WloT” Did she see the jacket yet? “@MDaware: LittleAware is nonplussed... @doconskis @mdaware @cbsdfw @aceofspadeshq Defining illness down. Think ‘prehypertension’. @doconskis @mdaware @cbsdfw @aceofspadeshq Defining illness down. Think ‘prehypertension’.... @monashanaes @ketaminh @MDAware hardest hit @monashanaes @ketaminh @MDAware hardest hit... YARPP powered by ...
Source: GruntDoc - October 20, 2014 Category: Emergency Medicine Authors: admin Tags: Medical Source Type: blogs

The LITFL Review 153
The LITFL Review is 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. Welcome to the 153rd edition, brought to you by: Anand Swaminathan [AS] (EM Lyceum, iTeachEM) Brent Thoma [BT] (BoringEM and Academic Life in EM) Chris Connolly [CC] Chris Nickson [CN] ( iTeachEM, RAGE, INTENSIVE and SMACC) Joe-Anthony Rotella [JAR] Kane Guthrie [KG] Mat Goebel [MG] Segun Olusany...
Source: Life in the Fast Lane - October 20, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Education LITFL R/V Source Type: blogs

Working in an ER in Liberia: A physician shares his story
In June 2014, the first patient with Ebola arrived at Liberia’s county hospital, Redemption. As tensions grew around the city of Monrovia, administrators at JFK Hospital began to devise plans for handling patients with suspected Ebola. Officials from the CDC then came and gave us lectures. They discussed prevention of spreading and what our plans would be in the event of a potential outbreak. Before that moment, there were no clear plans for what to do if a patient presented with symptoms of Ebola. No plans for isolation. No plans for treatment. To make matters worse, the scarcity of gowns, gloves, and personal protectiv...
Source: Kevin, M.D. - Medical Weblog - October 20, 2014 Category: Journals (General) Authors: Tags: Physician Emergency Infectious disease Source Type: blogs

Thomas Frieden And The U.S. Ebola Response
On Friday, October 17, the White House named Ron Klain the new Ebola czar. This move followed a storm of criticism in the media, on Capitol Hill, and elsewhere. The criticism focused on the multiple mistakes made by the U.S. agencies and Texas Health Presbyterian Hospital in Dallas in the weeks since Thomas Eric Duncan, infected with Ebola, arrived in the United States on September 19. Duncan set off a disturbing train of events that included secondary infections of two nurses, Nina Pham and Amber Vinson, along with the lingering threat of additional infections. That threat widened rapidly over the course of this past week...
Source: Health Affairs Blog - October 20, 2014 Category: Health Management Authors: J. Stephen Morrison Tags: All Categories Global Health Politics Prevention Public Health Source Type: blogs

Axis: Bold As Love
Axis determination is one of the most common ECG topics that I see junior doctors (and some senior doctors!) struggling with. Hopefully this tutorial will clear things up…   ECG Axis Determination The diagram below illustrates the relationship between QRS axis and the frontal leads of the ECG. Image reproduced from Chung   Normal Axis = QRS axis between -30 and +90 degrees. Left Axis Deviation = QRS axis less than -30 degrees. Right Axis Deviation = QRS axis greater than +90 degrees. Extreme Axis Deviation = QRS axis between -90 and 180 degrees (AKA “Northwest Axis”). There are several complem...
Source: Life in the Fast Lane - October 20, 2014 Category: Emergency Medicine Authors: Edward Burns Tags: Cardiology ECG Emergency Medicine axis deviation EKG LAD rad Source Type: blogs

The striking parallels between warfare and emergency departments
Preface: I love to write about many things. People, pets, children, family, nature. But over and over I come back to a theme: my colleagues in our specialty and the forces arrayed against us. I’m not trying to be the toxic voice, the endless complainer. But if people like me don’t beat the drum, then nothing will ever change for the better. In this column I will continue to explore issues of physician satisfaction, I am reminded of a lecture I attended during residency. Let me set the stage. During residency I was also a flight surgeon in the Indiana Air National Guard. This was during Operation Desert Storm, although ...
Source: Kevin, M.D. - Medical Weblog - October 18, 2014 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

Running a code is a team sport
“They need you in room 13,″ she said when I answered the phone and I ran back to the ICU.  The patient was coding and for each minute that felt like an hour, we tried, and failed, to save her.  She wasn’t breathing, her heart wasn’t working, and despite the 30 people gathered in the room, in the end, she died. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - October 18, 2014 Category: Journals (General) Authors: Tags: Physician Emergency Hospital Source Type: blogs

There is no excuse for physicians to take advantage of vulnerable patients
Patients are being stuck with huge and unexpected medical care bills in circumstances where they have no say in selecting the physician who is billing them, and no way for them to know in advance which services the physicians would render or what it would cost them, says the New York Times. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - October 18, 2014 Category: Journals (General) Authors: Tags: Policy Emergency Health reform Source Type: blogs

How did a Dallas hospital miss Ebola? Maybe we shouldn’t be surprised.
The first “wild” Ebola case in the United States has occurred in Dallas, Texas. The patient, who is from Liberia and had contact with a pregnant Ebola victim in his native country, was initially sent away from the emergency department (ED) of a Dallas hospital after reporting there with viral symptoms. He told the triage nurse that he had just arrived from Liberia, but despite this was sent home. How could this happen? Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - October 17, 2014 Category: Journals (General) Authors: Tags: Conditions Emergency Hospital Infectious disease Source Type: blogs

Teaching Health Centers: An Attainable, Near-Term Pathway To Expand Graduate Medical Education
We describe a near-term and attainable pathway to expand GME that could gain consensus among these stakeholders. This approach would sustain and expand Teaching Health Centers (THCs), a recent initiative that directly funds community-based GME sponsoring institutions to train residents in primary care specialties, dentistry and psychiatry. We further propose selectively expanding GME to meet primary care and other demonstrable specialty needs within communities, and building in evaluations to measure effectiveness of innovative training models. Our proposal includes: Congressional reauthorization and funding of the THC GM...
Source: Health Affairs Blog - October 17, 2014 Category: Health Management Authors: Richard Rieselbach, Paul Rockey, Thomas Nasca, Kathleen Klink, Robert Phillips, Malcolm Cox, David Sundwall, John Frohna, and Katherine Neuhausen Tags: All Categories Disparities Health Care Costs Health Reform Hospitals Medicaid Medicare Physicians Policy Politics Primary Care Veterans Workforce Source Type: blogs

Time to set some heads a-rollin'
I still maintain that ebola virus is a very minor public health concern in the United States, it is a very big public health concern in west Africa and possibly eventually elsewhere; and it is a very big threat to the global economy and to U.S. politics. But . . .We will never persuade the American people or the ignoramuses in the corporate media that our attention and our resources should be focused on west Africa, not Kennedy Airport, if it does not appear absolutely and transparently true that our medical and public health infrastructure is fully competent to protect us. And no, it doesn't look like that. The medical di...
Source: Stayin' Alive - October 17, 2014 Category: American Health Source Type: blogs

Think big, act now: creating a community of care
This report sets out NHS Alliance’s position with regard to the future of general practice and primary care. It recommends a new approach to health care with general practice at scale at its centre and an extended primary care team incorporating community pharmacy, community eye care, housing and emergency services radiating out from it. It also makes the case for a fundamental shift in the way in which we all view and access the NHS, and the requirement for dedicated and appropriate funding to support this transformation. Report NHS Alliance - press release (Source: Health Management Specialist Library)
Source: Health Management Specialist Library - October 16, 2014 Category: UK Health Authors: The King's Fund Information & Knowledge Service Tags: Developments in primary and community care Source Type: blogs

Nurse Nina Pham is a hero: Stop blaming her
The director of the Center for Disease Control (CDC) in Atlanta, Georgia apologized for implying that the nurse in Texas was responsible for her own infection with the deadly Ebola virus. This comes less than two weeks after hospital officials from Texas Health Presbyterian Hospital and other prominent officials blamed a different nurse for releasing the patient with Ebola from the emergency department possibly causing an Ebola outbreak. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - October 15, 2014 Category: Journals (General) Authors: Tags: Conditions Infectious disease Source Type: blogs

Ebola in Texas: A fascinating story of system errors
Ebola is in the United States!  Everybody (please don’t) panic!  Quarantine all Texans!  Though that might be a good idea anyway (just kidding).  More on Ebola in general in another post if I have time. First off though, we’ve found out more information about the sequence of events leading to the hospitalization of the patient, Thomas Duncan.  Apparently, he came to the hospital, told people he’d come back from Liberia, and was still discharged home.  He was only admitted 2 days later when his nephew called the CDC.  The tale reveals a fascinating story of medical quality and system error. Contin...
Source: Kevin, M.D. - Medical Weblog - October 15, 2014 Category: Journals (General) Authors: Tags: Conditions Emergency Hospital Infectious disease Source Type: blogs

Research and Reviews in the Fastlane 053
This study combines the results from the WARFASA and ASPIRE trials looking at aspirin prophylaxis. The results are promising. Aspirin 100 mg reduced the rate of recurrent VTE from 7.5%/year to 5.1%/year (HR = 0.68) without a significant change in bleeding rate (0.5%/year vs 0.4%/year). We often see patients in the ED with a history of unprovoked VTE who are on no long-term prophylaxis. This article argues that we consider aspirin for all these patients. Recommended by: Anand Swaminathan Trauma Stevens AC, Trammell TR, Billows GL, Ladd LM, Olinger ML. Radiation Exposure as a Consequence of Spinal Immobilization and Extri...
Source: Life in the Fast Lane - October 14, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Alternative Medicine Anaesthetics Cardiology Education Emergency Medicine Haematology Intensive Care Neurology Pediatrics R&R in the FASTLANE Respiratory Resuscitation Toxicology and Toxinology Trauma critical care literature Source Type: blogs

An ER missed Ebola. Here’s how it could happen to you.
How did the emergency department staff of a Texas hospital see, and discharge, a patient infected with Ebola? Despite the fact that blame spreads through hospitals faster than hemorrhagic fever viruses, I’m not interested in pinning down a single person, or a single thing, which may have allowed that to happen. I am very interested, however, in offering a few insights into what combination of factors might make it easy to send home a West African with a fever, without establishing the fact that he had a dangerous, contagious disease which finally caused his death. Continue reading ... Your patients are rating you online...
Source: Kevin, M.D. - Medical Weblog - October 14, 2014 Category: Journals (General) Authors: Tags: Physician Emergency Infectious disease Source Type: blogs