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Emergency Medicine

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

Research and Reviews in the Fastlane 040
In this study the role of a “1/2 dose” thrombolysis was evaluated for the reduction of pulmonary artery pressure in moderate PE. A total of 121 patients with moderate PE received either tissue plasminogen activator plus anticoagulation or anticoagulation alone with the primary end points of pulmonary hypertension and the composite end point of pulmonary hypertension and recurrent PE at 28 months. The results suggested that the ½ dose or “safe dose” thrombolysis was safe and effective in the treatment of moderate PE, with a significant immediate reduction in the pulmonary artery pressure that was ma...
Source: Life in the Fast Lane - July 21, 2014 Category: Emergency Medicine Authors: Soren Rudolph Tags: Anaesthetics Emergency Medicine Evidence Based Medicine Featured Gastroenterology Haematology Health Infectious Disease Intensive Care Neurology Pre-hospital / Retrieval Respiratory critical care literature R&R in the FASTLANE Source Type: blogs

Bad medical care: Is it better than none at all?
In my past few shifts in the emergency department, I have seen the following patients who were seeking further care after being treated by other providers. One was a child who had been seen twice at an urgent care clinic. He had a fever of 103 degrees and wasn’t eating. The first time he went to the urgent care center, he was diagnosed with an ear infection. He was started on amoxicillin and sent home. He returned to the clinic 8 hours later because he still had the fever and still wasn’t eating. When the clinic provider looked in his mouth, he saw a red rash that appeared to be an allergic reaction. He was therefore c...
Source: Kevin, M.D. - Medical Weblog - July 21, 2014 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

Safeguarding Children in Emergencies through Ethical Pediatric Research
Tomorrow, the Presidential Commission for the Study of Bioethical Issues (Bioethics Commission) will present its recommendations on pediatric medical countermeasure (MCM) research at the 10th Annual Pediatric Bioethics Conference in Seattle. The conference, hosted by the Treuman Katz Center for Pediatric Bioethics at the Seattle Children’s Hospital, takes place July 18 and 19, 2014; its […] (Source: blog.bioethics.net)
Source: blog.bioethics.net - July 18, 2014 Category: Medical Ethics Authors: Alannah Kittle Tags: Health Care Human Subjects Protection Medical Countermeasures syndicated Source Type: blogs

Subacute AnteroSeptal STEMI, With Persistent ST elevation and Upright T-waves
DiscussionWhen there is full thickness infarction, there is epicardial inflammation (post-infarction regional pericarditis), and the myocardium is at risk of "rupture."  The term "rupture" makes it sound like some sort of explosion or massive blowout, but it is usually a small, slow leak that, over time, can cause tamponade and death.  Rupture can be either free wall rupture (causing tamonade) or septal rupture, causing ventricular septal defect with left to right flow and resulting pulmonary edema and shock.  If detected early by ultrasound, the patient can be saved.  Our own Dave Plummer of HCMC repor...
Source: Dr. Smith's ECG Blog - July 18, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs

Paul Light on Government Failure
Chris Edwards Paul Light of Brookings and NYU is a top expert on the federal bureaucracy. He has a new study on federal government failures over the 2001 to 2014 period. Light’s paper is useful. He identifies 41 major federal failures, examines the reports completed on each, and classifies the types of mistakes that took place. From the 9/11 terrorist attacks to the recent veterans health care scandal, Light points to failures in both “operations” and “oversight.” Certainly, government operations and oversight fail frequently. But I look at many of Light’s 41 events and see more fundamental failures than he do...
Source: Cato-at-liberty - July 16, 2014 Category: American Health Authors: Chris Edwards Source Type: blogs

Conducting research without the consent of the research subject
A new study poses one of the most vexing ethical questions concerning research with human beings: When is it acceptable to conduct research without the consent of the research subject? In emergency situations, patients often arrive at the hospital unconscious or with severely impaired decision-making capacity. Progress in medical practice depends on results from carefully designed research; yet in these emergency cases such patients are unable to fulfill one of the basic ethical requirements for research—the ability to consent. Continue reading ... Your patients are rating you online: How to respond. Manage your online ...
Source: Kevin, M.D. - Medical Weblog - July 16, 2014 Category: Journals (General) Authors: Tags: Education Emergency Source Type: blogs

The LITFL Review 144
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 144th 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 - July 16, 2014 Category: Emergency Medicine Authors: Kane Guthrie Tags: Education eLearning Featured Health Intensive Care LITFL review LITFL R/V Source Type: blogs

Coming down on The Night Shift
I've been reviewing episodes of NBC's The Night Shift for EPMonthly. Specifically, I took the pilot, then episodes 5-8, while Dr. Aaron Bright handled episodes 2, 3 and 4.It's not a good show. The plot twists are predictable. The characters are mostly caricatures. Worst of all, to me, is that the medicine is awful - it's absolutely impossible for an emergency physician to say, "We manage patients like that," or "That's what my job is like."But I understand there are fans of the show. A lot of them. And they may want a collection of our medical impressions. So, here you go:Episode 1 - PilotEpisode 2 - "Second Chances"Episod...
Source: Blogborygmi - July 16, 2014 Category: Emergency Medicine Authors: Nick Genes Source Type: blogs

Acute and emergency care: prescribing the remedy
This report contains the consensus recommendations of this summit. It lists recommendations to address the challenges and to build safer, more effective and efficient urgent and emergency care services for all patients. Report The College of Emergency Medicine - news (Source: Health Management Specialist Library)
Source: Health Management Specialist Library - July 16, 2014 Category: UK Health Authors: The King's Fund Information & Knowledge Service Tags: Patient safety Quality of care and clinical outcomes Regulation, governance and accountability Source Type: blogs

Why the ER is a mixed blessing for society
We live in an incredible age. Life expectancies continue to rise. The environment in the U.S. is cleaner than it has ever been. The sum of the world’s knowledge is at the fingertips of any and every smartphone user, waiting to be accessed when they finish playing Candy Crush. The face of poverty in America is still terrible to behold; but it bears little resemblance to poverty down the long march of human history. We fight wars, but they are (so far) distant from our endlessly entertained shores. All in all, it’s a pretty good time to be alive in America. Continue reading ... Your patients are rating you online: How t...
Source: Kevin, M.D. - Medical Weblog - July 15, 2014 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

Healthcare Update Satellite — 07-14-2014
Practicing telemedicine may just get a whole lot easier. Federation of State Medical Boards creating an interstate “compact” that would reduce barriers by providing an “expedited license” to physicians who wish to practice medicine in multiple states. The physician has to establish a state of “principal license” and then may apply to the “Interstate Commission” to receive a license in another state after the “applicable fees” have been paid. The hundreds of dollars per year paid to each state to maintain licensure don’t appear to be one of the barriers that ...
Source: WhiteCoat's Call Room - July 15, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Research and Reviews in the Fastlane 039
Welcome to the 39th edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature. This edition contains 13 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R project or check out the f...
Source: Life in the Fast Lane - July 14, 2014 Category: Emergency Medicine Authors: Soren Rudolph Tags: Anaesthetics Cardiology Emergency Medicine Emergency Medicine Update Featured Infectious Disease Intensive Care Pre-hospital / Retrieval Resuscitation critical care literature R&R in the FASTLANE recommendations research and revi Source Type: blogs

One Page First Aid Guides for Parents and Caregivers
From Allergic Reactions to Warts, KidsHealth has one page first aid guides for 50 common childhood accidents and illnesses.  Parents, grandparents, babysitters and other caregivers can bookmark the page and be ready to respond to (almost) any mishap. One Page First Aid Guides (KidsHealth): http://bit.ly/1mCtws9 What to Include in Your First Aid Kit (KidsHealth): http://bit.ly/1sfiEDy (Source: BHIC)
Source: BHIC - July 14, 2014 Category: Databases & Libraries Authors: Kate Flewelling Tags: Children and Teens Emergency Preparedness Source Type: blogs

CCC update 006
The LITFL Critical Care Compendium is a living resource built around the knowledge base needed for the FCICM exam, but extends far beyond those conservative boundaries. Here is a quick summary of what is new and what has been significantly revised: Brain impact apnoea A still neglected cause of morbidity and mortality in traumatic brain injury (TBI) that mandates immediate prehospital intervention. Apnoea – along with catecholaminergic surge – is part of the ‘critical phase’ of TBI. This condition inspired the GoodSam app. We recently discussed this in RAGE Session Four. Chylothorax You don’t see it o...
Source: Life in the Fast Lane - July 14, 2014 Category: Emergency Medicine Authors: Chris Nickson Tags: Critical Care Compendium Emergency Medicine Featured Intensive Care Brain impact apnoea CCC chylothorax digibind digoxin toxicity Haemophagocytic lymphohistiocytosis (HLH) Intrinsic PEEP Sleep in ICU Speaking up Source Type: blogs

A medical student speaks up and saves a life
Recently, I was on call for surgery at a hospital in New York City. At 2 a.m. in the morning, we were paged to a trauma in the ED. After we stabilized the patient and moved him for CT scans and x-rays, I noticed a small stretcher tucked away in the back part of the ED, a place typically reserved for overflow patients when we run out of rooms. 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 - July 12, 2014 Category: Journals (General) Authors: Tags: Education Emergency Medical school Source Type: blogs

Medicine is like blackjack: Physicians need to count cards
In the game of blackjack, players will attempt to increase their odds of winning by using the frowned upon method of counting cards. Then basic principle is to add or subtract points to the cards dealt under the believe that the cards remaining in the deck are more or less likely to give the player a winning hand. Not a guarantee, of course, just trying to tip the odds in the players favor. 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 - July 11, 2014 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

Washington Wakes Up To Socioeconomic Status
John Mathewson, executive vice president of Health Care Services for Children with Special Needs (HSC) – a Medicaid managed care plan in D.C. for children on Supplemental Security Income (SSI) – recently spoke at the Association for Community Affiliated Plans (ACAP) CEO Summit before the July 4 Recess. Mathewson described what he has dubbed The Kitten Paradox: When HSC examined environmental factors for children with asthma, it found that the presence of pets in the house was a common thread, not too far behind having a smoker around. Yet, it turns out the value a cat brings by protecting from mice or spawning a litte...
Source: Health Affairs Blog - July 11, 2014 Category: Health Management Authors: Billy Wynne Tags: Access All Categories Disparities Environmental Health Health Reform Medicaid Medicare Nonmedical Determinants Policy Public Health Quality Source Type: blogs

The Price of Compassion - Commercialized Hospices and the Mistreatment of Vulnerable Patients
Introduction - Commercialized Hospices We have occasionally written about the rise of the commercialized hospice industry, and concerns that commercialized hospices may not be providing the compassionate care they promise.  As we have discussed before, the hospice movement began with small, non-profit, community based organizations meant to provide compassionate palliative care to the terminally ill.  However, in the US, the hospice movement has been co-opted by commercial hospices, often run by large corporations, which may put profit ahead of compassion.Several long investigative articles have appeared this yea...
Source: Health Care Renewal - July 10, 2014 Category: Health Management Tags: Carlyle Group deception Fillmore Partners Gentiva Golden Living HCR ManorCare hospices marketing private equity Vitas Source Type: blogs

TechTool Thursday 055 Sensitivity and Specificity
TechTool review Sensitivity and Specificity by Jolis Biotech on Android and iOS Sensitivity and Specificity is an app by Dr Jolis and his colleagues, which does exactly what it says on the tin. It provides you with stats information for using blood tests, imaging, and other signs & symptoms to diagnosis disease. If you’re wondering why that would be useful, you need to check this app out. The database is huge. Website: – Android –  iTunes - Website Design It has a nice icon and splashscreen, but otherwise there’s nothing too wild to report about the design. It’s clear, readable and there were no p...
Source: Life in the Fast Lane - July 10, 2014 Category: Emergency Medicine Authors: Tessa Davis Tags: Android Application Education Emergency Medicine Featured iOS Reviews Tech Tool Source Type: blogs

Research and Reviews in the Fastlane 038
This study, however, has major flaws and biases that question the validity of their conclusions. Only 19% of centers that were contacted agreed to contribute data to the Consortium. Additionally, the researchers do not assess the quality of the studies included in their meta-analysis. Regardless, observational data should not be used to trump the RCT data included in the recent, Cochrane review. Finally, Roche pharmaceuticals was a major sponsor of this research team. The accompanying editorial is a must-read. Recommended by: Anand Swaminathan Infection Control, Hand hygiene D’Egidio G et al. A study of the ...
Source: Life in the Fast Lane - July 10, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Anaesthetics Cardiology Emergency Medicine Featured Infectious Disease Intensive Care Neurology Palliative care R&R in the FASTLANE Radiology Resuscitation Trauma critical care literature recommendations research and reviews Source Type: blogs

New York Caps Uber “Surge” Pricing
Peter Van Doren Yesterday the New York attorney general reached a deal with the company Uber to cap its “surge” pricing during emergencies. The company, which uses an app to summon cars via a user’s smartphone, uses an algorithm that increases prices during periods of high demand, including emergencies and bad weather, to encourage more of its drivers to work. The agreement was reached in accordance with the City of New York’s law against price gouging, passed in 1979.   Was the agreement a good idea?  In the cover story of the Spring 2011 issue of Regulation, Texas Tech researcher Michael Giberson exami...
Source: Cato-at-liberty - July 9, 2014 Category: American Health Authors: Peter Van Doren Source Type: blogs

The LITFL Review 143
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 143rd 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 - July 9, 2014 Category: Emergency Medicine Authors: Kane Guthrie Tags: Education eLearning Emergency Medicine Featured Health Intensive Care LITFL review LITFL R/V Source Type: blogs

US healthcare, wait times and the truth…
It’s time for another post on truth and healthcare. (This almost sounds like a good series.) I’ve recently written that the VA healthcare system represents the truth—and that Americans should get over the Pollyanna-view that triage, wait lists, and taking care of increasing numbers of increasingly sick patients can be managed with magic. The truth to be discussed in this post is that long wait times and challenging access to care is already here. And that such is normal. If you have been a patient lately, you may already know this. One of the most common e-notes I get from my medical assistant reads like this: “Ref...
Source: Dr John M - July 9, 2014 Category: Cardiology Authors: Dr John Source Type: blogs

A simple act of kindness in the ER
As an emergency physician used to working in busy, urban ERs, I like to think that I’m not easily surprised. The other day, someone did something that really amazed me. Our patient was a young woman who had a headache and requested medications to take it away. On an average ER shift, we see dozens of patients with similar complaints to hers. On busy days, the evaluation and treatment become rote: take a history, do a physical exam, administer treatment, fill out paperwork, and so on and so forth. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide...
Source: Kevin, M.D. - Medical Weblog - July 8, 2014 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

Quick Visit
A mother brought her son to the emergency department with a rather non-emergent complaint … chapped lips. The registration clerk started taking the registration information. “Can I get the patient’s name and date of birth please?” “Yes, it’s Johnny …” The clerk got distracted by the patient who first licked his lips, then smacked his lips, then rubbed his finger back and forth over his lips. “You know, you shouldn’t do that. That’s probably why your lips are so irritated.” Back to the mother. “His name is Johnny Smith. His date of birth …&...
Source: WhiteCoat's Call Room - July 8, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs

Where's the Annual Social Security Report?
Jagadeesh Gokhale House Speaker John Boehner (R-Ohio) has announced his intention to sue President Obama for “failure to faithfully follow the nation’s laws” by taking extra-legal executive actions in some areas and failing to execute the laws in other areas such as immigration, judicial appointments, health care, foreign affairs, and so on. One area where he’s failing to execute the law is Social Security. For instance, the President and his leadership have repeatedly failed to publish on time the Annual Report of the Social Security Trustees, the yearly description of the program’s finances and future ...
Source: Cato-at-liberty - July 7, 2014 Category: American Health Authors: Jagadeesh Gokhale Source Type: blogs

Investing In The Social Safety Net: Health Care’s Next Frontier
Editor's note: In addition to Jennifer DeCubellis, Leon Evans also coauthored this post.  The United States spends 250 percent more than any other developed country on health care services, yet we are ranked below 16 other countries in overall life expectancy. A less frequently discussed statistic, however, is the degree to which the U.S. under-invests in social services: for every dollar spent on health care, only 50 cents is invested in social services. In comparison, other developed countries spend roughly $2 on social services for every dollar spent on health care. The U.S. is 10th among developed countries in its co...
Source: Health Affairs Blog - July 7, 2014 Category: Health Management Authors: Jennifer DeCubellis Tags: All Categories Chronic Care Health Care Costs Health Reform Medicaid Nonmedical Determinants Payment Policy Source Type: blogs

Webinar-From Hurricanes to Pandemics: Helping Practices Prepare for the Worst
From the American Academy of Pediatrics: “From Hurricanes to Pandemics: Helping Practices Prepare for the Worst Date: Friday, July 18, 2014 Time: 12:00 PM – 1:00 PM CDT Description: This one hour Webinar is geared toward the primary care provider who works in an office setting. The Webinar will offer general preparedness strategies and ideas for how pediatricians and their office staff can prepare for disasters. Tips will be shared on how pediatricians can work to improve preparedness in families with children with special health care needs, as they are more vulnerable in disasters. The Webinar will also assist...
Source: BHIC - July 7, 2014 Category: Databases & Libraries Authors: Kate Flewelling Tags: Children and Teens Emergency Preparedness Source Type: blogs

CDC Blast Injury Mobile Application
A new iPad and iPhone app from the Centers for Disease Control helps hospital and pre-hospital personnel assess and treat injuries from explosions. Learn more and download the app: http://1.usa.gov/1qDE9vY (Source: BHIC)
Source: BHIC - July 7, 2014 Category: Databases & Libraries Authors: Kate Flewelling Tags: Emergency Preparedness Public Health Source Type: blogs

On Call
Every ER has its call roster, that sacred list of oracles, laying out who we can call when our patients need some service that we cannot provide. If I need a cardiologist, or a neurosurgeon or even a dermatologist for some acute emergency condition, all I need to do is ring up the operator and tell them, “This is the ER doc, I need [insert name of specialty here].” And like magic, ten minutes later, I’m talking to the local expert in whatever the patient has.Fun fact: in the last month, I have consulted both physiatry and rheumatology from the ER.So I was a little surprised recently when I had a patient with a nine-m...
Source: Movin' Meat - July 7, 2014 Category: Emergency Medicine Source Type: blogs

Reducing hospital readmissions from the emergency department
All of the focus that CMS is putting on hospital readmissions via the Readmissions Reduction Program, and the financial penalties that readmissions can generate, is causing hospital administrators to look to the emergency department and emergency physicians to intervene and resolve the issues that interrupt recovery for post-hospitalization patients. 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 - July 6, 2014 Category: Journals (General) Authors: Tags: Policy Emergency Hospital Source Type: blogs

Conflicting state versus federal incentives confuse doctors
I get paid by Medicaid to see patients. How much? Exactly $52.28 if it is an easy patient issue, like a cold, and $78.54 for a harder one, like a kidney stone. Who decides when the issue is easy and when it is hard? I do. But I have to follow some complex rules when deciding whether to bill a 99213 (a level 3, or easier visit) vs a 99214 (a level 4, or harder visit). If I can bill a level 4 instead of a level 3, I get paid $26.26 (about 50%) more, so it is in my interest to turn simple problems into harder ones. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A soci...
Source: Kevin, M.D. - Medical Weblog - July 4, 2014 Category: Journals (General) Authors: Tags: Policy Emergency Medicare Source Type: blogs

Supreme Court Grants Cert In Wartime Suspension of Limitations Act Case
Walter Olson Should courts allow the federal government to ignore time deadlines for filing suit on the grounds that there’s a war on, even though it’s been 70 years since the end of the war on which such a delay was premised? On Tuesday the U.S. Supreme Court granted certiorari in a case raising that question, Kellogg Brown & Root Services, Inc. v. United States ex rel. Carter. I wrote about the issue last year; an excerpt: War is the health of the state,” wrote Randolph Bourne a century ago—from the special war taxes that can linger for a century, to the mohair subsidy program from Korean ...
Source: Cato-at-liberty - July 3, 2014 Category: American Health Authors: Walter Olson Source Type: blogs

Point of care (POC) cardiac troponin testing
Point of care testing of cardiac biomarkers is being increasingly used in the emergency care setting to enhance the triaging of patients presenting with chest pain and or breathlessness. Of these point of care troponin testing is being increasingly used. In one of these methods, fluorescence labeled detector antibody in a test cartridge [Kim TK et al. Point-of-Care Fluorescence Immunoassay for Cardiac Panel Biomarkers. J Clin Lab Anal. 2014 Mar 20. doi: 10.1002/jcla.21704]. The intensity of fluorescence at test and control lines on the strip were obtained using a laser fluorescence scanner to measure the concentration of t...
Source: Cardiophile MD - July 3, 2014 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Non invasive blood pressure (NIBP) monitoring
NIBP Non invasive blood pressure (NIBP) monitoring is now common place in intensive care units and emergency departments. Most cardiac monitors also incorporate NIBP in addition to electrocardiographic (ECG) and pulsoximetry (SpO2) monitoring. Automatic measurements can be made at programmable preset interval. Measurement can also be initiated manually at the bedside when additional measurements are needed. Most NIBP monitors use the oscillometric method of blood pressure measurement. The device automatically inflates the cuff and measures the blood pressure while deflating it. Systolic, diastolic and mean values are dis...
Source: Cardiophile MD - July 3, 2014 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

Preventing nightmares: A guide for medical students and residents
Nobody likes waking up in the middle of the night gasping for air. When you make a mistake in the emergency department, that’s exactly what happens. They come in all sorts of shapes and colors: The sixty-year-old man diagnosed with a strained lower back muscle who comes back with a ruptured abdominal aortic aneurysm. The fifty-four-year-old Hispanic female with generalized malaise who goes into cardiac arrest from a missed myocardial infarction. The two-year-old with gastroenteritis who returns to the ER the next day with a ruptured appendix. Continue reading ... Your patients are rating you online: How to respond. Ma...
Source: Kevin, M.D. - Medical Weblog - July 2, 2014 Category: Journals (General) Authors: Tags: Physician Emergency Malpractice 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 Y...
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 037
Conclusion: Use of an age-adjusted d-dimer threshold reduces imaging among patients age <50 years with a Revised Geneva Score ≤ 10. While the adoption of an age-adjusted d-dimer threshold is probably safe, the confidence intervals surrounding the additional 1.5% of PE that was missed using an age-adjusted threshold necessitate a prospective study before this practice can be adopted into routine clinical care. Recommended by: Salim R. Rezaie,  Jeremy Fried Read More: The Adventure of the Golden Standard (Rory Spiegel) Resuscitation Wik L et al. Manual vs. integrated automatic load-distributing band CPR with equal ...
Source: Life in the Fast Lane - July 2, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Anaesthetics Cardiology Emergency Medicine Featured General Surgery Health Infectious Disease Intensive Care Neurology Neurosurgery Radiology Resuscitation Trauma critical care literature R&R in the FASTLANE recommendations Source Type: blogs

One Way to Cure a Drug Seeker’s Back Pain
A gentleman in his 40s limped into the emergency department for evaluation of severe back pain. He had a chronic history of back pain, but had decided to forgo recommended surgeries because he was told that there was a chance his pain could worsen. He reportedly had multiple MRIs in the past … all of which showed “severely” bulging discs. He also just moved to the area the evening prior to his visit. In all of the excitement and heavy lifting, he strained his back, he couldn’t find his pain medications, AND he lost his wallet. That meant he had no ID and he couldn’t remember his address becaus...
Source: WhiteCoat's Call Room - July 1, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs

The LITFL Review 142
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 142nd 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 - July 1, 2014 Category: Emergency Medicine Authors: Kane Guthrie Tags: Education eLearning Emergency Medicine Featured Health Intensive Care LITFL review LITFL R/V Source Type: blogs

Spanish FOAM
Approximately 414 million people speak Spanish as a native language, making it second only to Mandarin in terms of its number of native speakers worldwide. There are more than 500 million Spanish speakers as a first or second language, and 20 million students of Spanish as a foreign language. With the help of native Spanish speakers such as Gabriel Heras la Calle we are updating the Spanish FOAM section of the EMCC blog page and the Spanish feeds hosted on FOAMEM. Tendiendo puentes y no levantando muros – #FOAMes Gabi, with his Humanizing Intensive Care Project along with other Spanish language based critical...
Source: Life in the Fast Lane - July 1, 2014 Category: Emergency Medicine Authors: Mike Cadogan Tags: Education eLearning EMCC Emergency Medicine Featured FOAM FOAMed Concha Zaforteza Cosas del PAC Gabriel Heras la Calle Humanizing Intensive Care Manrique Umana Reanimación REANYMA Spanish FOAM Spansih Urgencias Bidasoa Source Type: blogs

Have a conversation with your family about the end of life
I recently talked about how we might approach the idea of our own death. I wanted to start a discussion about how individuals engage with, think about and plan for the end of their life. In offering a medical perspective on what death is like, I hoped to stimulate self-reflection about this scary and foreign topic. However, when we think about death, we don’t just think about our own death; we also have to consider how those we love might pass away. This is something the medical system doesn’t prepare us for, and I hope to shed some light on this topic with this article. Continue reading ... Your patients are rating y...
Source: Kevin, M.D. - Medical Weblog - June 30, 2014 Category: Journals (General) Authors: Tags: Physician Emergency Palliative care Source Type: blogs

Pulsoximetry (SpO2) tracing
It is common to monitor the pulsoximetry tracing in all emergency departments, intensive care units and operation theaters now-a-days. It gives an instantaneous measure of the oxygen saturation and guides management. Early detection of a fall in oxygen saturation often helps in preventive measures which often avert a crash in the hemodynamic status. The plethysmograph is obtained usually by keeping the sensor on the index finger and connecting it to the bedside monitor. In the tracing shown above, the oxygen saturation is displayed as 94% and the heart rate as 72/minute. A good tracing indicates intact blood flow to the f...
Source: Cardiophile MD - June 30, 2014 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs

The Omega Man?
I wrote recently that I was losing no more than an hour of sleep each night over the prospect of a horrific global pandemic, mostly because we supposedly know what we are doing more so than the medieval folks who were decimated by the Black Death.Well, maybe, but three essays in the new BMJ should give us pause. The problem is that scientific understanding of infectious disease isn't enough if we don't have global mechanisms for putting that knowledge to work in an emergency. I think you'll only get the first paragraphs, but it isn't hard for me to hit the high points for you.First, Ilona Kickbusch (yeah yeah) and Mathias ...
Source: Stayin' Alive - June 30, 2014 Category: American Health Source Type: blogs

French Kevorkian Acquitted, Just Like Jack
Nicolas Bonnemaison is a French doctor who actively ended the lives of seven terminally ill patients on their request. Bonnemaison, a former emergency room doctor, was accused of "poisoning particularly vulnerable people" – five women and two men who died between March 2010 and July 2011. Like the multiple Michigan juries that acquitted Jack Kevorkian, this week, a French jury acquitted Bonnemaison of all charges. Jurors accepted Bonnemaison’s argument that he had not “played God” but  had taken medically justified decisions to curtail the agony of patients who had only a short time t...
Source: blog.bioethics.net - June 27, 2014 Category: Medical Ethics Authors: Thaddeus Mason Pope Tags: Health Care medical futility blog syndicated Source Type: blogs

TechTool Thursday 054 Resus Code Apps
TechTool review Code Apps for iOS – multiple developers For most of us, full-blown resuscitations are the most exciting and terrifying parts of our job. Someone is always allocated to be the scribe – but are there any apps that can make this job easier? I’ve been having a look at apps for keeping track of resus situations – specifically which drugs are given when, and general resus progress. I assumed there would be hundreds of these apps out there, but when it came down to it, I could only find a few that fitted the bill. Here I compare three iOS apps for this purpose: Full Code Pro by American Heart ...
Source: Life in the Fast Lane - June 27, 2014 Category: Emergency Medicine Authors: Tessa Davis Tags: Application Education eLearning Emergency Medicine Equipment / Technology Featured Health Informatics iOS iPad iPhone App Reviews TechTool code apps Code CPR Code Runner Full Code Pro Resus TechTool Thursday Source Type: blogs

My professional college beclowns itself
A fisking of a paranoid, ill-considered and frankly stupid idea a 9th grader would be ashamed to put forth. From the American College of Emergency Physicians ‘leadership’. ACEP Clarifies Campaign Rules By James M. Cusick, MD, FACEP Chair, Candidate Forum Subcommittee of the ACEP Council ACEP is a member-driven organization with a representative body of our peers – the ACEP Council – chosen through component bodies, including our chapters (1 representative per 100 members), our Sections of Membership, and other aligned organizations. There follows some boilerplate language designed to get you to tune out. No...
Source: GruntDoc - June 26, 2014 Category: Emergency Medicine Authors: GruntDoc Tags: Policy Rants Source Type: blogs