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Funtabulously Frivolous Friday Five 105
Question 1Rodney Dangerfield, the comedian, attends your emergency department. Complete his presenting complaint  “I drink too much. The last time I gave a urine sample it had…“?Reveal Answerexpand(document.getElementById('ddet114141590'));expand(document.getElementById('ddetlink114141590'))…an olive in itQuestion 2If one orders a Brompton’s cocktail, what might one get?Reveal Answerexpand(document.getElementById('ddet383681379'));expand(document.getElementById('ddetlink383681379'))Non-commercial hospital grade analgesic/sedativeMore commonly known as Brompton’s mixtureIt contains the...
Source: Life in the Fast Lane - November 28, 2014 Category: Emergency Medicine Authors: Neil Long Tags: Frivolous Friday Five Brompton cocktail chocolate survival FFFF Rapa Nui Rapamycin Rhabdophis tigrinus yamakagashi Source Type: blogs

Even if no life was saved, an ER physician makes a difference
I walk out of the patient room.  My eyes stare at the computer screen.  I’m behind, way behind.  I roll my head on my neck.  My neck feels tense, and I have a headache.  It’s been a long week.  I need a vacation.  Hurry up, click-click-click this computer, I think to myself.  Dammit, is this EMR really freezing up again? 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 - November 26, 2014 Category: Journals (General) Authors: Tags: Physician Cancer Emergency Source Type: blogs

Research and Reviews in the Fastlane 059
This study looked at national survey data from 2009-2010 of patients >18 y/o presenting to the ED (n=44,448 visits) and found that cardiac enzyme testing was performed in 16.9% of visits, including in 8.2% of visits lacking ACS-related symptoms (which includes things like nausea, vomiting, abdominal pain, dyspnea, etc). This begs the question, why then, was a troponin (or ck-mb) ordered? It’s probably not changing management. In an era in which we’re discovering that there are harms to downstream testing, this study calls out just how trigger happy we may be. As more sensitive cardiac assays are used, this m...
Source: Life in the Fast Lane - November 26, 2014 Category: Emergency Medicine Authors: Jeremy Fried Tags: R&R in the FASTLANE airway brain failure critical care Emergency Medicine General Surgery hypothermia Intensive Care prehospital recommendations Review Trauma Source Type: blogs

An elderly man with severe chest pressure......
This was sent to me by a medical student:The patient is an elderly man with no significant past medical history who developed what he describes as chest tightness throughout his anterior precordium, 9/10 in severity, associated with nausea, vomiting, diaphoresis and shortness of breath, lasting for greater than 2 hours, that started while he was lifting firewood. His symptoms did not go away with rest. He presented to his primary care physician's office. An EKG was recorded at 135 minutes after pain onset:There is no old ECG for comparison.  What do you think?He was treated with sublingual nit...
Source: Dr. Smith's ECG Blog - November 26, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs

ACO Update: An Opportunity for CME?, Challenges Ahead
Conclusion Dr. Pelzman ends his article by noting that when money enters the picture of care and becomes too significant of a presence, it has the potential to take physicians away from the most important goal: caring for patients. If ACOs are to benefit patients, he argues they must ensure for evidence-based care to prevent unnecessary emergency room visits, prevent patients from doctor-shopping, and keep them within systems where caregivers can better take care of patients. Dr. Pelzman acknowledges there is a business side to healthcare—ultimately someone is responsible for the bottom line—but when that becomes too m...
Source: Policy and Medicine - November 26, 2014 Category: American Health Authors: Thomas Sullivan Source Type: blogs

Exhibit Of The Month: Maps Tell Powerful Stories About Children, Neighborhoods, And Possible Policy Solutions
Editor’s note: This post is part of an ongoing “Exhibit of the Month” series. Readers who’d like to highlight other noteworthy exhibits from the same issue are encouraged to make their pitch in the comments section below. Maps and health have been powerfully intertwined since nineteenth-century British physician John Snow produced a hand-drawn map that famously showed a correlation between the locations where cholera was killing hundreds of Londoners during an 1854 epidemic and the Broad Street pump where locals unknowingly drew water contaminated with the deadly bacterium. Fast-forward to the twenty-first century...
Source: Health Affairs Blog - November 25, 2014 Category: Health Management Authors: Larry Wheeler Tags: All Categories Children Disparities Exhibit of the Month Nonmedical Determinants Source Type: blogs

When the art of medicine gets lost in the business
Andy was new to me. He told me he had seen several doctors over the past few years for various pains in his right arm. Some months ago, he had right shoulder pain that went away on its own, but for the past few weeks, he had pain in the middle of his upper arm. Last year he had tennis elbow and forearm pain for many months. 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 - November 25, 2014 Category: Journals (General) Authors: Tags: Physician Emergency Primary care Source Type: blogs

Public Relations and the Obfuscation of Management Errors - Texas Health Resources Dodges its Ebola Questions
Our last posts about how revenue focused, generically managed US health care (non) system would have difficulty handling the threat of the Ebola virus were in mid-October, 2014.  Yet since then we have learned little about what went wrong when a single hospital dealt with the first Ebola patient to present de novo in the US, and two of the hospital's own nurses who acquired the infection caring for him.  So since we have not learned all we should about our first brush with Ebola, there is still reason to worry that things may not go better should another person be unlucky enough to show up at a US health care fac...
Source: Health Care Renewal - November 24, 2014 Category: Health Management Tags: Ebola virus public relations Texas Health Presbyterian Hospital Texas Health Resources Source Type: blogs

Chandler Assessment of the Sick Child
My first registrar post in Australia was in a mixed ED with children. The most common question I statement I encountered was ‘I’m not sure if this child needs to come into Hospital’. I use the CHANDLER assessment tool to highlight potential red flags for paediatric admission. If 2 of the major groups are seen, the child should be strongly considered for admission and Paediatric specialist involvement. CHANDLER C – Colour Pale- perhaps dehydrated Blue- cyanosed, hypoxic, hypothermic Red- Rash, Burn, infection Pink- healthy H – Hydration status Moderate dehydration (4-6% loss) Capillary refill time ...
Source: Life in the Fast Lane - November 24, 2014 Category: Emergency Medicine Authors: Johnny Iliff Tags: Pediatrics CHANDLER sick child Source Type: blogs

Litfl Review 157
Welcome to the 157th 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 Delayed Sequence Intubation (DSI) has been part of the FOAM critical care armamentarium for years. Now, the evidence is published in the traditional literature. Scott discusses the article (Open Access Article for a limited time) and how DSI can ...
Source: Life in the Fast Lane - November 24, 2014 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review LITFL R/V Source Type: blogs

An Argument With No Clear Winner
“You’re going to the hospital.” “I’m NOT going to the hospital. There’s nothing they’d do and it would cost us thousands of dollars for nothing. Besides … we have to leave. We’re already late.” A husband was attempting to attach the family’s camper onto the trailer hitch of the family’s truck when the trailer slipped. His middle finger didn’t make it out of the way and got caught between the ball of the trailer and the top of the hitch. When family members helped him pull the camper back off of the hitch, they saw a lot of blood. Then the last portion of his middle finger dropped from inside the t...
Source: WhiteCoat's Call Room - November 23, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs

(Dis)comfort measures
Close to midnight and Tonya is somnolent, lying on an emergency department (ED) stretcher and not in her own bed at home. The change in location alters the fairy tale quality of the word somnolent from sleepy or drowsy to one that’s more sinister and worrisome. Especially when Tonya is dying of brain cancer, a single mother of thirty-four, a hospice patient now situated in the ED; a space powered by a rescue instinct when faced with a patient with rapid breathing and a sinking blood pressure. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media g...
Source: Kevin, M.D. - Medical Weblog - November 23, 2014 Category: Journals (General) Authors: Tags: Physician Cancer Emergency Source Type: blogs

Post operative cardiac arrhythmias
Post operative cardiac arrhythmias are a major cause of morbidity and mortality, more so following surgery for congenital heart disease. Tolerability of arrhythmia is less in the postoperative period than for similar arrhythmia in the preoperative period. Hemodynamic instability is more likely due to the possibility of myocardial dysfunction. Cardiopulmonary bypass, injury to the conduction system during surgery, metabolic and electrolyte abnormalities, especially hypokalemia and hypomagnesemia contribute to the increased incidence of postoperative arrhythmias. Stress of the surgery with enhanced sympathetic tone and use ...
Source: Cardiophile MD - November 23, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiac Surgery ECG / Electrophysiology Source Type: blogs

Vaccine-Injured Child Stolen by the State and Her Caring Mother Accused of Child Abuse
Conclusion For many years, I have been writing about such cases. There are now a growing number of parents who have been falsely accused of harming their vaccine-damaged children. Sadly, this case is yet another example. Loving, caring parents are having their children taken away from them because the majority of health care professionals and social workers are burying their heads in the sand and choosing to ignore the fact that no vaccine or medication is one hundred percent safe. All vaccines have the potential to cause adverse reactions. When you have such groups as the AAPS stating, “And yet, children under the age o...
Source: vactruth.com - November 22, 2014 Category: Allergy & Immunology Authors: Christina England Tags: Christina England Top Stories Child Protective Services (CPS) Hepatitis B vaccine Kathryn Hughes medical kidnapping Michael Belkin seizure Source Type: blogs

Why Do We Advocate for Rejuvenation Research?
Yesterday, I had occasion to spend six hours or so in the emergency room of a medical center largely focused on treating serious conditions that are most prevalent in old people. A part of that experience by necessity involved listening to the comings, goings, and conversations of those present. These are not private places: they are typically divided visually by screens but with no way to avoid overhearing the staff and patients. The people there are generally not too concerned about privacy in the immediate sense in any case, having far more pressing matters to focus upon. So, by proxy, one gets to experience small and...
Source: Fight Aging! - November 21, 2014 Category: Research Authors: Reason Tags: Activism, Advocacy and Education Source Type: blogs

Research and Reviews in the Fastlane 058
This study (n=60) randomized patients in the ED getting IV opioids to morphine (0.1 mg/kg) + placebo or morphine (0.1 mg/kg) + ketamine (group 1 0.15 or group 2 0.30 mg/kg). Patients in the ketamine arm had significantly decreased pain without significant adverse effects, although the group with the higher dose of ketamine had a seeming increase in side effects without added analgesic benefit. The literature is mounting that low dose ketamine has utility in the acute analgesia armamentarium but selecting the right population will likely be key (and more is not better). Recommended by: Lauren Westafer Further Listening: Cli...
Source: Life in the Fast Lane - November 20, 2014 Category: Emergency Medicine Authors: Soren Rudolph Tags: Education R&R in the FASTLANE Review Source Type: blogs

Police officers’ risk of sudden cardiac death is 34-69 times higher during restraints or altercations
This BMJ study found that police officers’ risk of sudden cardiac death (SCD) was 34 to 69 times higher during restraints or altercations; 32 to 51 times higher during pursuits; 20 to 23 times higher during physical training; and 6 to 9 times higher during medical or rescue operations, as compared with routine or non-emergency activities. The researchers also found that SCD accounts for up to 10% of all U.S. on-duty police deaths.References:Law enforcement duties and sudden cardiac death among police officers in United States: case distribution study. BMJ 2014; 349 doi: http://dx.doi.org/10.1136/bmj.g6534 (Published 18 N...
Source: Clinical Cases and Images - Blog - November 20, 2014 Category: Universities & Medical Training Tags: BMJ Cardiology Stress Source Type: blogs

We owe it to our patients to put on our game faces
When you walk into the emergency room to see a trauma patient, do you remind yourself as you enter the doors, “Keep your game face on?” When you finish a difficult surgery and make your way to the waiting area to review the prognosis with the family, do you tell yourself, “Take a deep breath. You can do this?” When you steel yourself to tell one of your favorite patients some seriously bad news, do you silently whisper, “It’s going to be OK?” Yeah. Me, too. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social media guide. Find out how. (Source: Kev...
Source: Kevin, M.D. - Medical Weblog - November 20, 2014 Category: Journals (General) Authors: Tags: Physician Emergency Surgery Source Type: blogs

What I'm about to say
I'm appearing on a panel tonight at our great university, entitled "Doctors reading race: how conceptions of race shape medical care." Since you probably can't attend, here's the sneak preview.When I first began to study this issue, 15 or 20 years ago, there were quite a few influential studies that identified disparities in physicians' treatment decisions based on patients' race or ethnicity. For example, Latino patients with long bone fractures were less likely to be prescribed opioids in emergency departments. Doctors were less likely to take a sexual history from adolescent white adolescent girls presenting with abdomi...
Source: Stayin' Alive - November 19, 2014 Category: American Health Source Type: blogs

Chest Pain and Right Bundle Branch Block
A male in late middle age with a history of RCA stent 8 years prior complained of chest pain.  EMS recorded the following ECG:What do you see?  The computer read "Right Bundle Branch Block"There is RBBB and LAFB, which can make it difficult to see the end of the QRS.  I have annotated it here:The lines mark the end of the QRS and beginning of the ST segment.  In RBBB, there should be no ST elevation, or minimal.  In fact, V1-V3 should have some ST depression and T-wave inversion.  Here you can see abnormal (diagnostic) ST elevation and an upright T-wave in V2-V3, with diagnostic ST elevation i...
Source: Dr. Smith's ECG Blog - November 19, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs

OIG Releases Annual “Top Management and Performance Challenges” Facing the Department of Health and Human Services
Yesterday, the Office of Inspector General released their annual summary of the most significant management and performance challenges facing the Department of Health and Human Services (HHS). The 2014 Top Management and Performance Challenges lists ten issues reflecting continuing vulnerabilities that OIG has identified for HHS over recent years as well as new and emerging issues that HHS will face in the coming year. For each category, OIG outlines the challenge, the progress that has been made regarding the challenge, and recommendations they offer going forward. Our coverage highlights a number of the challenges that O...
Source: Policy and Medicine - November 19, 2014 Category: American Health Authors: Thomas Sullivan Source Type: blogs

Strange Bedfoes Against NSA Reform Bill
Julian Sanchez The push to rein in the authorities of the National Security Agency—covertly expanded by a secret court to permit indiscriminate bulk collection of Americans’ communications  and financial records—has become a truly bipartisan affair. In a way, this is nothing new: Liberals who recall the abuses of the Hoover era have long teamed with conservatives skeptical of government power in efforts to check excessive surveillance.  With a Senate vote looming to move forward with the USA FREEDOM Act, however, a still stranger mix of opponents is seeking to block what has emerged as the primary vehicle ...
Source: Cato-at-liberty - November 18, 2014 Category: American Health Authors: Julian Sanchez Source Type: blogs

Take Heart Australia
Guest Post by Professor Paul Middleton, emergency physician and founder of Take Heart Australia I have spent the last 20 years practicing emergency medicine on the ground and in the air. I have attended countless cardiac arrests both in hospital and the pre-hospital setting; performed compressions on hundreds of chests; sent countless joules of energy through wobbling hearts, and squirted buckets of adrenaline into cannulae, IO needles and ET tubes…but I still have an empty feeling inside – I know we can do better. We hear about cardiac arrest all the time, and as clinicians working in emergency medicine and cr...
Source: Life in the Fast Lane - November 18, 2014 Category: Emergency Medicine Authors: Mike Cadogan Tags: Cardiology Pre-hospital / Retrieval Website Chain of survival OOHCA Paul Middleton Professor Paul Middleton Take Heart Take Heart Australia Source Type: blogs

The religion of emergency medicine: It’s time for a reformation
Emergency medicine, like every specialty, is it’s own religion. And on many levels, it tracks right along with the progression of religions from their ancient origins to their modern incarnations. Our unique profession grew out of a pressing need for physicians who could provide immediate and life-saving care to the sick and injured, at all hours of the day or night. The goals of our early practitioners and advocates, our “patristic” and “matristic” founders was to ensure that we did the right research, trained in the right skills and brought them to a nation and world in dire need of high quality...
Source: Kevin, M.D. - Medical Weblog - November 18, 2014 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

LITFL Review 156
Welcome to the 156th 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 Is clot retrieval in ischemic stroke the next development? Caution in allowing one marginally positive study to change practice. Rory Spiegel implores us to study our past mistakes (NINDS-2) so as to avoid repeating them. [AS] Master your manageme...
Source: Life in the Fast Lane - November 17, 2014 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review LITFL R/V Source Type: blogs

Run your emergency department like a restaurant
Imagine you walk into a restaurant named Luigi’s. From the décor and the smell of pasta sauce coming from the kitchen, you assume that this restaurant serves Italian food. You walk forward, your name is taken and you are then told to sit off to the side and wait until your name is called so that you can get a table. Time goes by, and no one gives you any eye contact or tells you what’s going on but you’re quite hungry and so you wait. Other people go get seated ahead of you and you don’t know why. Continue reading ... Your patients are rating you online: How to respond. Manage your online reputation: A social m...
Source: Kevin, M.D. - Medical Weblog - November 17, 2014 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

Scaring Students For Their Own Good
Jason Bedrick “I thought he was going to shoot me.” That’s the text message that a mother received from her terrified child at Jewett Middle Academy in Winter Haven, Florida. But the child wasn’t describing a psychotic school shooter. It was a drill. As the local CBS affiliate reported: Students at Jewett Middle Academy said they were terrified when police officers burst in the doors for a planned active shooter drill – but students and teachers are irked they were not told ahead of time. Seventh-grader Lauren Marionneaux told WTVT-TV that when the officers burst into her class with an AR-15, she was in ...
Source: Cato-at-liberty - November 17, 2014 Category: American Health Authors: Jason Bedrick Source Type: blogs

Let There be Light
I have been an emergency registrar approximately forever. Some people’s training years form a crisp, well defined, early-adult life phase. Mine are evolving into a meandering opus. In early 2013, awake with a newborn in the wee hours of the morning, (a highly recommended setting for major life decision making) I concocted an audacious plan to Finish My Training. Rotations, exam sittings and an interstate move all slotted in with tetris-like precision, it was brilliant in theory but too fragile for in vivo conditions. Such was the interdependency of the various elements that an unexpected delay in the completion of one co...
Source: Life in the Fast Lane - November 17, 2014 Category: Emergency Medicine Authors: Kristin Boyle Tags: Healthy Lifestyle Review Tech Tool Tech Tutes night-shift re-timer shift work shiftwork Source Type: blogs

We Still Don’t Know What’s Wrong
A few years ago, I was talking with a medical student who had just finished a shift in the ED. He was an excellent student, but today he had a string of patients who left him frustrated. The 40 year-old woman who presented with abdominal pain left the ED with a diagnosis of “abdominal pain.” We discharged the 35 year-old man who presented with a severe headache with a diagnosis of “possible tension headache.” A five year-old girl with a fever left with “fever of probable viral etiology.” We had gotten blood tests and a CT scan on the woman with abdominal pain, the results of which were normal. We had treated th...
Source: Academic Medicine Blog - November 17, 2014 Category: Universities & Medical Training Authors: David P. Sklar, M.D. Tags: Featured From the Editor ambiguity specialty choice tolerance for ambiguity Source Type: blogs

What a student learned: Medicine’s hidden curriculum
Students undergo a conversion in the third year of medical school: not “pre-clinical” to “clinical,” but “pre-cynical” to “cynical.” — Abraham Verghese, MD The scalpel hovered over the swollen, red and inflamed mass peeking through the opening in the sterile drapes. The patient lay on her side facing away from us, clutching the stiff emergency room pillow against her face and moaning as she rocked back-and-forth. Whenever the surgeon manipulated the mass, she yelped. I was a brand new medical student observing my first incision and drainage of a perirectal abscess. The surgeon sat on a rolling exam chair ...
Source: Kevin, M.D. - Medical Weblog - November 16, 2014 Category: Journals (General) Authors: Tags: Education Medical school Surgery Source Type: blogs

Vaccine-Injured Child Kidnapped from Family by Child Protective Services
Vaccine injury and medical kidnapping stories are becoming commonplace. They are often connected. One mother never thought for a second that vaccinating her child would tear her family apart. Rebekah McClain wants parents to learn what her family is almost unbelievably dealing with because they chose to vaccinate. No child deserves to suffer through this pain. This is her true story.   One Family’s Heartbreak “I have a son named Kacer Lee Harris. He was born on December 25, 2013. He is my Christmas miracle. I have been praying for years to have a child on Christmas Day. It’s all I’ve ever wanted. W...
Source: vactruth.com - November 15, 2014 Category: Allergy & Immunology Authors: Augustina Ursino Tags: Augustina Ursino Top Stories medical kidnapping Rebekah McClain Shaken Baby Syndrome (SBS) truth about vaccines Source Type: blogs

Using Mobile Technology To Overcome Jurisdictional Challenges To A Coordinated Immunization Policy
On March 20, 2014, the Government of Canada and the federal Minister of Health announced the release of ImmunizeCanada (ImmunizeCA), a smart phone application (app) designed to both provide accurate information on immunization for Canadians and allow them to track their and their family members’ immunizations. Based on a prototype developed for parents in Ontario and in partnership with the Canadian Public Health Association, our development team received funding from the Public Health Agency of Canada to build a national immunization app. Our task was to build an Apple- and Android-compatible app, containing all 13 prov...
Source: Health Affairs Blog - November 14, 2014 Category: Health Management Authors: Kumanan Wilson, Katherine Atkinson, and Jennifer Keelan Tags: All Categories Global Health Health IT Public Health Technology Source Type: blogs

Reforming Medicare: What Does The Public Want?
Is Medicare adequately meeting the needs of seniors, or are there ways that its core attributes could be improved? Numerous elected officials, policymakers, and other thought leaders have offered perspectives on ways to change the program. Few efforts, however, have been directed at understanding how the public—given accurate information, a variety of options, and a valid structure for weighing the pros and cons—would change Medicare’s basic design. The MedCHAT Project Recently, the American Enterprise Institute and the Brookings Institution co-hosted a briefing on the results of a California project that did...
Source: Health Affairs Blog - November 13, 2014 Category: Health Management Authors: Marge Ginsburg, Joseph Antos, and Kavita Patel Tags: All Categories Comparative Effectiveness Consumers Coverage Long-Term Care Medicare Policy Public Opinion Spending States Source Type: blogs

What Does Tolerance for Ambiguity Look Like?
By: Marie Caulfield, PhD, manager of data operations and services, Association of American Medical Colleges, Washington, DC Last year my daughter was admitted to a teaching hospital with a kidney infection. The medical student and residents on her treatment team recommended an MRI to rule out a possible anatomical cause. Dr. R., the attending physician, guided them through the case: the medical history did not suggest an anatomical problem, treatment would be the same regardless of the findings, and scans are uncomfortable and expensive. Dr. R. firmly said, “No MRI.” The medical student was clearly uncomfortable with l...
Source: Academic Medicine Blog - November 13, 2014 Category: Universities & Medical Training Authors: Guest Author Tags: Featured Guest Perspective medical students TFA tolerance for ambiguity Source Type: blogs

What in God's Name is Going on With Healthcare IT at Cambridge University Hospitals?
This story about a  UK hospital that recently "went live"with an American electronic health record/enterprise command-and-control system (EPIC) was not only predictable, but expected considering the sorry state of the health IT industry in terms of clinical leadership and regulation.(It appears this was a "big bang" rollout, see http://www.ehi.co.uk/news/EHI/8845/cambridge-goes-for-epic-big-bang, an implementation method better suited for warehouses and widget suppliers than major hospitals.)Addenbrooke’s staff blame blood shortage on new eHospitalBy CambridgeNews  |  Posted: November 05, 2014http://www.ca...
Source: Health Care Renewal - November 12, 2014 Category: Health Management Tags: Addenbrooke Hospital Cambridge University Hospitals healthcare IT crash healthcare IT dangers healthcare IT risk Patient care has not been compromised Source Type: blogs

Imminently Croakable
Coming out of a patient's room, my eyes immediately fell on a hallway bed on which a sobbing linebacker-sized 26-year old man rocked back and forth in a fetal position. He looked sort of like “a kidney stone,” but the tech handed me an EKG chirping "chest pain." The EMR indicated he had a past medical history of asthma, hypertension, and congestive heart failure, but he didn't take any medications. He smoked but denied drug use.   The EKG was not normal. There was no worrisome ST segment elevation, but left ventricular hypertrophy with diffuse T wave repolarization abnormalities suggested longstanding poorly...
Source: Lions and Tigers and Bears - November 12, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Palliative Care in Emergency Medicine
Applying some principles learned in Palliative Care to every-day Emergency Medicine practice – a guest post by Professor Ian Rogers FACEM, of St John of God Murdoch Hospital and University of Notre Dame in Perth, Western Australia Earlier this year I did a sabbatical in Palliative Care. I deliberately chose to work with a purely consultative service based in a tertiary teaching hospital. They did not admit under their own bed card nor was there a hospice on site to admit to. We saw patients from all across the hospital; from outpatients to ED, from ICU to slow stream rehabilitation. My aim was to gain an understandin...
Source: Life in the Fast Lane - November 12, 2014 Category: Emergency Medicine Authors: Mike Cadogan Tags: Palliative care Ian Rogers Prof Ian Rogers Source Type: blogs

It’s time to tell fast medicine to slow down
Americans tend to like fast things: instant coffee, sports cars, and speed dating. Many share a fascination with record holders, such as the world’s fastest runner or texter. And increasingly, the same goes for medicine. The number of minute clinics is exploding. Some emergency rooms now post their current wait times on roadside billboards. And increasingly, physicians and other health professionals are under pressure to increase the speed at which they see 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...
Source: Kevin, M.D. - Medical Weblog - November 11, 2014 Category: Journals (General) Authors: Tags: Physician Primary care Source Type: blogs

More Focus on Surprise Findings in Medical Tests
Emergency room imaging scans can unearth medical problems unrelated to a patient’s initial complaints. Health care providers are stepping up their tracking of and communication with patients about such ‘incidental findings,’ which are rarely followed up. (Source: WSJ.com: The Informed Patient)
Source: WSJ.com: The Informed Patient - November 11, 2014 Category: Consumer Health News Tags: FREE Source Type: blogs

Electronic Health Records: AMA Offers Blueprint to Improve Meaningful Use Program
Conclusion  The AMA’s blueprint comes on the heels of growing stakeholder concern about the Meaningful Use program, especially as it progresses beyond the initial stages. The AMA is frustrated by physicians’ struggles to meet the requirements and the blueprint is an opportunity to modify possible roadblocks facing EHR adoption in the United States. By offering additional flexibilities for physicians, the AMA believes the ultimate goal of Meaningful Use—improving patient care—will be realized. We will monitor EHRs and Meaningful Use as it continues to impact medical practices around the country.   ...
Source: Policy and Medicine - November 11, 2014 Category: American Health Authors: Thomas Sullivan Source Type: blogs

Research and Reviews in the Fastlane 057
This study compared bivalirudin to unfractionated heparin with the primary combined endpoint of death, CVA, reinfarction and target lesion revascularization. In spite of the fact that the trial was designed to favor bivalirudin (open-label), the authors found an increased rate in the primary outcome in the bivalirudin group (8.7% vs. 5.7%). Further proof that just because a drug is new, doesn’t mean it’s better. Recommended by: Anand Swaminathan Trauma, PediatricsAltgärde J, Redéen S, Hilding N, Drott P. Horse-related trauma in children and adults during a two year period. Scand J Trauma Resusc Emerg Med. 2...
Source: Life in the Fast Lane - November 10, 2014 Category: Emergency Medicine Authors: Soren Rudolph Tags: Cardiology Education Emergency Medicine Pediatrics Resuscitation Trauma Wilderness Medicine airway brain failure critical care General Surgery hypothermia Intensive Care prehospital recommendations Review Source Type: blogs

The LITFL Review 155
Welcome to the 154th 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 Beaut of the Week Cricoid pressure/force continues to be a contentious point amongst critical care practitioners. Where did it come from? The Bottom Line review and critique the original paper by Sellick. [SO] Insight into the mind of Scott Weingart. How the master...
Source: Life in the Fast Lane - November 10, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: LITFL review LITFL R/V Source Type: blogs

5 ways to ease the integration of NPs and PAs
I talk a lot with different physicians about integrating NP/PA providers into their practice.  I am frequently astonished by the level of reluctance, resistance and downright animosity from these physicians.  Many times a doctor will have a medical “horror story” with the NP/PA  playing  the  villain.  One bad encounter or event seems to  justify a complete rejection of the many positive attributes and contributions of these NP/PA providers, and negates the many studies that reveal comparable and safe care and outcomes.  Besides I have a few horror stories of my own, and guess who the villains are? Continue rea...
Source: Kevin, M.D. - Medical Weblog - November 10, 2014 Category: Journals (General) Authors: Tags: Policy Emergency Nurse Primary care Source Type: blogs

The Last Puzzle Piece
By: Vera P. Luther, MD, assistant professor, Department of Internal Medicine/Infectious Diseases, Wake Forest University School of Medicine My family has a tradition of working together on jigsaw puzzles during holidays and summer vacations. It’s a fun activity that involves teamwork. We enjoy the discovery of interesting shapes and making connections between pieces and groups, but it’s hard to deny that certain satisfaction in placing the last piece of a jigsaw puzzle, a special honor reserved for the youngest member of the family. The practice of medicine and working with people, each wonderfully complex and unique, ...
Source: Academic Medicine Blog - November 10, 2014 Category: Universities & Medical Training Authors: Guest Author Tags: Featured Guest Perspective medical students TFA tolerance for ambiguity Source Type: blogs

Implementing Health Reform: Defining Group Health Plans And More
A primary goal of the Affordable Care Act is to extend individual health insurance coverage through the exchanges and the premium tax credits to Americans who would otherwise be uninsured.  But most working-age Americans and their families remain insured through employer-sponsored group coverage. While seeking to expand individual coverage, therefore, the ACA also attempts to preserve group coverage. Employers and those who advise employers have, however, sought to break down the barrier between group and individual coverage. That is, they have tried to figure out how employers can subsidize individual coverage for their ...
Source: Health Affairs Blog - November 9, 2014 Category: Health Management Authors: Timothy Jost Tags: All Categories Employer-Sponsored Insurance Health Reform Medicaid Policy States Source Type: blogs

Medicine cannot be reduced to just a job. Here’s why.
A few months ago I was paged by a medical student in the emergency room at ten o’clock. I had just changed my clothes, and before my pager went off my attention had been squarely fixed on the newest Jack Reacher novel. You can usually tell when someone is going to ask you to come into the hospital from home, because there are two or three apologies before any details about the case come out. Eventually she got to the part where the patient was bleeding in his mouth, so I called my attending to give him the story and we decided to go in. He offered to stop by my house so we could ride in together, which I accepted bec...
Source: Kevin, M.D. - Medical Weblog - November 9, 2014 Category: Journals (General) Authors: Tags: Physician Cancer Medical school Residency Source Type: blogs

Kaci Hickox: Public health and the politics of fear
Steven H Miles, M.D. Kaci Hickox is a nurse who went to Sierra Leone with Doctors without borders to treat the emergency with Ebola. She is professionally brave, articulate and well trained. Sierra Leone, with 5000 cases, is one the epicenters of the Ebola epidemic.[1] [2] She was last exposed to patient care on October 21.[3] On Friday October 24, she returned to the United States, entering at Newark International Airport in New Jersey. There she was met by a disorganized set of officials who tried to determine what to do with her.… (Source: blog.bioethics.net)
Source: blog.bioethics.net - November 7, 2014 Category: Medical Ethics Authors: Steven Miles Tags: Featured Posts Public Health Source Type: blogs

Marijuana “Edibles” Make Candy Complicated
Pop Quiz! Question: If you look at the candy in the check-out aisle in your local store, an average chocolate bar is 1 serving, and an average bag of candy-covered chocolates (which has about 30 candies) is also 1 serving. What is the average serving of a marijuana edible chocolate bar or bag of a candy that has been infused with THC—the active ingredient in marijuana? Answer:  There is no average serving. Yes, it was a trick question.  But that’s kind of what marijuana edibles are…tricky.  At least for a person who doesn’t use marijuana regularly. For example, in Colorado, a single serving of an edible marijuan...
Source: NIDA Drugs and Health Blog - November 7, 2014 Category: Addiction Authors: The NIDA Blog Team Source Type: blogs

Ebola Shows America Needs Better Disaster Preparedness
Crafting an effective, whole-community strategy to respond to Ebola could stop the spread of the disease now and lay groundwork for responses to future outbreaks and other emergencies. In the long run, this could make public preparedness and resilience valuable assets for the U.S. (Source: The RAND Blog)
Source: The RAND Blog - November 7, 2014 Category: Health Management Authors: RAND Corporation Source Type: blogs