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

Diabetes Greatly Increases Risk of Heart Attack
Diabetes of any variety is a damaging distortion of normal metabolism. Once in progress, it causes further harm on an ongoing basis. The type 2 diabetes most often seen in older people is a lifestyle condition: the vast majority of cases are caused by being overweight, and can be reversed even at a late stage by adoption of a low-calorie diet and consequent weight loss. So when researchers note that being diabetic greatly increases heart attack risk, it is an interesting question as to the degree to which this is because patients are overweight, independently of diabetes, versus the degree to which it is due to the mechani...
Source: Fight Aging! - June 23, 2016 Category: Research Authors: Reason Tags: Daily News Source Type: blogs

Research and Reviews in the Fastlane 139
This study is a reanalysis of the data, attempting to identify the threshold where the benefit in functionality is produced, using ranges of <160, 160–169, 170–179, 180–189, and ≥190 mm Hg. The outcome was Rankin Scale at 90 days. Although the ranges proposed by the authors only include a <160 as the lowest, the linear analysis of SBP and Rankin Score shows a direct correlation going as low as 130-139mmHg, therefore the authors conclude that 130-139mmHg for SBP is the optimal range for management of patients with ICH. The study is a post-hoc analysis of a previous large study (open and unblinded) making no ...
Source: Life in the Fast Lane - June 23, 2016 Category: Emergency Medicine Authors: Soren Rudolph Tags: Clinical Research Education Emergency Medicine R&R in the FASTLANE Resuscitation Trauma Clinical Case critical care research and reviews Source Type: blogs

Common Law And Common Sense: The Supreme Court Redresses Patient Harm Under the False Claims Act
A young woman from a poor family in Massachusetts struggles in school, and is referred to a behavioral health provider serving Medicaid patients. After prolonged counseling of doubtful quality, she is diagnosed with bipolar disorder and medicated. She suffers a seizure from the medication. Several months later, still receiving less-than-optimal medical care, she seizes again and dies. Her distraught parents complain to state regulators, and learn that the individuals involved in her care were both unqualified and unsupervised. These are the facts in Universal Health Services Co. v. United States ex rel. Escobar, which was ...
Source: Health Affairs Blog - June 22, 2016 Category: Health Management Authors: William Sage Tags: Equity and Disparities Featured Health Professionals Medicaid and CHIP Medicare Quality false claims act Malpractice Massachusetts Supreme Court Universal Health Services Co. v. United States ex rel. Escobar Source Type: blogs

Zika, Flint, And The Uncertainties Of Emergency Preparedness
Ongoing Congressional debates concerning the spreading Zika virus provide the latest reminder about our national uncertainties in preparing for and responding to large-scale health emergencies. Storms, fires, industrial accidents, and infrastructure failures like the recent Flint water crisis add to the constellation of emergencies and “near misses” that threaten health and safety somewhere in the U.S. nearly every day. These events qualify as emergencies partly because of the uncertainties surrounding their locations, severity, and timing. Adding to the uncertainty, emergency preparedness is a responsibility shared by...
Source: Health Affairs Blog - June 22, 2016 Category: Health Management Authors: Glen Mays Tags: Costs and Spending Equity and Disparities Featured Organization and Delivery Public Health Quality CDC culture of health emergency funding National Health Security Preparedness Index States Zika Source Type: blogs

The superhuman efforts of the trauma surgeons at Orlando Health
A 6-year-old boy with abnormal pupils and gasping for breath. A 26-year-old pregnant woman with a gunshot wound to her abdomen. A 54-year-old male with blood pouring from a wound in his thigh. Now add 43 more patients. Imagine you are the paramedic at this scene.  Who do you take to the hospital first?  Who do you have to choose to walk past and leave at the scene while you take your patient to the hospital? Now imagine you are the surgeon.  You walk into an emergency room with blood everywhere — covering faces, limbs, the floors.  There is a cacophony of sound: screams, cries, gasps, whimpers.  Where do you s...
Source: Kevin, M.D. - Medical Weblog - June 22, 2016 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

Don’t hunt for non-existing culprits in STEMI crime scene !
Scientific cardiology has forced us to believe ACS management must be catheter based and all others are inferior  and  those who pursue the later , carry a risk of  being labelled as unethical in near future. However ,experienced cardiologists will know  where the truth lies. Now,in the interventional cardiology board rooms  there is a big  debate going on regarding the value of early total revascualrisation in STEMI with multivessel CAD.Suddenly , every lesion looks suspect ( Ex,current or future culprit ! ) and all stentable lesion are stented  either in an emergency or semi emergency fashion (The new age post PC...
Source: Dr.S.Venkatesan MD - June 22, 2016 Category: Cardiology Authors: dr s venkatesan Tags: acute coronary syndrome Cardiology -unresolved questions Primary PCI diferred pci for non ira ira non ira culprit vessels multivessel pci in stemi Source Type: blogs

We need to stop sugarcoating our cancer prognoses
Mrs. Liu, who was only 58 years old, had metastatic ovarian cancer. Despite radical surgery and chemotherapy, her disease persisted. Worse yet, her PET scan from a few months ago revealed that she had carcinomatosis — numerous deposits of cancer showered throughout her abdomen. This particular night, she starting having more nausea and couldn’t eat or drink anything without vomiting. So, she came to the ED. I was called into consult, and after talking with her, I laid hands on her abdomen: it was firm, unmistakably full of tumor. The subsequent CT scan confirmed that she had a malignant bowel obstruction. And now ...
Source: Kevin, M.D. - Medical Weblog - June 21, 2016 Category: Journals (General) Authors: Tags: Physician Emergency Surgery Source Type: blogs

Lessons learned from constipation
Here’s an excerpt from Wheat Belly Total Health about constipation. As uninteresting as it can seem at first glance, constipation can offer useful insights into diet and health, but not simple-minded insights like “get more fiber.”   A condition as pedestrian as constipation serves to perfectly illustrate many of the ways in which grains mess with normal body functions, as well as just how wrong conventional “solutions” can stray, Keystone Kops of health stumbling, fumbling, and bumping into each other, but never quite putting out the fire. Drop a rock from the top of a building and it predictabl...
Source: Wheat Belly Blog - June 21, 2016 Category: Cardiology Authors: Dr. Davis Tags: Wheat Belly Lifestyle bowel health cellulose constipation fiber grains prebiotic Source Type: blogs

ER misuse in our instant gratification society
Those of us who work in emergency medicine have all had these patients. They present with a complaint that started two years ago and for whatever reason now deem it an issue that needs immediate attention in the ER. I had a patient like this recently who not only had the issue for two years, but also had a primary care provider. Not only did the patient have a PCP, they saw their PCP a week before coming to the ER. Their provider also referred the patient for some outpatient studies. The studies were reasonable even though they would unlikely get to the root cause of the patient’s symptoms. Despite being reasonable, the ...
Source: Kevin, M.D. - Medical Weblog - June 21, 2016 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

Time to Put a Stop to Workplace Bullying
By RONALD WYATT, MD Civility is a system value that improves safety in health care settings. The link between civility, workplace safety and patient care is not a new concept. The 2004 Institute of Medicine report, “Keeping Patients Safe: Transforming the Work Environment of Nurses,” emphasizes the importance of the work environment in which nurses provide care.1 Workplace incivility that is expressed as bullying behavior is at epidemic levels. A recent Occupational Safety and Health Administration (OSHA) report on workplace violence in health care highlights the magnitude of the problem: while 21 percent of registered...
Source: The Health Care Blog - June 20, 2016 Category: Consumer Health News Authors: John Irvine Tags: OP-ED Uncategorized Source Type: blogs

When doctors and patients secretly record each other
A JAMA Viewpoint suggests that doctors should be aware that patients may be surreptitiously recording their conversations. The author, a neurosurgeon, takes a very benign view of this issue and recommends that if a doctor suspects that patient is recording a conversation, “the physician can express assent, note constructive uses of such recordings, and educate the patient about the privacy rights of other patients so as to avoid any violations.” He also says this would show that the physician was open and strengthen the relationship between the doctor and the patient. I’m not so sure. Here’s a diff...
Source: Kevin, M.D. - Medical Weblog - June 20, 2016 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

It is easy to be led astray by the computer....
I saw this ECG lying around:The computer called this "normal" with no other comment.what do you think?It is amazing that the computer called this normal, as there are clearly abnormal QRST's in beats 3, 4, and 5.What are they?I looked the case up on the McKesson system because one can highlight the run of abnormal beats in lead II across the bottom (see red box) and then one is able to see these abnormal beats in all 12 leads: Now what do you think?This is clearly WPW.  Among these beats there is clearly a short PR interval and delta waves.  The QRS is very abnormal due to the pre-excitation.I looked at the patie...
Source: Dr. Smith's ECG Blog - June 20, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs

LITFL Review 236
Welcome to the 236th 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 So for those of you that weren’t able to make it, or for the others that want to relive the greatness of SMACCDUB, the following FOAMed sites have published some fantastic podcasts summarising and discussing all that went on; ACPEducate, FOAMca...
Source: Life in the Fast Lane - June 19, 2016 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

The Black List Part II (Features Which Should Be In Every EHR, But For Some Reason Aren’t)
By HAYWARD ZWERLING, MD I have been involved in HIT for 2.5 decades as a designer and primary programmer of a commercial EMR which I developed for my practice and was sold from 2000 until 2015. As a result of that experience, and 15 years of interactions with the physicians who used my EMR, I developed some insights about which features have real utility to the practicing physician and how to design an EMR so that it is efficient and intuitively obvious how to use the EMR. I have since learned that many of those useful features and design considerations have not been incorporated into all EMRs. In my previous posting on Th...
Source: The Health Care Blog - June 19, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized The Black List Source Type: blogs

Being with families at the darkest moment of their lives
To her it was like any other day. She had dropped him off, as was their usual routine, and gone into the city to see a friend. He was an experienced member of the ski team. Practice was familiar. Take the lift up, ski down. Take the life up, slalom down. Take the life up … It all happened quickly. He slipped through rail of the lift. The impact on the cold, hard packed snow was devastatingly complete. Perhaps it was his head, or maybe his spine, but vital functions were cut off immediately; he went into cardiac arrest. The ski patrol started CPR. Someone alerted dad. He arrived almost as quickly as the paramedics. They i...
Source: Kevin, M.D. - Medical Weblog - June 18, 2016 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

Ho Lee-Fuq
I have seen no mention of this whatsoever in the New York Times, any of the major news networks, or for that matter the liberal blogs and on-line magazines. Only at Climate Progress did I learn that the temperature in Greenland's capital of Nuuk last week hit 75 degrees Fahrenheit, which is the warmest temperature ever recorded there in June. The percentage of the Greenland ice sheet surface that has melted is now 2 standard deviations above normal for June. The arctic sea ice is also on track for a record low.May was the hottest ever recorded globally, and we're on track for the hottest year ever for the third year in a r...
Source: Stayin' Alive - June 17, 2016 Category: American Health Source Type: blogs



2-Month Old Infant Suffered Apnea and Died Following 8 Vaccines
Conclusion After watching their son get buried, Cash’s parents were thrown into a world they didn’t know much about. They were now another set of grieving parents who senselessly lost their child due to medical practices recommended under a doctor’s care. Vaccines are being ignored when compiling infant mortality data. In 2013, Cash Dewayne Thomas was one of 23,440 babies who died in the United States before reaching their first birthday, according to the latest infant mortality data published in 2016. [19] About 11,300 newborns die within their first day of life, many soon after receiving their first hepatitis B vac...
Source: vactruth.com - June 16, 2016 Category: Allergy & Immunology Authors: Augustina Ursino Tags: Augustina Ursino Human Top Stories apnea Cash Dewayne Thomas Jesse Dewayne Thomas newborn vaccines truth about vaccines Vaccine Death Whitney Hill Source Type: blogs

Traumatic events – Preparing, Responding, and Coping
The Disaster Information Management Research Center (DIMRC) has a number of resources regarding preparing for, responding to, and coping with traumatic events. DIMRC Coping with Disasters, Violence and Traumatic Events, http://1.usa.gov/1Nwmm1n Disaster Lit®  searches Health care tools and information for surge response, http://1.usa.gov/262AwD5 Resources for the professional response workforce on shooting incidents, http://1.usa.gov/1Uzixwl Self-care and coping resources for journalists from the Dart Center, http://1.usa.gov/1UjDNIX Disaster Lit®  recently added resources TRACIE Topic Collection: Mass Gatherin...
Source: BHIC - June 15, 2016 Category: Databases & Libraries Authors: Annette Parde-Maass Tags: Emergency Preparedness Mental Health National Library of Medicine News Public Health Websites DIMRC traumatic events Source Type: blogs

UM Children’s Hospital Patient Gives Back in a Big Way
Michelle Kaminaris, a kindergarten teacher at Hampstead Hill Academy in East Baltimore, has seen kids miss school for all kinds of reasons. Like most of us, she never expected her own child to miss school due to a serious illness. But when her daughter Eva (an eighth grader at Hampstead Hill Academy) started showing flu-like symptoms, a trip to the doctor confirmed that Eva would be missing school due to pneumonia. From there, Eva had more tests and doctors found a tumor on her ovaries. The tumor was removed after an emergency surgery, but she still had to spend time recovering at the University of Maryland Children’s Ho...
Source: Life in a Medical Center - June 15, 2016 Category: Universities & Medical Training Authors: Hope Gamper Tags: Kids Patient Stories Uncategorized donation fundraising Hampstead Hill Academy Patient Story pediatrics UMCH Source Type: blogs

Confusion over HIPAA Causes Grief in Orlando
By ARTHUR CAPLAN, MD & CRAIG J. KONNOTH After the horrific shootings in the gay dance nightclub that killed 49 individuals, 53 survivors were rushed to surrounding hospitals.  In the hours that followed family members anxiously sought updates about their loved ones.  Yet, confusion over the privacy rules that govern health information prevented them from getting immediate access to what they surely needed to know. Confusion was not restricted to hospital staff.  Reporters and political officials alike were confused about what the law permitted. This is not the first time that HIPAA related confusion affected a gay...
Source: The Health Care Blog - June 15, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized HIPAA HIPAA Waiver Source Type: blogs

FDA Issues Guidance on Expanded Access to Investigational Drugs
The United States Food and Drug Administration (FDA) has recently issued guidance in response to a request in the 21st Century Cures Act, in an attempt to ease the procedural challenges doctors and patients must navigate when seeking access to investigational treatments. The Act called on the FDA to clarify key policy issues around expanded access to investigational drugs for individual patients with no other options. The guidance provides information about the implementation of the FDA's regulations on expanded access to investigational drugs for treatment use under an investigational new drug application (IND), which w...
Source: Policy and Medicine - June 15, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

We stand at the brink. Together on the dance floor. We are Pulse.
Recently, a patient of mine died of cancer, whom I loved very much.  She had a special way of enjoying life; a half, wise smile that after our many years together did not take me too seriously and reflected her deep inner strength.  She taught me about joy; I will miss her always.  Her husband, understanding my loss, said that it was alright, that I had done my best, that he would pray for me.  He empathized more with my pain, my loss, than with his own. This same morning, I learned of the slaughter at the Pulse.  I was mourning the death of one person of a terrible, but natural disease, while at a night club, a plac...
Source: Kevin, M.D. - Medical Weblog - June 14, 2016 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

CDC Protects Business From Chronic Health Threats to Major Emergencies
Business Pulse is a feature that offers businesses useful resources from the Centers for Disease Control and Prevention (CDC). Explore benefits associated with CDC’s work to protect Americans—including businesses and their workforces—from chronic threats that impact health and productivity to major health emergencies. Produced by the CDC Foundation, Business Pulse focuses on a different topic each quarter. To learn more http://bit.ly/24GHMlF (Source: BHIC)
Source: BHIC - June 14, 2016 Category: Databases & Libraries Authors: Carolyn Martin Tags: General Public Health Websites Source Type: blogs

Paramedics saved this woman’s life. They are the true heroes.
I’m pulling on my last elbow’s displaced wrist when a nurse pops in, and tells us a critical patient is two minutes away. “Mind staying?” my colleague asks. “Sure.” Paramedics are hunched over the patient as she is wheeled quickly into the resuscitation bay. At the top of the bed, a mask is secured over her mouth and oxygen is pumped with loosely gloved hands. It isn’t helping — her skin is grey — like the clay you hit when you’ve dug too far in your backyard. 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 - June 14, 2016 Category: Journals (General) Authors: Tags: Physician Emergency Heart Source Type: blogs

A Systems Approach Is The Only Way To Address The Opioid Crisis
The opioid crisis, which affects millions of people across the country, shows no signs of stopping. Indeed, the pace of addiction and death is so fast in some locations that the statistics are more overwhelming than helpful. Pioneering, effective interventions are needed — but they will only get us so far. The complexity of the opioid crisis requires medical, legislative, behavioral, educational, and legal changes, and it requires that these changes be made in coordination with each other, at the same time. States and communities will succeed only if they engage and align all actors to create systems that can prevent...
Source: Health Affairs Blog - June 13, 2016 Category: Health Management Authors: Lindsay Martin and Mara Laderman Tags: Drugs and Medical Technology Health Professionals Public Health Quality Behavioral Health Opioid Addiction opioids prescription drug abuse Substance Use Disorders Source Type: blogs

Help for Emotional Distress following Mass Violence
People dealing with emotional distress from the Orlando shooting or any other disaster are encouraged to use the Disaster Distress Helpline. From the Substance Abuse and Mental Health Services Administration (SAMHSA): “Call the Disaster Distress Helpline at 1-800-985-5990 or text TalkWithUs to 66746 for support and counseling. The Disaster Distress Helpline is a national hotline that provides 24/7, year-round crisis counseling for people who are experiencing emotional distress related to any natural or human-caused disaster. This toll-free, multilingual, and confidential crisis support service is available to all res...
Source: BHIC - June 13, 2016 Category: Databases & Libraries Authors: Kate Flewelling Tags: Emergency Preparedness Mental Health Source Type: blogs

Skin Cancer Prevention Resources from CDC
The Center for Disease Control has numerous shareable skin cancer prevention tools. The Sun Safety Tips for Men page has informational buttons to add to your website. The Skin Cancer Awareness page has infographics, fact sheets, a quiz and posters. Sun Safety Tips for Men: http://1.usa.gov/1tlP1DV Skin Cancer Awareness: http://1.usa.gov/1UpWcoO   (Source: BHIC)
Source: BHIC - June 13, 2016 Category: Databases & Libraries Authors: Kate Flewelling Tags: Emergency Preparedness Public Health Source Type: blogs

LITFL Review 235
Welcome to the 235th 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 Part 2 of the excellent review from our own Chris Nicholson of Intensive on what is and what isn’t an RCT. Great basics for the beginner and review for the experienced. [AS] The Best of #FOAMed Emergency Medicine EM Cases features a discussion...
Source: Life in the Fast Lane - June 13, 2016 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: LITFL review LITFL R/V Source Type: blogs

ECMO in Cardiac Arrest PechaKucha
PechaKucha presentation on the use of ECMO in the emergency department for refractory ventricular fibrillation in cardiac arrest Last update: Jun 11, 2016 @ 12:41 pm The post ECMO in Cardiac Arrest PechaKucha appeared first on LITFL: Life in the Fast Lane Medical Blog. (Source: Life in the Fast Lane)
Source: Life in the Fast Lane - June 11, 2016 Category: Emergency Medicine Authors: Johnny Iliff Tags: Education cardiac arrest ECMO PechaKucha VF Source Type: blogs

Preparing for heat and extreme heat
As the temperatures rise, many health organizations are reminding people to take precautions from the heat and sun. In “Using Data to Prepare for the Next Heat Wave,” the CDC shares how public health officials in Minnesota are using data on heat-related illnesses to identify areas that need increased attention. http://1.usa.gov/1YgxDMQ The AgriSafe Network reminds readers of the warning signs of heat-related illnesses as well as ways to prevent them. http://bit.ly/1WGR7KQ In a Successful Farming article, AgriSafe’s clinical director, Carolyn Sheridan, also provides tips for farmers (and other outdoor...
Source: BHIC - June 9, 2016 Category: Databases & Libraries Authors: Annette Parde-Maass Tags: Articles Emergency Preparedness Public Health Rural Source Type: blogs

Obama Administration Acts To Stabilize Marketplaces, Implement Expatriate Coverage Legislation
On June 8, the federal departments tasked with implementing the Affordable Care Act (ACA) released a barrage of regulatory issuances, including fact sheets, guidances, a blog post, and a notice of proposed rulemaking (NPRM). These issuances serve two major purposes. First, several of them, as summarized in a press release and fact sheet released by the Centers for Medicare and Medicaid Services (CMS), are intended to stabilize the marketplace risk pool. They are, that is, intended to draw healthy as well as unhealthy enrollees into the market and to discourage potential gaming on the part of insurers or enrollees that migh...
Source: Health Affairs Blog - June 9, 2016 Category: Health Management Authors: Timothy Jost Tags: Following the ACA Insurance and Coverage Medicaid and CHIP Medicare ACA Marketplaces Essential Health Benefits expatriate coverage minimum essential coverage risk pools special enrollment periods Source Type: blogs

The story of a man who did not feel well
Once upon a time, not that long ago, there was man who lived an uncomplicated life. One morning he awoke and did not feel well. He could not really describe his malaise, but he definitely was not his usual self. Nothing particularly noteworthy had happened to him except that his dog had recently died of old age. William, a scruffy little terrier, was 17 years old, and the man knew for a long time that he was slowly sliding downhill. He was blind and limped, and his death was certainly not a surprise. Anyway, that was weeks ago. The man continued to feel ill and after a while, he decided that he should seek some medical att...
Source: Kevin, M.D. - Medical Weblog - June 9, 2016 Category: Journals (General) Authors: Tags: Physician Geriatrics Source Type: blogs

Sooner or later, you will need the ER. Will it be there?
Sooner or later, you will need the ER. I don’t care how healthy you are, how much you hate going to the hospital for care, how much you distrust doctors or modern medicine, how rich you are, or how deep in the woods you live, the odds are almost 100 percent that in your lifetime you will end up in the ER. You may get lucky, and find yourself in a hospital that is staffed by highly qualified emergency physicians, backed up by a full roster of highly trained specialists and a bevy of great nurses, technicians and the latest in diagnostic equipment and sophisticated operating rooms and ICUs and cardiac cath labs and all th...
Source: Kevin, M.D. - Medical Weblog - June 9, 2016 Category: Journals (General) Authors: Tags: Policy Emergency Source Type: blogs

A Father's Day Tribute
​BY MARTHA ROBERTS, ACNP, CEN​This Father's Day, Emergency Medicine News would like to recognize a true leader in emergency medicine. James R. Roberts, MD, a distinguished professor and emergency physician, is one of the founding fathers of the specialty. Since 1972, he directly assisted in building the profession, paving the way for thousands of individuals who now call the ED their home.Dr. Roberts was one of the first emergency physicians in the country, and he has taught tens of thousands of students over the years including physicians, fellows, resid...
Source: The Procedural Pause - June 8, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Research and Reviews in the Fastlane 138
This study seeks to prove a saying attributed to Hippocrates: “It augurs well, if the patient’s mind is sound, and he accepts food that’s offered him; but, if the contrary conditions do prevail, the changes of recovery are slim.” In a nutshell, Hippocrates felt that a good appetite and good cognition bode well for mortality. The author’s found that in a group of community living older adults, a graded effect was present. The more severe appetite loss or poor cognition, the more likely the patient would have a poor prognosis. Recommended by Anand Swaminathan Trauma Ogura T, et al. Nonopera...
Source: Life in the Fast Lane - June 8, 2016 Category: Emergency Medicine Authors: Soren Rudolph Tags: Clinical Research Education Emergency Medicine LITFL R&R in the FASTLANE Review Trauma critical care Intensive Care literature Resuscitation Source Type: blogs

Research and Reviews in the Fastlane 138
This study seeks to prove a saying attributed to Hippocrates: “It augurs well, if the patient’s mind is sound, and he accepts food that’s offered him; but, if the contrary conditions do prevail, the changes of recovery are slim.” In a nutshell, Hippocrates felt that a good appetite and good cognition bode well for mortality. The author’s found that in a group of community living older adults, a graded effect was present. The more severe appetite loss or poor cognition, the more likely the patient would have a poor prognosis. Recommended by Anand Swaminathan Trauma Ogura T, et al. Nonopera...
Source: Life in the Fast Lane - June 8, 2016 Category: Emergency Medicine Authors: Soren Rudolph Tags: Clinical Research Emergency Medicine LITFL R&R in the FASTLANE Review Trauma critical care Intensive Care literature Resuscitation Source Type: blogs

Zika May Place Burden On Medicaid
Congress is currently debating the level of federal funding that should be made available to fight to reduce the spread of Zika. Administration officials working with local public health agencies on the ground have recently expressed fear that the funding levels are insufficient to prevent the disease from spreading. What is one overlooked concern? State budgets. Medicaid is jointly funded by states and the federal government and serves as a key financer of health care services if Zika spreads across the country this summer. The Centers for Medicare and Medicaid Services (CMS) recently released a bulletin to state Medicaid...
Source: Health Affairs Blog - June 8, 2016 Category: Health Management Authors: Emma Sandoe Tags: Equity and Disparities Medicaid and CHIP Public Health family planning States Zika Source Type: blogs

Are you the physician who yells?
I’ve never been the doctor who yells.  However, if you work in medicine, you’ve met him or her.  I’ll call this physician “Dr. Barkus Yellby.”  Dr. Yellby is angry.  A lot.  In the old days (and not so old days), he threw instruments in the OR when they weren’t what he wanted.  Or if the charts and labs weren’t ready for rounds, he slammed things on the desk and berated wide-eyed nurses who were holding back sobs. As an emergency physician, I’ve talked to him any number of times on the phone. “Did you even examine the patient?”  “Why are you calling me?’” “How ...
Source: Kevin, M.D. - Medical Weblog - June 8, 2016 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

Socialism Destroys Venezuela as its People Feel the “Bern”
Venezuela no longer can feed or care for its people. Yet many Americans have forgotten what socialism really is. Sen. Bernie Sanders campaigns as if Karl Marx was just another Santa Claus. Real socialism largely disappeared decades ago. The collapse of the Soviet Union and its Eastern European satellites effectively ended the age of collectivism. Nevertheless, oil-rich Venezuela since became a flamboyant exponent of socialism. Its travails should remind us how America’s power is built upon a prosperous economy. Prodigal spending at home and promiscuous intervention abroad are undermining our nation’s economic foundatio...
Source: Cato-at-liberty - June 7, 2016 Category: American Health Authors: Doug Bandow Source Type: blogs

Fame and Fetanyl
By KAREN SIBERT, MD A fentanyl overdose led to the recent death of musician and singer Prince, according to the medical examiner’s report released June 2. The drug seems likely to become as notorious as propofol did after the death of Michael Jackson in 2009. For all of us in anesthesiology who’ve been using fentanyl as a perfectly respectable anesthetic medication and pain reliever for as long as we can remember, it’s startling to see it become the cause of rising numbers of deaths from overdose.  Fentanyl is a potent medication, useful in the operating room to cover the intense but short-lived stimulation of sur...
Source: The Health Care Blog - June 7, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Fetanyl Source Type: blogs

Fame and Fentanyl
By KAREN SIBERT, MD A fentanyl overdose led to the recent death of musician and singer Prince, according to the medical examiner’s report released June 2. The drug seems likely to become as notorious as propofol did after the death of Michael Jackson in 2009. For all of us in anesthesiology who’ve been using fentanyl as a perfectly respectable anesthetic medication and pain reliever for as long as we can remember, it’s startling to see it become the cause of rising numbers of deaths from overdose.  Fentanyl is a potent medication, useful in the operating room to cover the intense but short-lived stimulation of sur...
Source: The Health Care Blog - June 7, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Fetanyl Source Type: blogs

Freestanding emergency departments: The model we need to study
I recently took care of a woman in her 50s that came to our emergency department (ED) complaining of chest pain. The pain had started shortly before arriving in the ED but within minutes, we performed a battery of tests, treated her pain, and gave her an aspirin. Still concerned about heart disease being the cause of her pain, I observed her overnight in our EDs observation unit and completed additional tests including a cardiovascular stress test. She was able to leave our ED within 15 hours with reassurance that her chest pain was likely benign. Only a few years ago, this patient would have required a time consuming and ...
Source: Kevin, M.D. - Medical Weblog - June 6, 2016 Category: Journals (General) Authors: Tags: Policy Emergency Source Type: blogs

LITFL Review 234
Welcome to the 234th 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 Simon Carley shatters our illusions of superiority, making us question whether we are really in the 93% that self-rate as “above average.” Are you as good as you think? [JS] The Best of #FOAMed Emergency Medicine Some interesting tid...
Source: Life in the Fast Lane - June 6, 2016 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

The opioid crisis: Does empathy make physicians more vulnerable?
It was Saturday evening, and Audrey G lay awkwardly on an emergency department stretcher in search of a comfortable position. She suffered from chronic hip pain, the unfortunate and unexpected effect of pelvic surgery. But her real chief complaint involved her drug-abusing husband, who that morning stole her recently filled bottle of oxycodone, an opioid pain medicine. Her story included the surgeon who doubted her pain and a year of failed therapies. Now only oxycodone touched the pain, or so she said, fighting back tears. The on-call physician didn’t know her and said to go to the ER. Any decision that involves prescri...
Source: Kevin, M.D. - Medical Weblog - June 5, 2016 Category: Journals (General) Authors: Tags: Physician Pain management Source Type: blogs

Compassionate care is at it’s best when selflessly focused on helping others
I’ve noticed, as I get older life seems to travel full circle no matter your path or destination.  I find myself trying to teach my son Grant things that my father attempted to teach me not so long ago. “Don’t do that, you’ll fall and hurt yourself, or try it this way, and the process will be much easier.” There is that brief moment of acknowledgment often followed by scraped knees or spilled paint.  I think back to my own bullheaded nature as a child with similar events that I could only learn through trial and error, not listening to wisdom from my father. Continue reading ... Your patients are rating you on...
Source: Kevin, M.D. - Medical Weblog - June 4, 2016 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

New Health Policy Brief: Ambulance Diversion
A new policy brief from Health Affairs and the Robert Wood Johnson Foundation (RWJF) discusses efforts to address ambulance diversion, a controversial strategy for temporarily relieving overcrowding in emergency departments (EDs). According to 2015 data, the national median time for a patient, from arrival to placement in an inpatient bed, was 279 minutes. Ambulance diversion was initially viewed as a safety valve. However, the approach has yielded unintended long-term negative consequences and raises questions of equity, since it disproportionately impacts minority populations. Since many factors can impact ED overcrowdin...
Source: Health Affairs Blog - June 3, 2016 Category: Health Management Authors: Lucy Larner Tags: Elsewhere@ Health Affairs Featured ambulatory care Emergency Medicine Health Policy Brief Source Type: blogs

The Rigid Patient
​A 24-year-old man with a history of schizophrenia presented with altered mental status. His mother said he had become more catatonic and rigid over the previous two days. She reported that he was prescribed Abilify 5 mg by mouth daily for three years, but a long-acting depot of Abilify 400 mg had been administered two days before by court order. His vital signs include a heart rate of 120 bpm, blood pressure 140/90 mm Hg, temperature 38.5°C, respiratory rate is 14 bpm, and SPO2 is 98% on room air. The patient is alert and diaphoretic. Pupils are 3 mm. Cogwheeling, rigidity, and two beats of ankle clonus are also o...
Source: The Tox Cave - June 2, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

FOOSH It Good
​A young woman came in after a FOOSH injury complaining of difficulty moving a painful shoulder. The Y view was difficult to obtain, but the AP view is below. What three radiographic signs help make the diagnosis?The signs include:n The light bulb sign is when the humeral head is rotated internally so it looks more like a lightbulb than a club.n The rim sign where there is an increased distance (more than 6 mm) between the arc of the glenoid and the arc of the humeral head. The distance is much closer at the top of the glenoid than the bottom in this image.n There is an angle in Moloney's arch. There s...
Source: Lions and Tigers and Bears - June 2, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Part 4 in a Series: Ultrasound-Guided IV Line Placement
It's time to be fearless and embrace the true utility — and maybe implement a new policy in your ED — of ultrasound-guided intravenous (IV) line insertion. Many physicians, NPs, and PAs already know how to place US-guided IVs, but we can help teach those who don't. Provider teaching can be in the form of real-time IV placement or a short 60-minute procedural training course open to all those who are interested. You can even use our procedural videos to help get you started! (http://emn.online/Mar16PP.)We all know our difficult patient population includes prior IV drug abusers, obese patients, patients with chr...
Source: The Procedural Pause - June 2, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs