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Healthcare Update Satellite — 12-16-2014
Answering the important questions … why does the flu vaccine suck this year? Keep a lookout for next month’s issue of EP Monthly which will tell you everything you need to know about influenza diagnosis and treatment. Of course, if you had read the backboard article in EP Monthly’s November issue, you’d already be doing this … Florida fire department abandons use of backboards for most trauma patients. 4 year old boy develops carotid artery dissection and left sided hemiparesis after riding a roller coaster. Fortunately, he had made significant recovery by six months. How scary is that, though...
Source: WhiteCoat's Call Room - December 17, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

The Economics of Uber's Surge Pricing
Matthew Feeney The recent tragic siege in Sydney has, perhaps unexpectedly, put Uber’s surge pricing system back in the headlines. Some considered the fact that Uber would allow for surge pricing to take effect amid a hostage crisis to be outrageous and insensitive. Yet, surge pricing ensures that Uber drivers will be on the road at times of peak demand and that the passengers who want an Uber ride the most will get one. Uber’s surge pricing system might seem strange and at times extortionate, but it merely puts on display basic economic forces that are at play all the time which most of us never question, and...
Source: Cato-at-liberty - December 16, 2014 Category: American Health Authors: Matthew Feeney Source Type: blogs

Triphasic left ventricular filling pattern
Brief Review Normal left ventricular filling pattern is biphasic with an early diastolic E wave which occurs soon after the opening of the mitral valve and a late diastolic A wave during atrial systole. Normally E wave is taller than A wave, but A wave can be taller in situations of left ventricular diastolic dysfunction (E/A reversal). A triphasic left ventricular filling pattern with an additional mid diastolic wave, called T wave 1 by some authors and L wave 2 by others, can occur in situations of left ventricular diastolic dysfunction, especially in hypertrophic cardiomyopathy. A corresponding L’ wave3,4 or T&...
Source: Cardiophile MD - December 16, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Echocardiogram Library Source Type: blogs

The Rule of the Ring
  A young woman was transported by EMS with excruciating ankle pain after slipping on the ice. A quick glance at the x-ray clearly shows the reason, but this should raise an additional red flag for EPs.   Always remember the "rule of the ring." The tibia and the fibula are held together by an interosseous ligament to form a ring in the lower leg. Undertake a search for a second abnormality if there is a fracture in the tibia or fibula above the ankle syndesmosis. This x-ray should beget another if you remember the rule of the ring.     This external rotation injury is a Maisonneuve fracture, in which there i...
Source: Lions and Tigers and Bears - December 16, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

LITFL Review 160
Welcome to the 160th 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 WeekThe London Trauma Conference was held this week. If you didn’t get a chance to go, and even if you did, there are some great summaries from Louise Chan on Resus.me and Iain Beardsell and Co. at St. Emlyns. [SL]The Best of #FOAMed Emergency Medicine...
Source: Life in the Fast Lane - December 16, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Education Review LITFL R/V Source Type: blogs

She died thirsty! Ice chips matter when it comes to patient satisfaction.
“My wife died uncomfortable and alone. She died thirsty!” The man who spoke those words came in to the emergency room recently where I was working a shift. He was accompanied by his wife, a 70-year-old with high sugar, weakness, and nausea. The team worked to get her seen under the presumption that her diabetes needed control. Once she was brought back to the room, she began vomiting. While waiting for the physician, she became thirsty, and asked for ice chips. She was told that, with doctor’s authorization, the nurse would bring them right in. Continue reading ... Your patients are rating you online: How to respo...
Source: Kevin, M.D. - Medical Weblog - December 15, 2014 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

Top stories in health and medicine, December 15, 2014
From MedPage Today: ED Throughput: A Fixable Problem. As I travel the freeways of the various cities I visit, I often come across billboards announcing waiting times at the local ED, or billboards promising no wait at all. Sometimes they just advertise “faster” care, whatever that means. Mumps Checks NHL Players. It has been a bad year for mumps and not even elite athletes are immune. Watch for Axial Back Pain in Psoriatic Pts. Patients with psoriasis have a higher prevalence of lower axial back pain than the general population while inflammatory back pain (IBP), spondyloarthritis (SpA), and alternating butto...
Source: Kevin, M.D. - Medical Weblog - December 15, 2014 Category: Journals (General) Authors: Tags: News Emergency Infectious disease Rheumatology Source Type: blogs

CCC Update 009
Here is a quick overview of the major updates and revisions to the LITFL Critical Care Compendium since CCC Update 008.Check these out:Airway and cervical spine injuriesPeople can get pretty twitchy about intubating patients with suspected cervical spine injuries. Apply MILS, use a bougie and perform rapid sequence intubation. What’s so hard about that?… Airway management in Major TraumaAn overview of the issues affecting airway management in major trauma, including the indications for intubation the possible causes of airway compromise in this setting.Antimicrobial stewardshipUpdated with a recent systematic rev...
Source: Life in the Fast Lane - December 15, 2014 Category: Emergency Medicine Authors: Chris Nickson Tags: Critical Care Compendium Emergency Medicine FCICM Fellowship Intensive Care CCC update FCICM exam Source Type: blogs

OIG Issues 2015 Work Plan
The Department of Health and Human Services Office of Inspector General recently released its 2015 Work Plan. OIG’s annual Work Plan summarizes new and ongoing reviews and activities that OIG plans to pursue with respect to HHS programs and operations during the current fiscal year and beyond. The OIG’s job is to detect fraud, waste, and abuse; identify opportunities to improve healthcare program economy; and to hold “accountable those who do not meet program requirements or who violate Federal health care laws.” The OIG conducts audits and investigation, and can impose civil monetary penalties where appropriate, s...
Source: Policy and Medicine - December 15, 2014 Category: American Health Authors: Thomas Sullivan Source Type: blogs

A costly anomaly on a brain MRI
It started with a mild case of nausea and got progressively worse. I became dizzy and shaky, but tried to ignore it. There was work to be done that afternoon. We were moving boxes into storage at my in-laws’ house in Michigan, and I needed to be strong. I carried boxes on unsteady feet, catching myself before bumping into walls. By early evening my legs were wobbly, and I felt like I was horribly seasick. The room was spinning and I had to lie down. I vomited. I laid back down. I vomited again, violently. I kept vomiting until there was nothing left. I had severe vertigo and couldn’t sit up without my head spinning, my...
Source: Kevin, M.D. - Medical Weblog - December 14, 2014 Category: Journals (General) Authors: Tags: Patient Emergency Neurology Source Type: blogs

smaccGOLD Education Q&A
Casey Parker (who you’ll know from BroomeDocs) and I were lucky enough to moderate a panel discussion on education at smaccGOLD.Here is the audio:The fantastic participants were:Jonathan Gatward, Intensivist, AustraliaRob Rogers, Emergency Physician, USAVictoria Brazil, Emergency Physician, USADamian Roland, Paediatric Emergency Physician, UKIrma Bilgrami, Intensivist, AustraliaLauren Westafer, Emergency Medicine Trainee, USAQuestions discussed include:Teaching in the context of a busy ED or ICU, including within the limits of the 4 hour rule: sniper teaching, flipping the classroom, in situ simulation and 5 ...
Source: Life in the Fast Lane - December 13, 2014 Category: Emergency Medicine Authors: Chris Nickson Tags: Education SMACC FOAM FOAMed smaccGOLD workshop Source Type: blogs

How To Be A Successful Patient: Young Doctors Offer Some Advice
I am proud to be a part of the American Resident Project, an initiative that promotes the writing of medical students, residents, and new physicians as they explore ideas for transforming American health care delivery.  I recently had the opportunity to interview three of the writing fellows about how to help patients take control of their health. Dr. Marissa Camilon (MC) is an emergency medicine resident at LA County USC Medical Center, Dr. Craig Chen (CC) is an anesthesiology resident at Stanford Hospitals and Clinics, and Dr. Elaine Khoong (EK) is a resident in internal medicine at San Francisco General Hospital. Here&...
Source: Better Health - December 12, 2014 Category: American Health Authors: Dr. Val Jones Tags: Expert Interviews Health Tips Apps Empowered Patients EMR Health Outcomes Mobile Health Poverty Texting The American Resident Project Source Type: blogs

Explaining variation in emergency admissions: a mixed-methods study of emergency and urgent care systems
This study aimed to understand variation in avoidable emergency admissions between different emergency and urgent care systems in England. It concluded that deprivation explained most of the variation in avoidable admission rates. Full report Summary report NIHR - publications (Source: Health Management Specialist Library)
Source: Health Management Specialist Library - December 12, 2014 Category: UK Health Authors: The King's Fund Information & Knowledge Service Tags: NHS measurement and performance Source Type: blogs

Walgreens App Allows for Virtual Checkups
Walgreens is teaming up with MDLive to launch a virtual physician visit feature on its mobile app, the company announced in early December. MDLive is a provider of virtual health services that will connect customers with certified physicians through video chat on a smartphone, tablet, or computer.   Virtual visits are for nonemergency health conditions, such as upper respiratory tract infections, ear aches, sore throats, and rashes, and are not intended for more serious symptoms such as chest pain. Physicians can write prescriptions after the virtual visits, too. The Walgreens app, which works with iOS and Android device...
Source: Technology & Inventions - December 11, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Married to a physician: Holiday blessings in disguise
Each year as the holidays approach, countless medical families prepare for the dreaded release of the holiday schedule. Will the physician spouse be home this year? Will the non-physician spouse be packing up three kids under the age of five and traveling across the country alone to visit family they may only see once a year? It can be stressful. It can also be a blessing in disguise. 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 - December 11, 2014 Category: Journals (General) Authors: Tags: Physician Emergency Orthopedics Source Type: blogs

Research and Reviews in the Fastlane 061
Welcome to the 61st 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 6 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...
Source: Life in the Fast Lane - December 10, 2014 Category: Emergency Medicine Authors: Jeremy Fried Tags: R&R in the FASTLANE airway critical care emergency Emergency Medicine Intensive Care recommendations Review Trauma Source Type: blogs

LITFL Review 159
Welcome to the 159th 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 WeekThis Will Revolutionize Education is a much-watch video for all educators at any level, on the role of innovation and the role of the teacher. [AS]The Best of #FOAMed Emergency MedicineAmal Mattu reviews a case of a 17-year-old with a wide irregular ...
Source: Life in the Fast Lane - December 9, 2014 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review LITFL R/V Source Type: blogs

The Wire
Nursing home staff became concerned about a patient because he was “floppy.” He was a 59-year-old man with stage 3 chronic kidney disease, right ventricular heart failure, hypertension, cirrhosis, and insulin-dependent type 2 diabetes mellitus. He had been sleeping all day, according to his nurse, but he was not responding when she checked on him in the evening, and she could “drop his arm and it would just hit his face.”   He was hypotensive (90/50 mm Hg) and bradycardic (about 30 beats/min) in the ED. Respirations were slow and shallow. He was protecting his airway, but was hypoxic (SpO2 82%). IV access was esta...
Source: Spontaneous Circulation - December 9, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

From the weirdness file
I should probably dig up my weirdness file and post a few bits from it. For now, here's a new one.I am doing some minor research on workflows in primary care clinics. One of the sites we're looking at is affiliated with a hospital, which has various draconian policies regarding people who are going to be on site and potentially having patient contact. I was required to get a badge, which meant answering a ridiculous quiz, getting a TB test, and antibody titers for measles, mumps and chicken pox. Also passing a criminal background check. I finally got my badge, which has a photo on the front. Then the security guard respons...
Source: Stayin' Alive - December 9, 2014 Category: American Health Source Type: blogs

FDA Combination Product Classification Again Struck Down By D.C. Court
Whether the FDA considers a product to be a “medical device” as opposed to a “drug” has very important implications. Manufacturers of devices face less burdensome regulation and far cheaper application fees. A long-litigated case, Prevor v. FDA (Prevor II), highlights the gravity of FDA’s decision with regards to combination products. After five years in court, Prevor and the FDA continue to dispute whether Prevor’s Diphoterine Skin Wash (DSW) should be regulated as a medical device—Prevor’s preference—or a drug. Most recently, FDA argued that DSW meets the drug definition because chemical action "meaning...
Source: Policy and Medicine - December 9, 2014 Category: American Health Authors: Thomas Sullivan Source Type: blogs

Holidays in the ER: What you’ll see is a lot of humanity
People ran to the church for refuge in Medieval times. It was considered a place of safety, a sanctuary from civil punishment. In the church, one could claim a right to justice, food, water and shelter. That role was recognized by church and government authorities alike; doubtless sometimes grudgingly as the wanted escaped harsh punishments. 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 - December 8, 2014 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

The time I almost got fired for saving a young woman’s life
I was a fourth-year surgery resident, on the transplant team. It was a difficult rotation, because the doctor who ran it was sexist and got along better with you if you flirted with him. He made innumerable sexual wisecracks in the OR while we were working, and preferred to round with his arm around me as he made further innuendoes. 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 - December 8, 2014 Category: Journals (General) Authors: Tags: Physician Emergency Residency Surgery Source Type: blogs

How I feel about ATLS, in someone else’ tweet
I had the good fortune to visit the Museum of 1990s Trauma Care over the past two days. It's called #ATLS. Fascinating historic artifacts. — Bill Hinckley (@UCAirCareDoc) December 5, 2014 Perfect. In case that tweet is’t permanent, a screencap: Related posts: My first tweet The inauspicious beginning:    ... RT @Apathetic_Cynic: 15 mins “@medicalaxioms:Most doctors feel a negative stress test is reassuring for some period of time after it’s done… RT @Apathetic_Cynic: 15 mins “@medicalaxioms:Most doctors feel a negative stress... RT @BenHowe: Photo of the CDC assuring us that everyth...
Source: GruntDoc - December 5, 2014 Category: Emergency Medicine Authors: GruntDoc Tags: Amusements Emergency Source Type: blogs

Oral Nerve Blocks Made Easy
The alveolar and other oral nerve blocks are technically more difficult than most of us realize or admit. In fact, I have heard several emergency physicians admit over the years that they have given up trying to do inferior alveolar nerve blocks because of their failure rate.   It’s actually understandable when you peruse the literature. The reported failure rate for inferior alveolar nerve blocks can range as high as 30-45 percent of cases, depending on the study.   An obvious and critical first step is to make sure you have the correct techniques down. These two videos show a dental colleague performing expert step-b...
Source: M2E Too! Mellick's Multimedia EduBlog - December 5, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Lumbar Puncture: Golden Rules
We feel it is extremely important to highlight some golden rules and additional pearls after our recent lumbar puncture series. (Read the first two articles about positioning and technique at http://bit.ly/1zRSOdC and http://bit.ly/1wY8MiJ.) These tips will help you ensure the best outcome for your patients.   Be Prepared §  Be aware that patients will be anxious. □   Spend dedicated time reviewing the procedure and informed consent. □   Make sure that they feel only the lidocaine injection. □   Most patients will do better with Versed as long as there are no contraindications. §  Be prepared for patients ...
Source: The Procedural Pause - December 5, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Transforming Rural Health Care: High-Quality, Sustainable Access To Specialty Care
Editor’s note: This post is also authored by Kate Samuels, a project manager at Brookings. It is informed by a case study, the fourth in a series made possible through the Merkin Initiative on Physician Payment Reform and Clinical Leadership, a special project to develop clinician leadership in health care delivery and financing reform. The case study will be presented on Monday, December 8 using a “MEDTalk” format featuring live story-telling and knowledge-sharing from patients, providers, and policymakers. Health care for patients in rural communities across the United States remains a unique challenge.  Des...
Source: Health Affairs Blog - December 5, 2014 Category: Health Management Authors: Kavita Patel, Margaret Darling, and Mark McClellan Tags: All Categories Connected Health Disparities Health Care Delivery Health IT Payment Physicians Policy Primary Care Quality Workforce Source Type: blogs

Transient ST elevation, rules out for MI, what is it?
A 70 year old diabetic complained of 6/10 epigastric pain.  Here is his initial ECG:There is diffuse ST elevation: II, III, aVF and V3-V6.  There is reciprocal ST depression in aVL.  This is diagnostic of inferolateral STEMIThe emergency physician activated the cath lab and gave appropriate antiplatelet and antithrombotic therapy.The PCI team came to talk to the patient, and while they were talking, the patient vomited and was pain free thereafter and said he felt much better.  They recorded another ECG:The ST elevation is resolved. There can be no other explanation than the patient spontaneously reperf...
Source: Dr. Smith's ECG Blog - December 5, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs

Top stories in health and medicine, December 4, 2014
From MedPage Today: Men on ADT Skipping Out on Bisphosphonates. Few men in Canada receiving androgen deprivation therapy (ADT) for prostate cancer have simultaneous bisphosphonate treatment to prevent fractures. What Every ED Should Have. The emergency department (ED) is one of the highest risk areas of any institution. Both the fast-paced environment and high patient volume and acuity contribute to this phenomenon. In addition, minimal information regarding the medical history of patients is known at the time of presentation. Even Without Concussion Football Players May Have Brain Changes. High school football players s...
Source: Kevin, M.D. - Medical Weblog - December 4, 2014 Category: Journals (General) Authors: Tags: News Endocrinology Neurology Source Type: blogs

Research and Reviews in the Fastlane 060
This study enrolled 2500+ from whom 362 had a DVT, among them 6.3% have proximal DVT not located in common femoral or popliteal locations. This study shows a significant number of patients with proximal DVTs that a 2-point scan would miss.Recommended by: Daniel CabreraEmergency Medicine, Adminstration Gupta, M. Happy Meals for Everyone? Ann Emerg Med 2014; 64(6): 609 – 611. PMID: 25454564This excellent editorial points out the positive and negative aspects of an accompanying study (PMID: 25182541) which examined the patient and ED characteristics associated with patient satisfaction scores. Obviously, a growing ...
Source: Life in the Fast Lane - December 4, 2014 Category: Emergency Medicine Authors: Jeremy Fried Tags: R&R in the FASTLANE critical care emergency Emergency Medicine Intensive Care Press Ganey recommendations Review Source Type: blogs

They didn’t do anything! The inverted homeopathy of the ER.
How often do we have this interaction: “My wife was here yesterday for belly pain.  That doctor didn’t do nothing! Told me she just needed to get over it. I am not happy and something needs to be done about this!” (Frequently spoken by spouse.) 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 - December 3, 2014 Category: Journals (General) Authors: Tags: Physician Emergency Radiology Source Type: blogs

Plumbing Problem
A woman in her mid-30s returned in tears with excruciating pain in her chipmunk cheek. Earlier that day she was discharged on Tylenol and sour candy for cheek swelling. The initial recommendations seemed appropriate for the most likely diagnosis: a salivary stone. Now what?   Physicians have an algorithm for many situations, and different chief complaints have well-travelled paths. This isn't one of them. When faced with an unusual diagnosis, I decide which outcome would be best for the patient and work back from there.   Hospitalization might be the final emergency department disposition unless her pain is much better c...
Source: Lions and Tigers and Bears - December 3, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Dirty Drugs
A 25-year-old man presents to the emergency department with palpitations. He reports injecting heroin, which he obtained from a new source, and is concerned that it was “not just heroin.” His initial vital signs include blood pressure 150/90 mm Hg, heart rate 130 bpm, respiratory rate 16 breaths per minute, and pulse oximetry 99% on room air. The patient appears uncomfortable, but is alert and oriented. His physical exam is remarkable for tachycardia and agitation.   The concern for an altered illicit drug is not uncommon in the ED. Cases and epidemics of tainted illicit drugs have been reported historically; the firs...
Source: The Tox Cave - December 2, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Collaborating On A Culture Of Health: Buncombe County, North Carolina
Editor’s note: This post is part of an ongoing series written for Health Affairs Blog by local leaders from communities honored with the annual Robert Wood Johnson Foundation Culture of Health Prize. In 2014, six winning communities were selected by RWJF from more than 250 applicants and celebrated for placing a priority on health and creating powerful partnerships to drive change. Located in the Blue Ridge Mountains, at the junction of the Swannanoa and French Broad Rivers, Asheville, N.C. is graced with natural beauty and an abundance of health and economic resources. But in 2012, many residents of Asheville and the s...
Source: Health Affairs Blog - December 2, 2014 Category: Health Management Authors: Paul Vest Tags: All Categories Disparities Health Philanthropy Nonmedical Determinants Public Health Source Type: blogs

Tension pneumothorax – time to change the old mantra?
Here is your ATMIST handover in resus: 28 year old male, injured 25 minutes ago, penetrating chest trauma, Asherman seal on anterior chest, RR 35, clearly deteriorating, high flow O2 administered.Initial observations: A – moaning, distressed, mask fogging, B – RR is now more like 40, with reduced expansion on the right, and absent breath soundsAre his neck veins distended? Trachea deviated? You are swift, brave and decisive – in goes the 14G cannula, 2nd intercostal space, mid clavicular line and…nothing happens. In fact, the patient continues to deteriorate…What is your next option?Following the recent ...
Source: Life in the Fast Lane - December 2, 2014 Category: Emergency Medicine Authors: Fraser Brims Tags: Education Respiratory 2nd ICS 5th ICS Ian Duffus tension tension pneumothorax Source Type: blogs

ECG changes in hypocalcemia: Mechanism
Prolongation of ST segment contributing to prolonged QT interval and corrected QT interval (QTc) is the hallmark ECG change in hypocalcemia. Hypocalcemia prolongs phase 2 of the myocardial action potential, thereby prolonging the ST segment. T waves are not generally affected in hypocalcemia because phase 3 of the myocardial action potential is not affected by calcium ions. Calcium channels close at the end of phase 2, with phase 3 being mostly related to potassium channel activity. Cases are on record in which severe hypocalcemia has mimicked ST elevation myocardial infarction in the emergency department. Coronary angiog...
Source: Cardiophile MD - December 2, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: DM / DNB Cardiology Entrance Source Type: blogs

Top stories in health and medicine, December 2, 2014
From MedPage Today: Medicare Tightens Non-Emergency Ambulance Use. Seniors living in three states will need prior approval from Medicare before they can get an ambulance to take them to cancer or dialysis treatments. NSAID Effective for RA Symptoms, Celebrex Easier on Stomach. Pelubiprofen, a non-steroidal anti-inflammatory drug (NSAID) that is related structurally and pharmacologically to ibuprofen, is as effective as celecoxib for reducing pain and stiffness in moderate to severe rheumatoid arthritis (RA) but it has a less favorable gastrointestinal (GI) profile than the COX-2 selective NSAID. Comorbidities Frequent in...
Source: Kevin, M.D. - Medical Weblog - December 2, 2014 Category: Journals (General) Authors: Tags: News Rheumatology Source Type: blogs

Accident and emergency survey 2014
Care Quality Commission (CQC) - The results of this annual patient survey finds that 80 per cent report a good A&E experience, but there are still problems with patient discharge and people waiting too long for pain relief. The findings demonstrate that departments are largely caring, however, more work needs to be done so that services are safer, are more effective and are more responsive to people’s needs. Report Press release (Source: Health Management Specialist Library)
Source: Health Management Specialist Library - December 2, 2014 Category: UK Health Authors: The King's Fund Information & Knowledge Service Tags: NHS measurement and performance Patient safety Quality of care and clinical outcomes Regulation, governance and accountability Source Type: blogs

A 50-something with severe chest pain and a normal ECG
A 50 something with no past history presented with sudden severe substernal chest pain with no radiation or associated symptoms.  The clinicians were very impressed with his presentation and were sure he was having an MI.  Here is his initial ECG:Not very revealing.  They had expected a positive ECG.A chest x-ray was completely normal.The first troponin was negative.  The pain persisted and another ECG was recorded 80 minutes later:There is now some nonspecific ST depression in V5 and V6.The second troponin returned negative at 5 hours.  The patient's pain persisted.The clinicians were certain that...
Source: Dr. Smith's ECG Blog - December 2, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs

Healthcare Update Satellite — 12-01-2014
According to this study recently published in the journal Neurology, etodolac (Lodine) (which may have been discontinued) creates the biggest risk of the medications studied. Think hand dryers are more “sanitary” than using paper towels? Think again. Bacterial counts in the air around jet air dryers were 27 times as high as those around paper towel dispensers and stayed around for up to 15 minutes after the drying ended. Bacterial counts for warm air dryers were about 6 times as high as those around paper towel dispensers. In other words, using a public bathroom with electric hand dryers is likely causing you t...
Source: WhiteCoat's Call Room - December 1, 2014 Category: Emergency Medicine Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs

Everyone cries when they bury their dead
When I was in college and decided I wanted to go to medical school, I kept a picture of a medical transport helicopter on my desk. It represented the excitement I wanted to experience one day. When I was in medical school, I loved nothing better than watching in the chaos of the trauma bay, helping as the blood spurted to the ceiling from a gunshot wound, assisting the insertion of IVs and chest tubes. 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 - December 1, 2014 Category: Journals (General) Authors: Tags: Physician Emergency Source Type: blogs

LITFL Review 158
Welcome to the 158th 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 WeekRethinking Pulseless Electrical Activity (PEA). Our current algorithms leave much to be desired in terms of PEA management. The ED ECMO crew discuss updated thoughts on PEA and using a different approach to diagnosis and treatment. [AS]The Best of #F...
Source: Life in the Fast Lane - December 1, 2014 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: LITFL review LITFL R/V Source Type: blogs

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