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Total 309 results found since Jan 2013.

Maintenance of Certification: American Board of Anesthesiology Ends 10-Year Exam; ABIM Considers New Continuous Testing Model As Well
Recently, the American Board of Anesthesiology (ABA) announced it will become the first medical board to restructure its Maintenance of Certification (MOC) program. The Maintenance of Certification in Anesthesiology Program, or MOCA, has required physicians to take a recertification test every 10 years. It will be replaced by a program known as “MOCA 2.0,” which will allow anesthesiologists to continuously assess themselves and identify knowledge gaps through an online portal, including a "MOCA Minute" that allows physicians to answer multiple-choice questions at their own convenience. This shift is noteworthy because ...
Source: Policy and Medicine - September 21, 2015 Category: American Health Authors: Thomas Sullivan Source Type: blogs

Research and Reviews in the Fastlane 099
This study took a sample from healthy pregnant patients (n=760) at different stages of gestation. They found, unsurprisingly, that d-dimer increases with gestational age, congruent with limited prior literature. They propose a continuous increasing d-dimer in pregnancy. With PE experts such as Dr. Kline proposing gestation adjusted d-dimer, this is a research space to watch. Recommended by: Lauren Westafer Systems and administration Del Portal DA, et al. Impact of an Opioid Prescribing Guideline in the Acute Care Setting. J Emerg Med 2015. PMID: 26281819 As many EDs implement voluntary opioid prescribing guidelines, this...
Source: Life in the Fast Lane - September 9, 2015 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Anaesthetics Cardiology Education Emergency Medicine Haematology Intensive Care critical care literature R&R in the FASTLANE recommendations research and reviews Source Type: blogs

Research and Reviews in the Fastlane 096
This study assessed the speed and accuracy of medication administration in simulated pediatric resuscitations. 10 teams consisting of physicians and nurses participated in a cross over study, so that they did one simulation with the new syringes and one without. Time to delivery of medications was quicker with the new syringes (47 versus 19 seconds, a difference of 27 seconds; 95%CI 21-33 seconds). Teams were also more accurate using the new color-coded syringes, with dosing errors occurring 17% of the time with the conventional approach and 0% of the time with the new syringes (absolute difference 17%; 95% CI 4-30%). Obvi...
Source: Life in the Fast Lane - August 19, 2015 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Airway Anaesthetics Cardiology Education Emergency Medicine Pediatrics Resuscitation Trauma EBM Intensive Care literature R&R in the FASTLANE recommendations research and reviews Respiratory urology Wilderness Medicine Tagg Source Type: blogs

Research and Reviews in the Fastlane 085
This study was a retrospective cohort study of 298 patients with confirmed PE. In this population, a 45% were HST negative while 55% were positive. From the HST-negative group, there were no death, CPR or need of thrombolysis compared with 6% of mortality and 9% of CPR or thrombolysis in the HST-positive group. It appears that HST is a good prognosis biomarker in patients with pulmonary embolism. Recommended by: Daniel Cabrera Emergency medicineLin BW. A Novel, Simple Method for Achieving Hemostasis of Fingertip Dermal Avulsion Injuries. J Emerg Med 2015. PMID: 25886984 Fingertip avulsion injuries are typically frustra...
Source: Life in the Fast Lane - May 27, 2015 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Airway Anaesthetics Cardiology Clinical Research Education Emergency Medicine Intensive Care R&R in the FASTLANE Social Media critical care examination literature recommendations research and reviews Source Type: blogs

Atrial Septal Defect (ASD)
Atrial septal defect (ASD) is one of the commonest congenital heart diseases in the adult. It is a defect in the septum separting the two upper chambers of the heart. The defect in the septum between right and left atrium can be in various locations. The commonest variety which occurs almost in the centre is known as ostium secundum type. If it occurs at the lower end, it is called ostium primum variety. Ostium primum defect is often associated with a cleft of the mitral valve and leakage of the mitral valve (mitral regurgitation). There is another type of defect known as sinus venosus ASD. Sinus venosus ASD can occur ne...
Source: Cardiophile MD - April 24, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs

A Relatively Narrow Complex Tachycardia at a Rate of 180.
I received a text message with this image: "Cardioversion didn't work.  Any thoughts?" What do you think?  The heart rate is 180.I was viewing this on my phone, but I saw what I thought were P-waves.  I could barely see them in lead II:There are probable P-waves at the arrows, but I wasn't certainI texted back: "Could be very fast sinus."There is also a wide QRS at 113 ms and a large R-wave in aVR, so sodium channel blockade is likely.   Common culprits in this situation are tricyclic overdose and cocaine toxicity (remember cocaine not only increases dopamine in central synapses, but is also a...
Source: Dr. Smith's ECG Blog - February 8, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs

Oculo cardiac reflex : An unique neural link between the eyes and Heart
Heart by development  originates from near  the same spot , where the brain develop (Neuralcrest) .Hence there is no surprise  though a richly a vascular organ, heart  retains many neural connections with brain .Eyeballs with it’s  extensive neural connections  can be considered  direct extension of brain. Occulo cardiac reflex . When the eyeballs or the ocular muscles are manipulated or massaged slowing of heart rate can occur .This is due to  a reflex called  Occulo cardiac reflex mediated by  vagal stimulation .This phenomenon is also referred to as  Aschner phenomenon The circuit Afferent _Trigeminal ...
Source: Dr.S.Venkatesan MD - February 3, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Neuro cardiology circuits for occulo cardiac reflex diver's reflex eye ball massage trigemianl vagal reflex Source Type: blogs

Research and Reviews in the Fastlane 068
Welcome to the 68th 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 - January 29, 2015 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Cardiology Education Emergency Medicine Infectious Disease Intensive Care LITFL Microbiology Psychiatry and Mental Health critical care examination LITFL R/V R&R in the FASTLANE recommendations Review Source Type: blogs

Research and Reviews in the Fastlane 067
This study looks into the question and finds that medical students randomized to having their simulated patient die report increased cognitive load and had poorer learning outcomes. The authors caution that this doesn’t mean we shouldn’t have simulated patients die but that we need to plan for this outcome intelligently.Recommended by: Anand SwaminathanPediatricsMaffei FA et al. Duration of mechanical ventilation in life-threatening pediatric asthma: description of an acute asphyxial subgroup. Pediatrics 2004; 114(3):762-7. PMID: 15342851Interestingly, while we often preach to not intubate the asthmatic…...
Source: Life in the Fast Lane - January 21, 2015 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Anaesthetics Cardiology Education Emergency Medicine Intensive Care Pediatrics R&R in the FASTLANE Resuscitation critical care examination recommendations Review Source Type: blogs

Hospitalized Woman with New Complaint Everyday Diagnosed with Broken Furnace Syndrome.
Fargo, ND - Bertha Jensen was hospitalized two weeks ago for chest pain rule out, but a new complaint every day has prevented doctors from sending her home during the cold winter months.  That is, until a breakthrough in discharge planning was discovered by her current Hospitalist. Consider Broken Furnace Syndrome for difficult winter discharges."When I was a resident in Minneapolis, I took care of at least a dozen cases of Broken Furnace Syndrome every winter," said Hospitalist Dr. David Penter, who is known for his uncanny ability to spot patients with ulterior motives from a mile away.Broken Furnace Syndrome is any...
Source: The Happy Hospitalist - January 7, 2015 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs

Research and Reviews in the Fastlane 064
This study showed a poor specificity (48%) for two tools in identifying stroke patients in the field speaking to the need for better tools and/or better training. A low specificity means lots of patients without disease may be treated.Recommended by: Anand SwaminathanEmergency Medicine, Neurology Hamaekers AE, Henderson JJ. Equipment and strategies for emergency tracheal access in the adult patient. Anaesthesia. 2011 Dec;66 Suppl 2:65-80. PMID: 22074081How to access the cricothyroid membrane….or not! – a great review of the literature for different ways of gaining emergency airway access via the cricothyroid...
Source: Life in the Fast Lane - December 31, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Cardiology Education Emergency Medicine Gastroenterology Intensive Care Neurology Ophthalmology Pediatrics Pre-hospital / Retrieval Resuscitation critical care Press Ganey R&R in the FASTLANE recommendations Review Source Type: blogs

Heparin antidote – protamine sulphate
Heparin antidote – protamine sulphate Brief Review Abstract: Heparin antidote is protamine sulphate. It is used when quick reversal of the action of heparin is needed as in case of bleeding or after an open heart surgery. Low molecular weight protamine is under development. Protamine sulphate is a polypeptide, originally derived from salmon sperm, which binds to unfractionated heparin and neutralizes its effect. Hence protamine sulphate has been widely used to reverse the anticoagulant effects of heparin, especially after open heart surgery.1 It is also the treatment of choice in case of significant bleeding with he...
Source: Cardiophile MD - December 24, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Low molecular weight protamine paradoxical bleeding with protamine protamine allergy protamine sulphate 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

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

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