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Total 309 results found since Jan 2013.

Unusual calls in cardiology : A Pacemaker lead and a clavicle fracture !
A tense anesthetist  calls for help ! I had an unusual cardiac consult last week .A middle aged man who was to undergo routine ortho surgery wanted  a cardiac clearance. It was  a through and through fracture of clavicle , why do they need a cardiology opinion , it seemed a  simple  procedure I asked over phone The anesthetic  fellow who was  in charge of the patient told me ,”There is a wire just going parallel to the clavicle sir .I  believe it is pacemaker lead” I agreed to see the patient immediately This was the X-ray It was obvious why they got tensed up  as the pacemaker wire criss -crossed sur...
Source: Dr.S.Venkatesan MD - July 31, 2014 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized Source Type: blogs

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

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

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

Research and Reviews in the Fastlane 037
Conclusion: Use of an age-adjusted d-dimer threshold reduces imaging among patients age <50 years with a Revised Geneva Score ≤ 10. While the adoption of an age-adjusted d-dimer threshold is probably safe, the confidence intervals surrounding the additional 1.5% of PE that was missed using an age-adjusted threshold necessitate a prospective study before this practice can be adopted into routine clinical care. Recommended by: Salim R. Rezaie,  Jeremy Fried Read More: The Adventure of the Golden Standard (Rory Spiegel) Resuscitation Wik L et al. Manual vs. integrated automatic load-distributing band CPR with equal ...
Source: Life in the Fast Lane - July 2, 2014 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Anaesthetics Cardiology Emergency Medicine Featured General Surgery Health Infectious Disease Intensive Care Neurology Neurosurgery Radiology Resuscitation Trauma critical care literature R&R in the FASTLANE recommendations Source Type: blogs

Research and Reviews in the Fastlane 035
This study suggests that antiemetics are not nearly as potent as widely believed. These drugs have been shown to be effective in preventing nausea (i.e. pretreatment for chemo) but it’s appears that the mechanism for halting nausea is different than that for preventing it. Recommended by: Anand Swaminathan Read More: Nausea? We’ve Got Placebo for That The Best of the Rest Emergency Medicine, Pulmonary 1. Kew KM, Kirtchuk L, Michell C. Intravenous magnesium sulfate for treating adults with acute asthma in the emergency department. Cochrane Database Syst Rev. 2014 May 28;5 PubMed ID: 24865567 This Cochr...
Source: Life in the Fast Lane - June 18, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Anaesthetics Cardiology Emergency Medicine Evidence Based Medicine General Surgery Intensive Care Palliative care Pediatrics Respiratory Resuscitation Trauma critical care literature R&R in the FASTLANE recommendations resear Source Type: blogs

Research and Reviews in the Fastlane 034
This study was hoping to show that NAC will keep all those contrast CTs from giving our patients contrast induced nephropathy (CIN). It did not. It looks like the real answer is fluids (and that maybe we are not killing off so many kidneys anyway).  Recommended by: Zack Repanshek Pediatrics 9. Wang J, Xu E, Xiao Y. Isotonic versus hypotonic maintenance IV fluids in hospitalized children: a meta-analysis. Pediatrics. 2014 Jan;133(1):105-13 PubMed PMID: 24379232 Meta-analysis of 10 RCTs looking at maintenance IV fluids in hospitalized pediatric patients. The study found a RR = 2.24 for hyponatremia in comparing hypo...
Source: Life in the Fast Lane - June 12, 2014 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Anaesthetics Cardiology Emergency Medicine Featured Health Intensive Care Pediatrics Pre-hospital / Retrieval Renal Resuscitation Trauma critical care literature R&R in the FASTLANE recommendations research and reviews Source Type: blogs

Longevity and Long-Term Care: The Medical Crisis of the 21st Century : Part 2
Throughout the 20th century, most Americans saw “longevity” as a goal. If we took care of our bodies, we reasoned, we could “live longer and better.” But in the 21st century, I suspect that some of us will learn to fear “longevity” the way we now fear cancer. This is the second in a series of posts that will explore the anguish that some experience when they live into their late eighties and nineties–and how we, as a society, can address the hardships of “old, old age.”                                            Senile Dementia    Thanks to better diets, exercise, and advances...
Source: Health Beat - May 19, 2014 Category: American Health Authors: Maggie Mahar Tags: Knocking on Heaven's Door Alzheimer's Alzheimer's drugs Compassion and Choices fast medicine Long-term care longevity over-treatment pacemakers palliative care senile dementia slow medicine Uncategorized Consumer Reports Katy B Source Type: blogs

Can we measure diastolic blood pressure by palpation ?
Learned physicians will agree, BP recording by classical auscultatory   method  is  not always an  easy task ! Such an important clinical sign is left to the whims and fancies of human ear’s ability to detect  of low pitched vibrations emanating from deep seated brachial artery .(5 phases of Korotkoff ) Since  Korotkoff sounds are low frequency sounds , it is best heard with bell of the stethoscope ? How many of us do it ? There is little surprise , two BP  recordings  rarely  match even if it’s performed minutes  apart  ! While phase one is easily identified , the gap between phase 4 and 5 can be v...
Source: Dr.S.Venkatesan MD - March 31, 2014 Category: Cardiology Authors: dr s venkatesan Tags: Clinical cardiology blood pressure measurment how to measure diastolic bllod pressure by palpation korrotkoff sounds measuring bp without stethoscope Source Type: blogs

SGR Fix The Final Deal?
On Thursday, February 6th, a bipartisan group of congressional lawmakers announced they had reached a deal on legislation to repeal Medicare's widely criticized sustainable growth rate formula, replacing volume-based payments with measures that reward care efficiency and quality. The legislation is described below, but stakeholders should be cautious about its prospects given the remaining political hurdles it faces. SGR Repeal and Medicare Provider Payment Modernization Act The bill, the SGR Repeal and Medicare Provider Payment Modernization Act, was jointly announced by the chairmen and ranking minority members of th...
Source: Policy and Medicine - March 3, 2014 Category: Health Medicine and Bioethics Commentators Authors: Thomas Sullivan Source Type: blogs

New and Established Patient E/M Definitions (CMS vs. CPT ®)
I get lot of requests from readers of The Happy Hospitalist asking how to know if a patient is a new or established patient. Identifying the correct classification will prevent delays or denials of payment.  Many evaluation and management (E/M) codes are by definition described as new or established.  This lecture will attempt to explain various important clinical aspects related to this determination. Keep in mind while the Centers For Medicare& Medicaid Services (CMS) uses Current Procedural Terminology (CPT) codes, CMS definitions do not always agree with CPT ® definitions. This discre...
Source: The Happy Hospitalist - February 27, 2014 Category: Internal Medicine Authors: The Happy Hospitalist Source Type: blogs

New and Established Patient E/M Definitions (CMS vs. CPT®)
I get lot of requests from readers of The Happy Hospitalist asking how to know if a patient is a new or established patient.  Identifying the correct classification will prevent delays or denials of payment.  Many evaluation and management (E/M) codes are by definition described as new or established.  This lecture will attempt to explain various important clinical aspects related to this determination.  Keep in mind while the Centers For Medicare & Medicaid Services (CMS) uses  Current Procedural Terminology (CPT) codes, CMS definitions do not always agree with CPT® definitions.  This di...
Source: The Happy Hospitalist - February 27, 2014 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs