Quick Poll: Procedures on the recently deceased?

The Annals of Emergency Medicine will soon be publishing the following article:

The Ethics of Using the Recently Deceased to Instruct Residents in Cricothyrotomy by Dr. Andrew Makowski

In light of past experiences, and in the context of my “other” occupation as a clinical ethicist, I posted a link on Twitter and got this response from Dr. Casey Parker, of BroomeDocs.com:

 

Followed by this, from Dr. Seth Trueger:

 

This led to a few other responses from some very smart people on Twitter.  See the full conversation, Storified, here

Now, although I was happy to read the piece and felt that Dr. Makowski really did a great job of getting down to the key issues, I’ve begun to wonder.   How common is the practice of performing invasive procedures on recently deceased patients in the Emergency Department?  Have you seen this happen?  Heard of it?  Ever participated?

Please help us out by taking a minute to respond to this short poll (also embedded below).  It’s just my attempt to get a sense of how the EM and Critical Care communities – at least those who are online – feel about the question.  

Thank you! 

 ~David  

~Many thanks to Dr’s Parker and Truger who took the time to give the survey a once-over prior to release. 

 

If you have any trouble with the embedded form, just follow this link: http://goo.gl/forms/5CXxmDMXpC  – please share with your friends!

The poll will be accepting responses until Feb. 6 at 23:59, US ET (GMT-5).

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Small Bowel Obstruction Likelihood Ratios.

A 78-year old man presents with abdominal pain and decreased oral intake. His vitals are normal but he looks uncomfortable. After you introduce yourself, you palpate his abdomen which is diffusely tender. Your immediate gestalt is “Small Bowel Obstruction” but you’re not sure why. Frankly, you think, “I can do better than gestalt.”

Can you?

1. What are the various positive and negative likelihood ratios for clinical and radiographic features of a small bowel obstruction? (recall +LR>10 is considered useful for genuinely increasing suspicion of disease, -LR <0.1 is considered useful for genuinely decreasing suspicion of disease).

1a. Previous surgery?

1b. Abdominal distension?

 

2. What is the sensitivity and specificity of imaging modalities for small bowel obstruction?

2a. A normal abdominal X-ray?

2b. Air fluid levels seen on abdominal X-ray

2c. CT findings.

 

3. In a trained EM provider, what are the likelihood ratios for small bowel obstruction using bedside ultrasound?

 

Your questions answered!

1. What are the various positive and negative likelihood ratios for clinical and radiographic features of a small bowel obstruction? (recall +LR>10 is considered useful for genuinely increasing suspicion of disease, -LR <0.1 is considered useful for genuinely decreasing suspicion of disease).

1a. Previous surgery? +LR 3.8 (surprisingly unhelpful), -LR 0.19 (pretty good)

1b. Abdominal distension? +LR 5-16 (not helpful or helpful, depending on study cited, and patient). -LR 0.4 (not that helpful).

 

2. What is the sensitivity and specificity of imaging modalities for small bowel obstruction?

2a. A normal abdominal X-ray? sensitivity 66-77% (many false negatives).

2b. Air fluid levels seen on abdominal X-ray? specificity 50-57% (many false positives).

2c. CT findings? 92% sensitive and 93% specific. This is the “gold standard.”

 

3. In an EM provider with “brief training”, what are the likelihood ratios for small bowel obstruction using bedside ultrasound? +LR 9.5 possibly truly useful), -LR 0.04 (impressive). Looking for dilated loops of bowel >2.5cm across and “fluid moving around” instead of a bunch of air.

 

Want to know how to do ultrasound for small bowel obstruction?

http://www.ultrasoundoftheweek.com/uotw-20-answer/

http://5minsono.com/sbo/

http://www.ultrasoundpodcast.com/2012/10/episode-36-small-bowel-obstruction/

 

Other resources:

FOAMcast episode 23 on SBO and Acute Mesenteric Ischemia. 

Rosen’s Chapter 92.  Roline and Reardon. Disorders of the Small Intestine.

Tintinalli Chapter 45. Hess. Intestinal Obstruction and Volvulus.

 

PulmCCM launches new educational content section: your submissions welcome

Hot off the blog-press is PulmCCM's new Educational Resources section. This exciting new endeavor will be a forum for sharing your knowledge with the world. If you've created a useful educational clinical resource, why limit your audience to your colleagues at your local institution? Increase your impact exponentially by posting your work on PulmCCM where thousands can learn and benefit. [... read more]

The post PulmCCM launches new educational content section: your submissions welcome appeared first on PulmCCM.

the Gatekeeper.

Download PDF

“There are stories that are true, in which each individuals tale is unique and tragic, and the worst of the tragedy is that we have heard it before, and we cannot allow ourselves to feel it too deeply. We build a shell around it like an oyster dealing with a painful particle of grit, coating it with smooth pearl layers in order to cope. This is how we walk and talk and function, day in, day out, immune to others’ pain and loss. If it were to touch us it would cripple us or make saints of us; but, for the most part, it does not touch us. We cannot allow it to.”
Neil Gaiman

 

For the most part it does not touch us. For the most part we make pearl.

…..for the most part.

 


Photo: one of our amazing Triage Nurses keeping the gate.


LITFL Review 166

LITFL review

Welcome to the 166th 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

resizerIt’s Junior Doc changeover time in sunny blighty.  Point your new Juniors to this fantastic series from the team in Virchester.  This podcast talks over the basics of Problems in Early Pregnancy. [CC]

 

Helping to get around the difficulty of group learning and shift work in the ED, @ACPEducate has added a new feature, Google hangouts on EM-focused topics, hosted on Jonathan Downham’s Critical Care Practitioner site. Scroll halfway down the page to access the video clip. Much more in the pipeline over the next few weeks! [SL]

 

The Best of #FOAMed Emergency Medicine

The Best of #FOAMcc Critical Care

The Best of #FOAMtox Toxicology

  • A review of the evidence for the use of haemodialysis in lithium toxicity from the team over at Poisons Review. [CC]

The Best of #FOAMus Ultrasound

#The Best of #FOAMped Pediatrics

The Best of Medical Education and Social Media

News from the Fast Lane

Reference Sources and Reading List

Brought to you by:

The post LITFL Review 166 appeared first on LITFL.

This is Australia

Linda Downs station windmill, images courtesy of Holmes family

Linda Downs station windmill, images courtesy of Holmes family

Its Australia day today, January 26th.
I live in a land of contrasts. Its summer here and in the far north, its tropical storm season. So there has been a lot of rain. Still many parts of our state are in official drought. Last year was hottest ever on record. In my patch of retrieval/PHARM turf, the rains have brought a welcome relief to many though.
I enjoy flying amongst some of the most beautiful terrain and displays of Mother Nature on Earth.
So here’s an updated view from my office. Have a great Australia Day wherever you are!

2014-12-05 19.03.30
2014-12-05 19.03.35

Fence line underwater at Linda Downs

Fence line underwater at Linda Downs

Linda Downs station & the mighty Georgina River in flood

Linda Downs station & the mighty Georgina River in flood


Filed under: Prehospital medicine, Rural medicine Tagged: 2015, australia-day