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I believe that Dr Rowe is pound-for-pound the best EM researcher in Canada. He completed the majority of his research on a shoe-string budget while managing a formidable career. Now the Associate Dean of Research at the University of Alberta, a Canadian Tier 1 Research Chair and former Senior Associate Editor CJEM, he came to share his experience as a clinical researcher. Through his familiar blue slides and jocular presentation style Brian dropped some important pearls about how to get published.
Brian’s published a book, 28 book chapters and over 385 peer-reviewed manuscripts. It goes without saying he has a wealth of experience that, he humbly admits, came with many failures along the way. He stressed perseverance and an ethical duty to publish as ultimately we’re doing it for the patients’ benefit.
PUBLICATION BIAS INFLUENCES SYSTEMATIC REVIEWS and Systematic Reviews INFLUENCE PATIENT CARE
from http://doylepartners.com/
Guidelines/Cochrane etc all base their advice on what’s out there. Ultimately the truth may not be revealed if we don’t publish – especially if the results are negative.
Sir Ian Chalmers ” It is unethical to conduct research and NOT to publish it”
Okay I’ve got you thinking that you actually want to conduct research. How do you go about it?
“Every paper has a home. It’s your job to find the that home” Dr Brian Rowe
Y0UR M1ND 15 R34D1NG 7H15 4U70M471C4LLY W17H0U7 3V3N 7H1NK1NG 4B0U7 17
‘A good paper is like fine wine…it needs to age and mature a bit.’ Anonymous
Editors often make decisions about your paper in less than 5 minutes. You can appease them by:
If you simply cannot do revisions required [for example if it would compromise the intended objective] – try another journal. Make sure to use the comments that they gave you in the next submission.
“I’ve been rejected more times than a pimple-ridden teenager” Brian Rowe
In the world of journal submissions, rejections are common. You are not alone. High quality journals like CMAJ only accepts 5-7% of submitted manuscripts [NEJM 2%]
I’d like to acknowledge my friend and brilliant colleague Rob Woods for his edits. As always, comments are welcome.
The post Dr Brian Rowe on Getting Your Article Published appeared first on ERMentor.
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| Probable junctional rhythm, with wide QRS (162 ms) and peaked T-waves. Obvious hyperkalemia. But there is also ST elevation in III and aVF, with reciprocal ST depression in I and aVL, and ST depression in V2 and V3. Is there also an infero-posterior STEMI? |
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| Sinus rhythm with a normal QRS at 94 ms, with hardly any change in the serum potassium. All the difference is in calcium administration. The ST elevation is gone. |
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| Sinus rhythm with wide QRS at 133 ms and obvious Peaked T-waves with obvious hyperkalemia. But there is also significant ST elevation in V1-V3. Is there anterior STEMI? |
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| QRS = 88 ms and ST elevation is now normal, not excessive. |
3.5 out of 5 stars
Survival of Acute Hypernatremia Due to Massive Soy Sauce Ingestion. Carlberg DJ et al. J Emerg Med 2013 Jun1 [Epub ahead of print]
This fascinating case report from the University of Virginia Medical Center describes a 19-year-old male who — apparently on a dare — ingested a quart of soy sauce (17-18% sodium chloride).
When brought to the emergency department 2 hours later he unresponsive (GCS = 3) and had possible seizure activity. His pulse rate was 147 bpm. Head CT was unremarkable. Labs were significant for a sodium of 177 mmol/L and glucose of 384 mg/dL. Four-and-a-half hours after ingestion his sodium was 191 mmol/L.
At that point, the treating physicians reasoned that since a sodium level this high has been strongly associated with fatality and the development of hypernatremia in this case was quite rapid, it would be reasonable to correct the electrolyte abnormality quickly.
The patient received 6 liters of 5% dextrose (D5W) over 30 minutes, followed by free water at a slower rate. His mental status gradually improved, and 32 hours after ingestion his sodium level was 145 mmol/L. At follow-up one month after the admission his mental status was reported as normal and he was “performing well on college examinations.”
The authors state that, to their knowledge, the corrected sodium level of 196 mmol/L is the highest ever reported from acute salt ingestion in a patient who survived.
Chronic hypernatremia should be corrected slowly, since the brain adapts over time to a high sodium level by producing idiogenic osmoles. In this situation, reversing hypernatremia too rapidly can cause cerebral edema, seizures, or herniation. In the case reported here, the sodium level increased so acutely there was no time for this adaptive mechanism to occur.
There are many videos on YouTube of adolescents and young adults taking the so-called “soy sauce challenge.” This seems even less wise than enduring the “cinnamon challenge,” which TPR has reported on before.
Tip o’ the hat to @ToxTalk, who alerted me to this article.
Gday,
I was lucky enough to record a new podcast with Dr Seth Trueger – inspired by the recent online discussions around lactate, or more specifically lactate-clearance as a marker, or a goal of therapy in the treatment of septic patients.
This is a topic my team will be covering at the ACEM Winter Symposium here in Broome this weekend. It has been a weird preparation for our discussion in front of a whole bunch of ED Specialists – everytime I sit down to plan the talk I see another FOAMed resource or opinion which changes the landscape.
This podcast needs a bit of background in order for the whole conversation to make a bit of sense.
Lactate Clearance has been around for 10 years or so as a therapeutic goal – or at least of a marker of “winning” when we are resuscitating septic patients.
Nguyen, Rivers and co popularised lactate clearance as a marker of improvement in 2004 – a few years after the original EGDT trials by Rivers.
Then in 2009 Jones et al did a comparison between SvcO2 and lactate as markers to guide therapy in sepsis resuscitation – they showed they both worked equally as well. Jones et al showed it was “non-inferior” to SvCO2 to guide resuscitation.
Then in March this year Prof. Paul Marik and Dr Renaldo Bellomo wrote a review article titled “Lactate clearance as a target of therapy in sepsis: a flawed paradigm.” In this paper they utilise a lot of pathophysiology and common sense to show why the traditional concept of lactate as a marker of anaerobic metabolism was a flawed concept.
This provoked a short sharp retort from Dr Scott Weingart on his Emcrit podcast (much shorter than our longish dissection!) Have a listen to his thoughts then carry on to our discussion.
I was supposed to be taking the position that lactate clearance is a flawed concept – and Seth was taking the pro stance. But we pretty much ended up agreeing on everything!
OK. Onto the podcast. Love to hear you comments Play below or DOWNLOAD Direct here
Casey
TechTool review of CT Scanning in Critical and Emergency Care by Frasford Pty Ltd on iPad
CT Scanning in Critical and Emergency Care aims to teach ED health professionals to better understand CT scans and pick up common abnormalities. It contains tutorials that work through CT interpretation cases
Design and User Interface
The app looks great and is so simple and pleasant to use. The screens are all clear and the actual scan graphics and accompanying audio are faultless. What more could you ask for?
[DDET CT Scanning on iPad 4]
[/DDET]
Clinical Content
There is a lot of great educational content in here. There are over 60 cases which include a clinical scenario and a CT scan. For each case, you can:
Cost
Room for Improvement
Overall
- I really enjoyed using this app and it has advanced my adult CT interpretation ability by leaps and bounds.
- It’s an excellent way of providing CT education, and has common ED presentations that ED docs should be expected to recognise.
- A great use of mobile app technology to deliver effective medical education
The post TechTool Thursday 031 appeared first on Life in the Fast Lane medical education blog.
Simultaneously in your ED you encounter;
You have fentanyl, midazolam and ketamine in your pharmacy. Propofol is nowhere to be found. Of the three drugs, which would you use, all by itself, to provide procedural sedation for these patients?
Ketamine is an excellent choice for moderate/procedural sedation in the pediatric ED because it has a short durtauion of action, fast onset and low risk of side effects. Its street drug cousin is PCP – but I don’t usually see kids ripping the doors off of cop cars after getting it. The drug is either effective, or it isn’t and via the binding of MDMA receptors it produces a “lights are on but nobody’s home” or trance-like state. It provides;
It doesn’t mess with;
The initial IV dose is 1 to 1.5 mg/kg.with repeat doses of 0.5 to 1 mg/kg given q5-10 minutes as needed. If you are also giving Propofol, you can give 0.5 mg/kg. The IM dose is 4 to 5 mg/kg with a repeated IM dose of 2 to 4 mg/kg after 10 minutes if needed. IM dosing takes longer and has a higher risk of side effects, so I prefer IV. More on that later.
Upon administration, which is generally given over 2 minutes, you will see;
The duration of action of a single IV dose is 5-10 minutes, whereas IM doses can last 30 minutes on average.
Overall the risk of adverse effects is low (<4%) and may be associated with age <2 years of >13 years, initial dose in excess of 2.5mg/kg, total dose >5mg/kg and coadmihstration with midazolam, atropine/glycopyrrolate. The three most common are;
This is the most common, and is the basis for making sure that patients are NPO for at least a little bit. The issue of how long to fast before ED procedures is complicated – and I’ll address it in a future post. But suffice it to say I believe that 2 hours after clears, and 4 hours after solids is fine – though others may disagree. IM increases the risk 26% vs 12% according to a RCT by Roback et al. Alhough I don’t always give it, studies have shown that premedication with ondansetron reduces the risk of vomiting with a number needed to treat of 13. The overall frequency is roughly 8% and peaks around age 12.
More common in children older than 15, and in those with a prior history of psychosis. Severe cases can resemble Godzilla rising from the ocean. MIdazolam does not decrease the risk of emergence reactions, and may increase the risk of other side effects. Therefore I do not routinely administer it with my patients, unless I have exceeded 4mg/kg of ketamine.
Very rare (1/5,000-10,000) and responds to positive pressure ventilartion with a bag valve mask, as the pressure will “pop” open the vocal cords. This appears to be an idiosynchratic reaction. With effective PPV it generally resolves in 1-2 minutes. In a single observational study the IM route was associated with an increased risk of laryngospasm OR 5.2; 95% CI 2.3-11.9. The aforementioned study by Roback did not show a significant difference in the rates of laryngospasm however.
The post Briefs: Special K is not just for breakfast appeared first on PEM Blog.
Das ist natürlich eine komische Frage. Ich glaube, man kann sicherlich sagen, dass man von einem Arzt keine schriftstellerischen Fähigkeiten erwartet. Man erwartet aber, dass Textstücke, Bestätigungen und natürlich auch Arztbriefe grammatikalisch einwandfrei und konzise geschrieben sind. Dass sie inhaltlich natürlich auch korrekt sein müssen, versteht sich von selbst. Und dann gibt es ja noch die “Beschwerdeschreiben” und natürlich auch noch die Kommunikationen innerhalb des Kollegenkreises.Vielleicht sollten Sie sich verinnerlichen, dass jedes verfasste Schriftsstück ein “Spiegel” des eigenen ichs ist. Und so findet auch eine Beurteilung von anderen statt.
Wer wissenschaftlich aktiv sein will bzw. seine Doktorarbeit (oder sogar Habilschrift) verfassen will, für den ist es umso wichtiger, ein paar Leitsätze zu kennen, wie ein Text zu erstellen ist. Und das ist zu erlernen und eigentlich keine Hexerei.
Wie schaut es in der Realität aus? Nun …. will dazu nicht viel sagen. Vielleicht nur die kurze Bemerkung: Es gibt immer Möglichkeiten, den eigenen Stil zu verbessern.
In der “Die Zeit” war vor nicht allzu langer Zeit ein von Autoren zusammengestellte “Stilkunde” im Deutschen. Ich finde diese Artikel sehr sehr gut und auf den Punkt geschrieben. Nehmen Sie sich doch mal Zeit, Ihre eigenen Textentwürfe “laut” vorzulesen …. es hilft! Also, viel Spass dabei 
Bilindiği gibi acil servis hekimleri hastalardaki semptomları değerlendirirken öncelikle en kötü ve en acil olan seçenekleri eleyerek işe başlar. Örneğin göğüs ağrısı, bir acil hekimi için ekarte edilene kadar enfarktüs, aort diseksiyonu, pnömotoraks ve benzeri mortal tanılardır. Bu tanıları ekarte ederken bir takım algoritmalar kullanılır. Bugün sizinle paylaşacağım vakayı ise itiraf etmeliyim ki bu algoritmalar içine oturtamadım. Bazı soruların aklıma takılması üzerine kısa bir literatür taraması yapıp sonuçları sizlerle paylaşmak istedim.
28 yaşında erkek hasta acil servise göğüs ağrısı ile başvuruyor. Yaklaşık olarak on gündür retrosternal bölgede huzursuz edici bir ağrı anlatıyor. Ağrıyı azaltan artıran bir şey yok. Kardiyak risk faktörleri yok. Nefes darlığı şikayeti yok. Son iki gündür acil servis başvurusu olan hastaya miyalji tanısı konulmuş ve iki gündür ağrı kesici kullanıyor.
Tansiyon basıncı 110/80 mmHg Nb: 100/dk SO2 : %99 SS: 20/dk Ateş:37,1oC. Fizik muayenede patolojik bulgu saptanmadı. Çekilen EKG’si tamamen normal olan hastanın kardiyak değerleri de normal sınırlarda geldi. Wells skoru düşük olan hastanın D-dimer’i normal olarak geldi. Çekilen akciğer grafisi normaldi.
Bu noktadan sonra hastaya toraks tomografisi çekildi. (Açıkça söylemeliyim ki gözden kaçabilecek küçük bir spontan pnömotoraks haricinde belirli bir ön tanım yoktu. Bu vakada hastanın ısrarlı başvurusu olmasa tomografi çekmeyebilirdim.)
Hastada spontan pnömomediastinum (SPM) tanısı konulması üzerine göğüs cerrahisine yatırıldı. 5 gün oral beslenmesi kesilen ve yatak istirahatına alınan hastanın şikayetlerinin gerilemesi üzerine taburculuğu yapıldı.
1- Böyle bir hastada çok kolaylıkla non-spesifik göğüs ağrısı tanısı konulabilir. Bir acil hekimi hangi durumlarda SPM ön tanısı düşünüp toraks tomografisi istemelidir?
2- Bu hastalara tanı konulamazsa ciddi bir mortalite ve morbitide ile karşılaşılır mı?
Tetikleyebilecek herhangi bir hastalığı olmayan kişilerde mediastinumda serbest hava görünmesi olarak tanımlanan SPM ilk kez 1939 yılında Hamman tarafından tanımlanmış.(1) (Kendi ismiyle anılan bulgusu da var. Hamman bulgusu: Kalp oskültasyonunda kalp atımlarıyla beraber duyulan çıtırtı-krepitasyon sesi.) Literatürde yakın yıllarda birisi 2007 yılında diğeri ise 2012 yılında yayınlanan iki tane SPM olgularından oluşan vaka serileri yayınlanmış.
Macia ve arkadaşlarının 2007 yılında yayınladığı retrospektif çalışmada 1990 ve 2006 yılında başvuran 41 SPM’li hasta incelenmiş. Vakaların %82,9 erkek iken %17,1’i bayan hastaymış. %85’inde göğüs ağrısı semptomu mevcutken %49’unda nefes darlığı %44’ünde boyun ağrısı mevcutmuş. Yine boyun bölgesinde cilt altı amfizem %66 vakada mevcutken sadece %29 hastada göğüs duvarı üzerinde cilt altı amfizem saptanmış. %12 hastada Hamman bulgusu mevcutmuş. Önemli bir veri ise hastaların %78’ine semptomları ve akciğer grafisi ile tanı konulabilmiş. Diğer 7 hastaya ise toraks BT ile tanı konulmuş. Hastaların %41,7’sinde lökositoz saptanmış.(2)
Tüm vakalar hastaneye yatırılmış. %85,4’üne analjezi verilirken %68,3’üne yatak istirahatı %29,3’üne ise oksijen desteği sağlanmış. Ek olarak 10 hastaya bronkodilatör tedavi verilirken 5 vakaya antibiyotik tedavisi eklenmiş. Hiçbir hastada ciddi bir komplikasyon gelişmemiş.(2)
Dr. Ji-Yoon Ryoo ise 1999 ile 2012 yıllarında başvuran 32 SPM olgusunu retrospektif olarak inceleyip 2012 yılında yayınlamış. Vakaların %78,1 erkek hastayken %21,9’u bayan hastaymış. Sadece hastaların %6’sı 30 yaş üstüymüş. Bu seride de %51,2 ile göğüs ağrısı en sık semptom iken boyun ağrısı %23,3 ile en sık ikinci semptom, %14 ile nefes darlığı ise üçüncü sık semptom olarak belirtilmiş. 32 vakanın 27’sine (%84,3’ü yazar yüzdeliği kendi belirtmemiş) sadece akciğer grafisi ile tanı konulurken geri kalan hastalara boyun grafisi ve toraks BT ile tanı konulmuş. 14 hastanın (%43) lökositozu mevcutken bunların sadece 4 tanesi 15.000/μL değerinin üzerinde saptanmış.(3)
25 vaka hastaneye yatırılırken yatak istirahatı ve oksijen desteği sağlanmış. Paralitik ileus gelişen tek hastada intravenöz sıvı desteği sağlanmış. Antibiyotik tedavisi uygulanmamış. Ciddi bir komplikasyon bildirilmemiş.(3)
ÖNEMLİ NOT: Bu noktadan sonra yazılanlar yukarıdaki makaleler ışığında yazarın sesli düşüncüleridir. Herhangi bir bağlayıcılığı yoktur. Yazar yorumlarınızı beklemektedir.
Bu veriler ışığında aslında SPM vakalarının çoğunun dikkatli bir muayene ve basit akciğer grafisiyle tanı alabileceğini görüyoruz. Tanı alamayan ama klinik bulgulardan özellikle boyun ağrısı ve cilt altı krepitasyonu olan hastalarda tomografi ile SPM tanısının üstüne gidilebileceği görülmekte. Yukarıda sunulan hastada olduğu gibi sadece göğüs ağrısı olan bir hastada ise bu tanının kolaylıkla atlanabileceğini düşünmekteyim. Ancak atlanılması durumunda bile yukarıdaki olgu serilerinin sonlanmaları düşünüldüğünde ciddi bir mortalite ya da morbitide ile karşılaşılmayacağı görülmektedir.
Kaynakça;
1. Hamman L. Spontaneous mediastinal emphysema. Bull Johns Hopkins Hosp 1939;64:1-21.
2. Macia I, Moya J, Ramos R, Morera R, Escobar I, Saumench J, et al. Spontaneous pneumomediastinum: 41 cases. Eur J Cardiothorac Surg 2007;31:1110-4.
3. Ryoo JY. Clinical analysis of spontaneous pneumomediastinum. Tuberc Respir Dis (Seoul). 2012 Sep;73(3):169-73. Epub 2012 Sep 28.
Dr.Şeref Kerem ÇORBACIOĞLU
29/05/2013 -- Travmada direk grafi mi? Pan-CT mi? (0)
28/01/2013 -- Acilde Trombolitik Tedavi: Üç Farklı Klinik Durum (0)
24/01/2013 -- Resüsitasyon Odasında BT (0)04/02/2013 -- Etomidat efsanesi bitti mi? (0)The post NADİR BİR GÖĞÜS AĞRISI VAKASI appeared first on acilci.net.
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A quick heads up about this year’s not-for-profit Bedside Critical Care conference in Cairns.
Last year’s conference was great — I got to invite people to come join the FOAM party using one of my favourite medical stories (together with plenty of slides of phallic vegetables, of course), as well have give a heap of tox talks and workshops over 5 days. Sadly, I won’t be there this year, but there will be even better people there instead!
This is what is happening in Cairns, north Queensland from September 23rd to 27th 2014 at Shangri La on the marina:
This year’s themes include:
Check out the program here, it is packed with good stuff. Register here. The whole thing is organised by my SMACC co-conspirator Roger Harris and backed up by the IntensivecareNetwork.com. If you’re planning to go, remember to book early so you don’t miss out accommodation during the holidays.
Have fun getting meducated!
The post Bedside Critical Care 2013 appeared first on Life in the Fast Lane medical education blog.
The Critical Care Conference with a difference is back and is booking up fast!
E’ mattina, e al cambio turno ci viene detto” c’è poi il sig Alberto, è stato fatto tornare oggi per una fibrillazione atriale insorta ieri mattina, purtroppo è ancora in FA e penso che dovrai procedere con la cardioversione elettrica…” Uno degli specializzandi, da poco arrivato in pronto soccorso, argomenta:” cosa usate per il monitoraggio [...]
The post Capnografia e sedazione procedurale appeared first on EM Pills.
Stopping a trial early for benefit is like winning money gambling at a casino. If you've ever won money, why aren't you there right now, winning more?Take any of the big games where you play against the House: slot machines, blackjack, or craps. I like craps -- it's fun, when you win everybody wins (except the one guy sitting next to the dealer betting wrong), and I hear that it's the best odds in a casino, other than counting cards at blackjack or cheating.
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| Do not want. |
Değerli arkadaşımız Dr. Ayhan Özhasenekler yeni bir şeyler okumuş, acilci.net takipçileri ile paylaşmak istemiş, bize de buyursunlar demek düşer. İyi okumalar…
Yusuf Ali Altuncı
Travma sezonu açıldı! Bu iş sezonluk mu demeyin, ülkemiz genelinde trafik kazalarının ön planda olduğu bahar ve yaz ayları herkesin bildiği gibi travma sezonudur. Bölgemizde özellikle yüksekten düşme ve ateşli silah yaralanmaları da trafik kazaları ile aynı klasmanda fakat farklı kulvarlarda yarış halindeler. Her yılın sonunda birinci değişebiliyor, fakat genel gözlemimiz at başı yarışta oldukları…
Hazır sezon açılmışken, bir de IX. Ulusal Acil Tıp Kongresinde (ATUDER 2013) “Sistem Travmalarında Güncellemeler” adlı nazik bir sunu daveti geldi. Konu travma olunca en önemli kaynağın ATLS (Advanced Trauma Life Support) olabileceğini düşündüm. Araştırmaya başladım ve The ATLS Subcommittee, American College of Surgeons’ Committee on Trauma and the International ATLS working group tarafından özel rapor olarak kaleme alınan “Advanced trauma life support (ATLS®): The ninth edition” adlı yazıya J Trauma Acute Care Surg dergisinde rastladım. Herkes hatırlar; ATLS en son 2008 yılında 8. baskı olarak güncellenmişti. Yukarıda adı geçen makalede; ATLS 9. baskının 2012 yılı Ekim ayında güncellendiğini ve bu baskıdaki değişiklikleri gördüm.
ATLS 9. baskıdaki yeni güncellemelerde özellikle üç değişiklik dikkatimi çekti;
1. Havayolu bölümünde; video laringoskopinin, potansiyel olarak zor hava yolu olan hastalarda yardımcı olarak kullanılabileceği kanıt düzeyi 1-3 olarak,
2. Pediatrik havayolu bölümünde; <1 yaş altı infantlar dışındaki tüm çocuklarda kaflı endotrakeal tüplerin kullanılması gerektiği kanıt düzeyi 1-2 olarak,
3. Başlangıç değerlendirilmesi ve şok bölümlerinde; agresif resüsitasyon teriminin kaldırıldığı, kanama kontrol altına alınmadan önce ılımlı hipotansiyonu içeren dengeli resüsitasyon yapılmasının daha doğru olacağı ve bununla ilişkili olarak şok durumunda başlangıçta verilen 2 lt kristaloid yerine 1 lt kristaloid verilmesi gerektiği, tahmini kan kaybının önemli miktarda olduğu veya masif transfüzyon gerektiren hastalarda trombosit ve plazma solüsyonlarının (herhangi bir oranı zorunlu kılmayan) erken dönemde kullanılması gerektiği kanıt düzeyi 1-4 olarak belirtiliyordu.
Yazıda ayrıca ATLS kursu içerisindeki sorular ile senaryolarda yapılan değişikliklerden söz edilmekte ve “myATLS” adlı uygulamanın da akıllı telefonlarınıza indire bileceğinizden bahsedilmekte
Demiştim ya sezon açıldı! Bu değişikliklerden haberdar olmak ve yeni sezona bu değişikliklerle girmek biz Acil Tıpçıların asil görevi.
Paylaşmak istedim, travmasız günler diliyorum…
Bilgiyi paylaşmak dileğiyle….
Daha fazlası için;
Advanced trauma life support (ATLS®): the ninth edition. ATLS Subcommittee; American College of Surgeons’ Committee on Trauma; International ATLS working group J Trauma Acute Care Surg. 2013;74(5):1363-6.
Dr Ayhan ÖZHASENEKLER
Dicle Üniversitesi Tıp Fakültesi
Acil Tıp AD Öğretim Üyesi
ATU, Yrd Doç
Diyarbakır
drhasenek@hotmail.com
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31/05/2013 -- Acilci.net, kongreyi konuştu… (0)The post Özhasenekler: ATLS 9. baskı çıktı appeared first on acilci.net.
Notaufnahmen und auch Intensivstationen sind immer wieder mit bewusstlosen jungen Menschen konfrontiert, bei denen der Verdacht auf k.o. Tropfen Verabreichung diskutiert werden muss bzw. wird.
Wer kann sich nicht an eine vor vielen Jahren im Münchner “Donisl” Geschichte erinnern, bei der ein paar Kriminelle k.o. Tropfen ins Getränk gemischt haben und anschließend die “Gäste” ausgeraubt haben. Auch auch St. Pauli gibt es ähnliche Geschichten. Und diese Drogen stehen immer wieder in Verdacht, auch eingesetzt zu werden, um junge Frauen zu vergewaltigen. Insbesondere “liquid ecstasy” (gamma-Hydroxy Buttersäure) steht hier unter großem Verdacht. Aber ist dem wirklich so?
Liquid Ecstasy ist eine Substanz mit kurzer Halbwertszeit und somit schnellem Wirkeintritt und rascher Abflutung der Wirkung. Zunächst wirkt sie stimulierend, euphorisierend, öffnend und offensichtlich auch sexuell stimulierend. Bei höheren Dosierungen wird eine Sedierung erreicht bis zum Koma. Aufgrund der nur teilweise vorhandenen Analysemöglichkeiten (Gaschromatographie) und der kurzen Halbwertszeit wird diese Substanz nur selten toxikologisch erfasst. Aber wird sie tatsächlich zum “Date Raping” eingesetzt?
Nun, ich hätte vermutet: Ja, Klaro! Doch wenn man die Literatur durchschaut, ist man erstaunt. Meist wird Liquid Ecstasy selbst verabreicht, bei Date Raping spielt Alkohol und andere Drogen wie Cannabis oder Heroin die deutlich überwiegende Rolle. Kriminalstatistiken gehen von einer verschwindend geringen Anzahl von Patienten aus, die mittels k.o. Tropfen für sexuelle Vergehen gefügig gemacht werden.
Im Deutschen Ärzteblatt ist 2009 ein äußerst interessanter Artikel zu dieser Problematik publiziert worden, und weitere Details ermöglicht auch der Blick in Wikipedia (Liquid Ecstasy, k.o. Tropfen).
Welche Aspekte müssen nun bei Patienten mit entsprechenden Symptomen berücksichtigt werden? Ich finde, dass die im Ärzteblatt publizierte Tabelle einen sehr guten Überblick gibt!
Und nicht vergessen: Die betroffenen Patienten sind vital gefährdet! Sicherung der Atemwege und enge Observation sind obligat!
Cliquer sur l’image pour accéder au site internet ou sur la vidéo pour la faire démarrer
Voici un excellent site internet sur les calculs rénaux (en anglais) , d’où j’ai tiré cette vidéo. On vous explique les différents types de calculs rénaux, les symptômes, les causes et on vous donne des recommandations diététiques. Tout est en anglais, désolé…
Comme il est dit dans l’introduction, le calcul rénal est une affection douloureuse et fréquente qui touche plus de 5% de tous les adultes aux USA. On estime que près de 2 millions de personnes consultent leur médecin ou les urgences pour un calcul rénal chaque année.
Si vous avez vécu un épisode de calcul rénal, vous savez à quel point c’est désagréable et douloureux. Il est donc important de comprendre non seulement comment les calculs se forment, mais aussi ce que vous pouvez faire pour prévenir la formation de nouveaux calculs. Les calculs rénaux ont un taux élevé de récidive. Quelqu’un ayant fait un calcul a un risque de 30 à 50% d’un refaire un dans les 5 prochaines années.
Il faut suivre les recommandations de votre médecin, qui s’adaptent au type de calcul que vous avez fait (il en existe 5 types). Ce site internet – en anglais – vous donne quelques conseils simples et pratiques.
Anomalies biologiques retrouvées lors d’un bilan de lithiase urinaire
Calcul rénal d’oxalate de calcium
Guide pour la prophylaxie de la lithiase urinaire
http://www.kidney.org/atoz/content/kidneystones.cfm
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Shot some cool video? Want to do more than just share it? Have a computer sitting around, begging for some Hollywood-Lite video production. Here is a brief overview of how to shoot good video with your cell phone camera, as well as an outline of some of the common options for non-linear video editing.
It is easy enough to shoot footage with your cell phone – it is grafted to your person at all times after all. There’s a difference between shaky footage of your children playing in the backyard and an educational video to a patient with a good exam finding. Here are some tips to get the best video possible with the device you are most likely to have on hand:
Your computer probably has video editing software already installed – the free Windows Movie Maker – or cheaply available as is the case of iMovie on Mac. There are many other options, but I’ll stick to those two since they are the most popular. It is beyond the scope of this website to provide a thorough walkthrough, but trust me when I say that these programs are very easy to learn, and the native tutorials are excellent. Nevertheless, here are a few links for each to get you started.
There are two ways to approach this fortunate scenario. If you have a background in video production and editing you can build your own studio and get a computer with at least 8 GB of RAM and dedicated video memory. Then, you can pick from the pro video editing options, which include, but are not limited to:
Or, you can leverage resources available at your institution and hire out. The benefit is that you’ll have dedicated personnel who will produce high quality content. The downside is that it’ll cost ‘ya. Video production can be expensive, and it includes more than just time spent behind the camera, but also for editing, processing and posting online. This can turn a one hour shoot into a 20-30 hour project that reaches a 4 digit price range (plus).
The post Tech Tuesdays: Video editing is fun! appeared first on PEM Blog.
It's a quiet Sunday afternoon when you're dispatched to a residence for a 77 year old female complaining of abdominal pain. Your dispatch notes indicates she was at the ED the day prior. Upon your arrival, you're met on the porch by the patient's son who directs you inside.
Your patient is sitting in a recliner, with mild respiratory distress, clutching her abdomen. Her skin appears a bit moist, and is warm when you touch her arm to feel for a radial pulse. When you ask her what is going on, she simply replies, "my belly won't stop hurting."
Your partner makes quick work of her vitals while you get the run down on her history.
Your general impression of the patient is she just looks unwell. Your partner relays her vitals.
Her son asks that you take her to the smaller, local hospital so, "she does not have to wait as long as she did at the ED yesterday." When you ask for her discharge instructions, he can only find the sheet which says Chest Pain and very generic information.
When you ask about her pain earlier, she denied any chest pain, however, to be prudent you obtain a 12-Lead:
You assist her to your stretcher, securing her with seat belts, and begin moving her to the truck.
Martin Bromiley, commercial airline pilot and founder of Clinical Human Factors Group
Dr Nicholas Chrimes, anaesthetist and co-inventor of VORTEX
Tonight on the podcast we interview Martin Bromiley, an aviation pilot and human factors advocate since the tragic death of his wife during a routine operation as a result of a Cannot Intubate Cannot Ventilate complication of anaesthesia in 2005. I get his views on the role of aviation, commercial and military , in helping medicine become safer and more resilient when unexpected crises occur. Also we have our old friend of the show, Dr Nicholas Chrimes of VORTEX fame, provide insight and commentary from an anaesthesia viewpoint. He discusses the role of simulation training and cognitive aids in preparing ourselves for the “seconds from disaster” situations.
BE SURE TO FOLLOW THESE GUYS ON TWITTER!
@MARTINBROMILEY
@NICHOLASCHRIMES
Right Click and Choose Save-as to Download the Podcast.
Despite some important limitations, this is probably one of the best internal medicine review books in existence.
The book is loaded with essential and hard-to-find charts, lists, tips and Board review questions. For example, on page 289 there is a table devoted to the mimics of idiopathic pulmonary fibrosis (IPF). The table provides essential clinical vignettes, along with pertinent radiologic and laboratory findings. This information is very useful because IPF itself is incurable. It is therefore important to be able to identify IPF mimickers, which are sometimes treatable. Glomerulonephritis, biliary disease, dementia and many other conditions are similarly well-treated.
The book tells you what to “do” and which answers to select on the American Board of Internal Medicine Certification (or Maintenance of Certification) Exam. In fact, there are many charts based on the “if you see this… do that” theme. This is a very helpful way to prepare to answer questions and make decisions under time pressure. In addition, the “Don’t Be Tricked” sections are extremely useful. They identify wrong answer choices (“decoys”) and tell you which answers not to choose on the test.
The book has some noteworthy limitations. There is no index and some topics are surprisingly curt. For example, the role of electrocardiography in the evaluation of patients with syncope is distilled to a vague sentence and a half on page 136. (“ECG: Done in all cases. The finding of an arrhythmia and conduction block may establish the diagnosis, but a normal ECG does not rule out a cardiac etiology.”) Outright errors are very few and far between, which is a remarkable achievement for a Board review book with this level of detail and depth. I read through most of the book, and I managed to find only one mistake. (On page 267, the binge eating/purging subtype of anorexia nervosa is incorrectly conflated with bulimia nervosa.)
Overall, Board Basics 3 by the American College of Physicians is an exceptional Board review book. I highly recommend it to anyone who is preparing for the Internal Medicine Boards. It may very well be, as the authors claim, “the best Board prep tool that you will find anywhere.”
[Please read important Disclaimer.]
The post Book Review: Board Basics 3 appeared first in The Medical Media Review.
This 15 minute lecture takes a look at ultrasound for pneumothorax detection.
It discusses lung sliding, lung pulse, comet tail artefact, B-lines, A-lines, and the contact or lung point.
It also touches on potential pitfalls including the non-ventilating lung, COPD / emphysema and lung bullae, and surgical emphysema.
James Rippey
The post Ultrasound for Pneumothorax Detection appeared first on The Sono Cave.
