EM-Bloghttp://www.em-blog.com/blog/en-US2010-03-10T01:44:00ZSquarespace Site Server v5.9.2 (http://www.squarespace.com/)The Mythbuster attends the Scientific Assembly in Boston by Yosef Leibman, MDhttp://www.em-blog.com/blog/2010/3/8/the-mythbuster-attends-the-scientific-assembly-in-boston-by.htmlRichard Bukata2010-03-08T21:51:19ZThe Coming Mobile Tsunami — Lessons from the mHealth Conference by Raj Chand, MDhttp://www.em-blog.com/blog/2010/3/6/the-coming-mobile-tsunami-lessons-from-the-mhealth-conferenc.htmlRichard Bukata2010-03-07T02:13:12ZRadiation Crunch Time in the ED by Stephen Colucciello, MDhttp://www.em-blog.com/blog/2010/3/4/radiation-crunch-time-in-the-ed-by-stephen-colucciello-md.htmlRichard Bukata2010-03-04T16:51:48ZEthics In Our Practice: Doing Nothing by Jim Ducharme MD CM FRCPhttp://www.em-blog.com/blog/2010/2/26/ethics-in-our-practice-doing-nothing-by-jim-ducharme-md-cm-f.htmlRichard Bukata2010-02-26T17:15:45ZThe Mythbuster Is Facing Off With the Chief of Staff! by Yosef Leibman, M.D.http://www.em-blog.com/blog/2010/2/24/the-mythbuster-is-facing-off-with-the-chief-of-staff-by-yose.htmlRichard Bukata2010-02-24T21:27:02Z

As we left the Mythbuster in the last blog, he was facing off with the chief of staff of St. We Never Change hospital.  Dr. Pendergast has come to the rescue of his beleaguered surgical staff who fell from the evidence onslaught of the Mythbuster

The Mythbuster fires over the first salvo-

Doctor- are you waiting six hours for your repeat enzymes in chest pain patients? Better check out the delta test- that is, if you recheck your enzymes two hours after the first set you will see a change for the worse- see Ann Emerge Med 2004,44:12 and AJEM 2000 18:1.

Pendergast winced

Still using CPK MB because it is cheaper?- well some feel it doesn't work. Circulation 2008:1182200 noted it went up in asthma, PE, head trauma, muscle disease- all in the absence of heart disease. Won't help in renal failure- CPK MB goes up in that too. Troponin isn't the end all to be all either- often goes up in PE, and even in exercise.  Ever thinking about going by clinical grounds alone?

Pendergast staggered.

Telling your EMS guys to put oxygen on all patients with chest pain?  Did you know a meta analysis showed that this may increase infarct size and perhaps mortality? (Heart 2009 95:198) Oxygen causes reduced blood flow to the coronaries.

Pendergast started to look very woozy

Not allowed to shock asystole?  Since 1992 the AHA has been saying no. But there is no evidence it does make a parasympathetic storm that will not allow heart restarting and since fine v fib maybe hard to pick up, there may be benefit to shocking it. (AJEM 26(9)618)

You are an educated man, Pendergast.  All these articles came out within the last year and a half- you are interested in helping your patients.

Pendegast suddenly roared like wounded lion "Take this, mythbuster!" and he whipped out  the ACC/AHA guidelines for unstable angina and STEMI. (JACC 50 e1-157) Mythbuster winced. He quickly turned to the Dogma Devastator and said " Did you mail for help?"

The devastator nodded. 

Pendergast reached for the defibrillator and slowly turned towards the 'buster.  Next time the last in the installment- will the mythbuster be toast?

]]>Mere Cellulitis by Drs. Mailhot, Perera, and Mandaviahttp://www.em-blog.com/blog/2010/2/22/mere-cellulitis-by-drs-mailhot-perera-and-mandavia.htmlRichard Bukata2010-02-22T22:14:18ZSay It Isn't So by Gregory L. Henry, MDhttp://www.em-blog.com/blog/2010/2/19/say-it-isnt-so-by-gregory-l-henry-md.htmlRichard Bukata2010-02-19T18:57:33ZGregory L. Henry, MDAnother sacred cow in emergency medicine is being butchered.  I was once reminded that sacred cows made the tastiest intellectual burgers and it seems that the surgeons agree.  This month’s issue of the Journal of Trauma has an interesting article in which they used cadavers to confirm that applying cervical collars to the neck of trauma patients may actually cause distraction, harm and compression of the spinal cord.  When will the heresy end?  Things we have done for years are now being shown to be useless, surprise!!!  I could barely stand it when they took beta blockers away from most of my patients with acute coronary syndromes.  It was absolutely painful.  It was near mortifying when it was shown that figure of eight dressings actually impeded the healing of most clavicle fractures.  I guess the only constant in medicine is still change and what is today’s great truth is tomorrow’s folly.  A very wise professor, who I had in medical school, once said that he was perfectly well aware of half of what he was telling us was wrong.  He just didn’t know which half that it was.  So on we trudge changing our activity.  Finding out that blowing in the mouth does very little in CPR and that the drug box is basically useless and that most of what we do for the swine flu doesn’t work reconfirms the old adage from Dr. Hook and the medicine show “Money for Nothing and Chicks for Free”.

]]>Frustrated in Haiti by Alfred Sacchetti, MDhttp://www.em-blog.com/blog/2010/2/17/frustrated-in-haiti-by-alfred-sacchetti-md.htmlRichard Bukata2010-02-17T14:49:40ZAlfred Sacchetti, MDFrom every communication I have received from Haiti, it is bad, very very bad.  The amount of human misery borders on indescribable.  What seems to be even more disturbing is the inability of even the most well intentioned medical providers to help. 

I work in a hospital that is part of the Catholic Health East (CHE) Hospital System.   CHE routinely participates in Global Outreach Programs that provide medical missions to various third world areas, including Haiti.  Many of the ED staff volunteer for these missions and some have even worked at the Haiti clinic.

When the earthquake occurred the ED staff readily signed up to be part of relief teams to go to Haiti.  Those that could not go themselves, agreed to cover the vacated spots of the docs, techs and nurses who would be going. 

None of us have gone anywhere. 

We are still waiting for CHE in conjunction with some of the major relief organizations to secure an area for us to set up shop. 

In communicating with other emergency docs, nurses, trauma surgeons and the like I am hearing the same story over and over.   We are ready but there is just no infrastructure in place to allow us to do anything.  Every ED on the east coast has staff primed to help, but can’t get out the door. Teams that flew in early are still stuck in the Dominican Republic, others that made it to Haiti found no resources to provide even the most rudimentary of care.   Some teams have been successful in delivering care and should be commended on their ability to manage the myriad of logistical problems that have short circuited other medical relief efforts.

One of our anesthesiologist with disaster experience actually worked with a team in Haiti to bring a field hospital with them.  He left last week, but we have not heard from him. 

In the mean time we sit in a fully equipped ED with enough supplies and medical personnel to care for half of "Port-au-Prince.  We are not suffering, in fact we are very comfortable, well fed and healthy.  But still we are frustrated by not being able to help those who are suffering.   

We are very very frustrated.

]]>Looking After Our Elderly - Ten Rules For Showing Respect by Sue Ieraci, MBBS, FACEMhttp://www.em-blog.com/blog/2010/2/15/looking-after-our-elderly-ten-rules-for-showing-respect-by-s.htmlRichard Bukata2010-02-15T16:18:39Z72-Hour ED Revisits by Tom Scaletta, MDhttp://www.em-blog.com/blog/2010/2/12/72-hour-ed-revisits-by-tom-scaletta-md.htmlRichard Bukata2010-02-12T16:07:09Z