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Saturday, January 4, 2014
US Diagnosis of Intraperitoneal Air
Very cool, from this study. Id be curious if this reverb artifact exists without significant free fluid?
This demonstrated free intraperitoneal fluid in Morison’s pouch (Video Clip S1). Upon attempting views of the pelvis, distinct hyperechoic foci with reverberation artifacts were visualized within the free fluid, suggesting associated free intraperitoneal air (Video Clip S2).
This demonstrated free intraperitoneal fluid in Morison’s pouch (Video Clip S1). Upon attempting views of the pelvis, distinct hyperechoic foci with reverberation artifacts were visualized within the free fluid, suggesting associated free intraperitoneal air (Video Clip S2).
A new syncope rule? The Anatolian Syncope Rule (Turkey)
Check out this Turkish paper which has developed a syncope rule VERY sensitive for adverse events. Makes me rethink butting heads with medicine when they ask for orthostatics (as this syncope rule finds orthostasis highly correlating with adverse events). It is yet to be validated by anyone outside of Turkey.
Of important note the rule is, as they state:
The newly proposed ASR performed with higher sensitivity but lower specificity when predicting mortality
Read the paper here.
Below are the 6 parameters with high predictive value for adverse events:
Im not sure how to interpret the "precipitating cause" (maybe someone -Melville or Amisha?), from their results section they state:
Precipitating factors were drugs, diabetes and neurologic disorders in patients with orthostatic syncope (40% of the known precipitating group). Fever, dehydratation, fasting and long standing were the precipitating factors in vasovagal syncope (45% of the known precipitating group). The other 15% were due to arrhythmia and cardiogenic causes.
Wednesday, January 1, 2014
Why do we discharge, and can we predict bounce back?
Fascinating paper on discharge decision making. They analyzed why the physician discharged.
Most physicians (even these Canadians who we often perceive as being more algorithmic) stated they used clinical judgement (nearly70%) compared to evidence-based reasoning.
Also, the adverse event rate in 366 discharges was low. 10. With only one death. HOWEVER, upon review by 3 trained ED physicians almost all of these were deemed to be PREVENTABLE.
Its a provocative paper and offers and interesting discussion on discharge decision making which is one of the heaviest tasks we have.
Here is the Paper.
Most physicians (even these Canadians who we often perceive as being more algorithmic) stated they used clinical judgement (nearly70%) compared to evidence-based reasoning.
Also, the adverse event rate in 366 discharges was low. 10. With only one death. HOWEVER, upon review by 3 trained ED physicians almost all of these were deemed to be PREVENTABLE.
Its a provocative paper and offers and interesting discussion on discharge decision making which is one of the heaviest tasks we have.
Here is the Paper.
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