October 28, 2019

Have you ever wondered how to get your text color to match your image color?  It’s not hard and can make a good slide become an amazing slide.  Matching colors make consistent, professional-looking PowerPoint or Keynote slides.  The steps to make this happen are very simple and in this post, I will hopefully show you how it’s done.  This feature is available from PowerPoint 2013 on, but not on older versions (This can also be done on keynote).

October 24, 2019

Background: Follow-up with a primary care (PC) provider is an important part of healthcare.  Many countries have a robust outpatient system, and the US is no different. However, in the US, there are many challenges to follow up including: appointment availability, insurance status, unclear discharge instructions and socioeconomic status.  Removing some of these barriers by scheduling an appointment before ED discharge could potentially increase outpatient follow up. Use of a simple, low resource bedside intervention that schedules follow-up appointments prior to ED discharge could improve health outcomes and decrease return ED visits.

October 17, 2019

Background: In patients with hemodynamically stable supraventricular tachycardia (SVT), vagal maneuvers are the traditional first step in management.  There are several  vagal techniques in the literature which include, standard valsalva maneuver (sVM), modified Valsalva maneuver (mVM), and carotid sinus massage (CSM). All three techniques aim to increase vagal tone to slow down conduction in the AV node and, hopefully, result in termination of Atrioventricular nodal reentry tachycardia (AVNRT)and atrioventricular reentrant tachycardia (AVRT).  The authors of this trial performed a RCT evaluating the effectiveness of sVM vs mVM vs CSM at not only terminating SVT but also having a sustained effect up to 5 minutes.

October 15, 2019

Background: Evidence from the CRASH-2 trial showed an absolute reduction in mortality of 1.5% (NNT = 67) in patients with extracranial bleeding treated with tranexamic acid  (TXA) within 3 hours of injury. However, CRASH-2 did not answer the question of effect on mortality in patients with intracranial hemorrhage (ICH), as these patients were excluded from the trial.  It makes biologic sense that administration of TXA in patients with traumatic brain injury (TBI) might prevent or reduce ICH expansion and thus avert brain herniation and death.  There were two smaller RCTs [2] that showed a reduction in death with TXA in patients with ICH. However, both of these trials were small and considered to be hypothesis generating only. TICH-2 [3] was an international, randomized, double-blind, placebo-controlled phase 3 trial in adults with ICH from acute stroke with ≈2300 patients and showed no difference between groups in functional status at day 90. TICH-2 did show a small improvement in hematoma expansion at day 2 and death by day 7.  Due to the fact that these  findings were secondary outcomes they were also hypothesis generating. All of the above positive findings therefore required confirmation in a larger randomized trial, which has finally arrived…CRASH-3.

October 10, 2019

Background: Serial lactate measurements is a common core measure that we follow in septic shock resuscitation. A number of readers have written in enquiring about whether resuscitation with lactated ringers instead of 0.9% saline would lead to increases in serum lactate.   It’s a great question, and one that I am not sure I had a solid answer for before reviewing this topic.  LR contains 28 mmol/L of sodium lactate and, on the surface, it seems reasonable to think that infusion of LR would lead to lactate increases. This could potentially confound the interpretation of serial serum lactate measurements.
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