Interesting and useful articles

[Dryacku]

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I was hoping people could share some interesting articles or articles they refer to. This maybe very helpful to medical students and residents

 

[Precedex]

I was hoping people could share some interesting articles or articles they refer to. This maybe very helpful to medical students and residents

Sword swallowing and its side effects.
BMJ. 2006 Dec 23;333(7582):1285-7

Witcombe B, Meyer D.
Department of Radiology, Gloucestershire Royal NHS Foundation Trust, Gloucester GL1 3NN. [email protected]

OBJECTIVE: To evaluate information on the practice and associated ill effects of sword swallowing. DESIGN: Letters sent to sword swallowers requesting information on technique and complications. SETTING: Membership lists of the Sword Swallowers' Association International. PARTICIPANTS: 110 sword swallowers from 16 countries. RESULTS: We had information from 46 sword swallowers. Major complications are more likely when the swallower is distracted or swallows multiple or unusual swords or when previous injury is present. Perforations mainly involve the oesophagus and usually have a good prognosis. Sore throats are common, particularly while the skill is being learnt or when performances are too frequent. Major gastrointestinal bleeding sometimes occurs, and occasional chest pains tend to be treated without medical advice. Sword swallowers without healthcare coverage expose themselves to financial as well as physical risk. CONCLUSIONS: Sword swallowers run a higher risk of injury when they are distracted or adding embellishments to their performance, but injured performers have a better prognosis than patients who suffer iatrogenic perforation.

PMID: 17185708 [PubMed - indexed for MEDLINE]
PMCID: PMC1761150

 

[Precedex]

Gotta love this one for all you BIS believers. God bless German research.

Anesth Analg. 2003 Aug;97(2):488-91, table of contents. Links

The bispectral index declines during neuromuscular block in fully awake persons.

Messner M, Beese U, Romstöck J, Dinkel M, Tschaikowsky K.
Department of Anesthesiology, Friedrich-Alexander Universität, Erlangen-Nuernberg, Germany. [email protected]

Bispectral index (BIS) is an electroencephalographic variable promoted for measuring depth of anesthesia. Electromyographic activity influences surface electroencephalography and the calculation of BIS. In this study, we sought to determine the effect of spontaneous electromyographic activity on BIS. BIS was monitored in three volunteers by using an Aspect A-1000 monitor. The experiment was repeated in one volunteer. Electromyographic activity was recorded. Alcuronium and succinylcholine were administered. No other drugs were used. In parallel with spontaneous electromyographic activity of the facial muscles, BIS decreased in response to muscle relaxation to a minimum value of 33 and, in the repeated measurement, to a minimum value of 9 when total neuromuscular block was achieved. In two volunteers, no total block was achieved. BIS decreased to a minimal value of 64 and 57, respectively. In turn, recovery of BIS coincided with the reappearance of spontaneous electromyographic activity. During the entire experiment, the volunteers had full consciousness. BIS, assessed by software Version 3.31, correlates with spontaneous electromyographic activity of the facial muscles. BIS failed to detect awareness in completely paralyzed subjects. Thus, in paralyzed patients, BIS monitoring may not reliably indicate a decline in sedation and imminent awareness. IMPLICATIONS: The bispectral index (BIS) is an electroencephalographic variable intended for measuring depth of anesthesia. Electromyographic activity influences the calculation of BIS. We found that the administration of a muscle relaxant to unanesthetized volunteers decreases the bispectral index value. Thus, awareness in totally paralyzed patients cannot be excluded.

PMID: 12873942 [PubMed - indexed for MEDLINE]

 

[Gimlet]

Complete neuromuscular blockade in awake volunteers? That's badass! I wonder how much they got paid?

 

[lord_jeebus]

Maybe the volunteers were Messner M, Beese U, Romstöck J, and Dinkel M

 

[dhb]

Lung Ultrasound; this $hit is tight:

Lung ultrasound in acute respiratory failure an introduction to the BLUE-protocol.Lichtenstein D.
Resuscitation Service, Ambroise-Paré Hospital, Faculté Paris-Ouest, Boulogne, France. [email protected]

Critical ultrasound, apparently a recent field, is in fact the outcome of a slow process, initiated since 1946. The lung was traditionally not considered as part of ultrasound, yet we considered its inclusion as a priority in our definition of critical ultrasound. Acute respiratory failure is one of the most distressing situations for the patient. An ultrasound approach of this disorder - the BLUE-protocol allows rapid diagnosis. Its main features will be described. Each kind of respiratory failure provides a particular ultrasound profile. In this difficult setting, initial mistakes are frequent. The BLUE-protocol proposes a step-by-step approach for making accurate diagnosis. By combining three signs with binary answer (anterior lung sliding, anterior lung-rockets), with venous analysis when required, seven profiles are generated, yielding a 90.5% accuracy. This rate is highly enhanced when simple clinical and laboratory data are considered. The BLUE-protocol can be achieved in three minutes, because the use of an intelligent machine, a universal probe, and standardized points allow major time-saving. Lung ultrasound in the critically ill was long available. In a domain where everything must be fast and accurate, the BLUE-protocol can play a major role in the diagnosis of an acute respiratory failure, usually answering immediately to questions where only sophisticated techniques were hitherto used.

1: Minerva Anestesiol. 2009 May;75(5):313-7.

 

[Licoricestick]

Maybe the volunteers were Messner M, Beese U, Romstöck J, and Dinkel M

Yes - they were

 

[Licoricestick]

I was hoping people could share some interesting articles or articles they refer to. This maybe very helpful to medical students and residents

Epidemiology and prognosis of coma in daytime television dramas

David Casarett, assistant professor1, Jessica M Fishman, faculty fellow2, Holly Jo MacMoran, research coordinator3, Amy Pickard, research coordinator3, David A Asch, professor1



BMJ 2005;331:1537-1539 Abstract

Objective To determine how soap operas portray, and possibly misrepresent, the likelihood of recovery for patients in coma.
Design Retrospective cohort study.
Setting Nine soap operas in the United States reviewed between 1 January 1995 and 15 May 2005.
Subjects 64 characters who experienced a period of unconsciousness lasting at least 24 hours. Their final status at the end of the follow-up period was compared with pooled data from a meta-analysis.
Results Comas lasted a median of 13 days (interquartile range 7-25 days). Fifty seven (89%) patients recovered fully, five (8%) died, and two (3%) remained in a vegetative state. Mortality for non-traumatic and traumatic coma was significantly lower than would be predicted from the meta-analysis data (non-traumatic 4% v 53%; traumatic 6% v 67%; Fisher's exact test both P < 0.001). On the day that patients regained consciousness, most (49/57; 86%) had no evidence of limited function, cognitive deficit, or residual disability needing rehabilitation. Compared with meta-analysis data, patients in this sample had a much better than expected chance of returning to normal function (non-traumatic 91% vv 7%; both P < 0.001). 1%; traumatic 89%
Conclusions The portrayal of coma in soap operas is overly optimistic. Although these programmes are presented as fiction, they may contribute to unrealistic expectations of recovery.
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For other similar enjoyment (including a discussion on the relative merits of a double blind crossover study looking at the effectiveness of parachutes for the prevention of injruy and death caused by gravitational challenge) check out the BMJ christmas editions!

Sorry - did you want serious articles?

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Emergency Medicine Journal 2005;22:815-816; doi:10.1136/emj.2005.030205 © 2005 BMJ Publishing Group Ltd and the College of Emergency Medicine.

Cricoid pressure in emergency rapid sequence induction

John Butler, Consultant and Ayan Sen, Clinical Fellow
Department of Emergency Medicine, Manchester Royal Infirmary,


ABSTRACT

A short cut review was carried out to establish cricoid pressure reduced aspiration during rapid sequence induction (RSI) of anaesthesia. A total of 241 papers were identified using the reported search, of which three represented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. There is little evidence to support the widely held belief that the application of cricoid pressure reduces the incidence of aspiration during a rapid sequence intubation.

Three part question
In [patients undergoing emergency RSI] does [cricoid pressure] reduce the [incidence of aspiration of gastric contents/ morbidity/mortality]?

Clinical scenario
You are about to perform an RSI in a 26 year old man with a severe head injury. You have been told that the gentleman has consumed a significant amount of alcohol in the last three hours. The nurse asks you whether application of cricoid pressure will stop him aspirating.

Search strategy
Medline 1950 to July 2005 via OVID; Embase 1988 to July 2005 via OVID: [{Sellick’s manoeuvre.mp} OR {Cricoid pressure.mp} OR/cricoid pressure] LIMIT to HUMAN and ENGLISH and ABSTRACTS. Cochrane Database of Systematic Reviews 2005.

Search outcome
Medline: 241 papers in total of which 3 papers were relevant to the question (table 2). Embase: 119 citations, no new references found. Cochrane: No new papers found.


Comment(s)
Cricoid pressure has been described as the "linchpin of rapid sequence induction" and has become widely accepted as the standard of practice during anaesthesia in the UK and USA. However, it is not widely used in some continental countries. Although it is a simple manoeuvre there have been concerns about its safety and efficacy. Opinion on its use varies widely from those who believe it should remain the standard of care to those who urge for re-evaluation of the technique. Concern has been expressed that cricoid pressure may interfere with airway management, obscuring the laryngeal view and creating difficulties in passing the endotracheal tube. This may lead to a failure of airway tecniques and subsequent morbidity and mortality. The evidence presented in this review suggests that none of the papers confirm the perceived clinical benefit of cricoid pressure in reducing the incidence of aspiration during an emergency RSI.
It will be interesting to see whether a technique that is now so widely engrained in anaesthetic practice will ever be submitted to a more rigorous evaluation.

CLINICAL BOTTOM LINE
There is little evidence to support the widely held belief that the application of cricoid pressure reduces the incidence of aspiration during a rapid sequence intubation.

 

[BADMD]

I was hoping people could share some interesting articles or articles they refer to. This maybe very helpful to medical students and residents

I throw this one at the EBM zealots who won't accept that some things just haven't/can't be studied.

Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials

Gordon C S Smith, professor1, Jill P Pell, consultant2

1 Department of Obstetrics and Gynaecology, Cambridge University, Cambridge CB2 2QQ, 2 Department of Public Health, Greater Glasgow NHS Board, Glasgow G3 8YU

Correspondence to: G C S Smith [email protected]
Abstract

Objectives To determine whether parachutes are effective in preventing major trauma related to gravitational challenge.

Design Systematic review of randomised controlled trials.

Data sources: Medline, Web of Science, Embase, and the Cochrane Library databases; appropriate internet sites and citation lists.

Study selection: Studies showing the effects of using a parachute during free fall.

Main outcome measure Death or major trauma, defined as an injury severity score > 15.

Results We were unable to identify any randomised controlled trials of parachute intervention.

Conclusions As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomised controlled trials. Advocates of evidence based medicine have criticised the adoption of interventions evaluated by using only observational data. We think that everyone might benefit if the most radical protagonists of evidence based medicine organised and participated in a double blind, randomised, placebo controlled, crossover trial of the parachute.

 

[Licoricestick]

I throw this one at the EBM zealots who won't accept that some things just haven't/can't be studied.

Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials

Yep - that's the one I was talking about!