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Emergency Medicine Pitfalls

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1101. Medical error

residents arrive at teaching hospitals, causing an increase in medication errors according to a study of data from 1979–2006. Human factors and ergonomics [ ] commonly encountered in medicine were initially identified by psychologists and in the early 1970s. , author of , says these are "cognitive pitfalls", biases which cloud our logic. For example, a practitioner may overvalue the first data encountered, skewing his thinking. Another example may be where the practitioner recalls a recent or dramatic (...) death rate in the U.S. alone at 251,454 deaths, which suggests that the 2013 global estimation may not be accurate. Contents Definitions [ ] The word error in medicine is used as a label for nearly all of the clinical incidents that harm patients. Medical errors are often described as in healthcare. Whether the label is a medical error or human error, one definition used in medicine says that it occurs when a provider chooses an inappropriate method of care, improperly executes an appropriate method

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2012 Wikipedia

1102. Bioinformatics

for genes to be used at prognosis, diagnosis or treatment is one of the most essential applications. Many studies are discussing both the promising ways to choose the genes to be used and the problems and pitfalls of using genes to predict disease presence or prognosis. Analysis of mutations in cancer [ ] Main article: In , the genomes of affected cells are rearranged in complex or even unpredictable ways. Massive sequencing efforts are used to identify previously unknown in a variety of in cancer (...) -services available from various or public institutions. Open-source bioinformatics software [ ] Many tools have existed and continued to grow since the 1980s. The combination of a continued need for new for the analysis of emerging types of biological readouts, the potential for innovative experiments, and freely available bases have helped to create opportunities for all research groups to contribute to both bioinformatics and the range of open-source software available, regardless of their funding

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2012 Wikipedia

1103. Liver

the . The expanding liver bud is colonized by . The bipotential hepatoblasts begin differentiating into and . The biliary epithelial cells differentiate from hepatoblasts around portal veins, first producing a monolayer, and then a bilayer of cuboidal cells. In ductal plate, focal dilations emerge at points in the bilayer, become surrounded by portal mesenchyme, and undergo tubulogenesis into intrahepatic bile ducts. Hepatoblasts not adjacent to portal veins instead differentiate into hepatocytes and arrange (...) to have in adults. Breakdown [ ] The liver is responsible for the breakdown of and other . The liver breaks down via , facilitating its excretion into bile. The liver is responsible for the breakdown and excretion of many waste products. It plays a key role in breaking down or modifying substances (e.g., ) and most medicinal products in a process called . This sometimes results in , when the metabolite is more toxic than its precursor. Preferably, the toxins are to avail excretion in bile or urine

2012 Wikipedia

1104. Coronary artery bypass surgery

or performing bypasses on beating state (on-pump beating). One end of each vein graft is sewn on to the beyond the obstruction and the other end is attached to the or one of its branches. For the , the artery is severed and the proximal intact artery is sewn to the LAD beyond the obstruction. Aside the latter classical approach, there are emerging techniques for construction of composite grafts as to avoiding connecting grafts on the ascending aorta (Un-Aortic) in view of decreasing neurologic complications (...) .; Morice M.-C.; Kappetein A.P.; et al. (March 5, 2009). "Percutaneous Coronary Intervention versus Coronary-Artery Bypass Grafting for Severe Coronary Artery Disease". N Engl J Med . 360 (10): 961–72. : . . Desai ND (January 2008). "Pitfalls assessing the role of drug-eluting stents in multivessel coronary disease". Ann Thorac Surg . 85 (1): 25–7. : . . Hannan, EL; Wu C; Walford G; et al. (January 24, 2008). "Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease". N

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2012 Wikipedia

1105. Back to the Bedside: The 8-year Evolution of a Resident-as-Teacher Rotation. (PubMed)

Back to the Bedside: The 8-year Evolution of a Resident-as-Teacher Rotation. Teaching our residents to teach is a vital responsibility of Emergency Medicine (EM) residency programs. As emergency department (ED) overcrowding may limit the ability of attending physicians to provide bedside instruction, senior residents are increasingly asked to assume this role for more junior trainees. Unfortunately, a recent survey suggests that only 55% of all residencies provide instruction in effective (...) teaching methods. Without modeling from attending physicians, many residents struggle with this responsibility.We introduced a "Resident-as-Teacher" curriculum in 2002 as a means to address a decline in bedside instruction and provide our senior residents with a background in effective teaching methods.Here, we describe the evolution of this resident-as-teacher rotation, outline its current structure, cite potential pitfalls and solutions, and discuss the unique addition of a teach-the-teacher

2010 Journal of Emergency Medicine

1106. Iodine

goiter and some thyroid disorders. It is also used for treating a skin disease caused by a fungus (cutaneous sporotrichosis); treating fibrocystic breast disease and breast pain (mastalgia); weight loss; preventing breast cancer, eye disease, diabetes, and heart disease and stroke; and as an expectorant. Iodine is also used for serious bacterial diseases called anthrax and syphilis. Iodine is also used to for radiation emergencies, to protect the thyroid gland against radioactive iodides. Potassium (...) iodide tablets for use in a radiation emergency are available as FDA-approved products (ThyroShield, Iosat) and on the Internet as food supplements. Potassium iodide should only be used in a radiation emergency, not in advance of an emergency to prevent sickness. Iodine is applied to the skin for skin inflammation (dermatitis) and other skin disorders such as eczema and psoriasis, to kill germs and heal wounds, to prevent soreness inside the mouth or along the digestive tract (mucositis), and treat

2009 National Centre for Complementary and Alternative Medicine

1107. Muscle Relaxants and Post-Anesthesia Complications

extubation. Possible deleterious effects of this could be pneumonia, bronchitis, myocardial infarction, cardiac insufficiency, stoke or re-operation. In a pilot study we were able to identify clinical assessment criteria to assess patients' risk for aspiration, which are now part of the post-anesthesia evaluation of every patient. Unfortunately there is a major pitfall arising from the inability to clearly identify PORC. Although objective neuromuscular monitoring is the golden standard to measure (...) ] Eligibility Criteria Go to Information from the National Library of Medicine Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Layout table for eligibility information Ages Eligible for Study: Child, Adult, Older Adult Sexes Eligible for Study: All Accepts

2008 Clinical Trials

1108. Wide Complex Tachycardias: Understanding this Complex Condition Part 2 - Management, Miscellaneous Causes, and Pitfalls (PubMed)

Wide Complex Tachycardias: Understanding this Complex Condition Part 2 - Management, Miscellaneous Causes, and Pitfalls 19561715 2011 11 10 2018 11 13 1936-900X 9 2 2008 May The western journal of emergency medicine West J Emerg Med Wide Complex Tachycardias: Understanding this Complex Condition Part 2 - Management, Miscellaneous Causes, and Pitfalls. 97-103 Garmel Gus M GM Stanford University School of Medicine/Kaiser Permanente, Santa Clara, CA, USA. eng Journal Article (...) United States West J Emerg Med 101476450 1936-900X 2007 08 18 2007 10 19 2007 11 26 2009 6 30 9 0 2009 6 30 9 0 2009 6 30 9 1 ppublish 19561715 PMC2672253 Circulation. 2006 Feb 21;113(7):e156-7 16490826 Ann Emerg Med. 1992 Mar;21(3):318-21 1311158 N Engl J Med. 2001 Aug 2;345(5):351-8 11484693 Ann Emerg Med. 1993 Aug;22(8):1360-4 8333645 Emerg Med Clin North Am. 2005 Nov;23(4):1083-103 16199339 Tex Heart Inst J. 1994;21(2):130-3 8061537 Am J Cardiol. 1987 May 1;59(12):1107-10 3578051 Ann Emerg Med

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2008 Western Journal of Emergency Medicine

1109. The medical world is flat too. (PubMed)

to that of the same surgery in India, Thailand, and Singapore. Supply chaining is another example that applies to the field of medicine, particularly pharmaceuticals. Most pharmaceutical firms are located in developed countries, but 80% of the pharmaceuticals are manufactured in developing countries. A phenomenon that may be unique to the United States is that we off-shore some of our diagnostic capabilities, primarily during out nighttime hours. Under the rubric of "Nighthawk," X-rays, including CT scans (...) , are digitized and sent to Australia, Spain, and other countries during our nighttime hours. A diagnosis is made and sent back to the referring hospital in the US, usually within 30 minutes. I think an argument can be made that almost all of the issues that Friedman talks about in his book, apply to the field of medicine. Trauma care is a microcosm of medicine and uses most of the resources shared by other specialties. The trauma patient has to be identified and ambulances called, usually by 911 or similar

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2008 World Journal of Surgery

1110. Telephone Consultations (PubMed)

and prioritizing emergencies. Government incentivised directives, in the form of Advanced Access and now Extended Access, have driven changes in consulting practice with an increasing number of clinical contacts being provided by phone. [ ] Primary care (whether from traditional or corporate providers) is challenged to provide more flexible access and telemedicine may, in part, help to meet the 'gap'. Consumer demand - with the advent of mobile communication technologies and a faster, 'money rich-time poor (...) - the telephone has become a vital administrative tool enabling practices to achieve targets within the Quality and Outcomes Framework (QOF) of the new GMS (nGMS) contract. For example, telephones are widely used to prompt attendance at clinics and to monitor a chronic disease patient's progress without the need to come in to the surgery. The use of telephone consultation is growing in other areas of medicine, not just in primary care. For example, telephone follow up has been shown to be safe for oncology

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2008 Mentor

1111. Abdominal Trauma

feedback. if you would like to report a specific issue with this page, please visit our . Thank you, we just sent a survey email to confirm your preferences. Further reading and references ; European Association of Urology (2015) ; Imaging in pediatric blunt abdominal trauma. Semin Roentgenol. 2008 Jan43(1):72-82. ; Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 1: does the 'seatbelt sign' predict intra-abdominal injury after motor vehicle trauma (...) and pencils. They are usually more predictable with regard to injured organs. However, a high index of suspicion must be maintained to avoid missing occult injuries. Assessment History Initially, evaluation and resuscitation occur simultaneously. In general, do not obtain a detailed history until life-threatening injuries have been identified and therapy has been initiated. However, to predict injury patterns better and to identify potential pitfalls, ascertain the mechanism of injury from bystanders

2008 Mentor

1112. Abdominal Pain in Childhood

[ ] Acute abdominal pain is a common complaint in childhood and it can be caused by a wide range of underlying surgical and non-surgical conditions. The most common non-surgical condition is gastroenteritis, while the most common surgical condition is appendicitis. Appendicitis accounts for more than 40,000 hospital admissions in England every year. Appendicitis is the most common non-obstetric surgical emergency during pregnancy, with an incidence of 0.15-2.10 per 1,000 pregnancies [ ] . The frequency (...) Infantile colic (gripe) Occurs in babies in the first few months after the birth month. Babies scream, draw up their knees and experience severe pain. Episodes can last up to three hours and occur often in a week. Changes in feed type and routine may help. Over-the-counter medicines - eg, simeticone - may help but have not been proven to be of benefit [ ] . Mesenteric lymphadenitis This is associated with adenoviral infection. It presents similarly to appendicitis but there is no peritonism

2008 Mentor

1113. Statement on tick-borne encephalitis

Committee Statement (ACS) Committee to Advise on Tropical Medicine and Travel (CATMAT) 20 Pages - 415 KB Preamble The Committee to Advise on Tropical Medicine and Travel (CATMAT) provides the Public Health Agency of Canada (PHAC) with ongoing and timely medical, scientific, and public health advice relating to tropical infectious disease and health risks associated with international travel. PHAC acknowledges that the advice and recommendations set out in this statement are based upon the best current (...) to eggs or egg products should be vaccinated only under close clinical monitoring with readiness for emergency treatment. However, FSME-IMMUN® vaccine has apparently been safely administered to > 100 persons with allergies to egg whites (note that the types of egg allergy were not described in this study) . Impaired immune system Immunosuppressed individuals may respond poorly to TBE vaccination . If they are at risk of TBE, it may be appropriate to determine their immune response after the primary

2006 CPG Infobase

1114. MRI for the detection of foetal abnormalities

MRIs for the detection of foetal abnormalities performed at three major centres. Three foetal medicine units within Melbourne are involved in referring patients to three different MRI units: The Mercy Hospital for Women refers patients to the Austin Repatriation Hospital, The Monash Medical Centre refers on to Southern Health, and The Royal Women’s Hospital refers patients to the Royal Children’s Hospital. Patients referred to any of these centres for a foetal MRI must undergo a repeat tertiary (...) level ultrasound and have consulted a foetal medicine specialist. In addition, geneticists, counsellors and social workers may need to be consulted (personal communication, Southern Health). It is likely that all states are conducting a limited number of foetal MRI scans, however it is strongly recommended that foetal MRIs should only be performed and interpreted in centres of excellence with appropriate experience and part of a multidisciplinary diagnostic team. Foetal MRI has been performed

2007 Australia and New Zealand Horizon Scanning Network

1115. The Acutely or Critically Sick or Injured Child in the District General Hospital

authority CEs and emergency care leads Description An inter-collegiate expert working group has considered issues regarding anaesthetic and other services available to children who are critically sick or injured in district general hospitals, and has produced this report. It was open to consultation between August and December 2005 and was finalised with the benefit of comments received. Cross-reference N/A Superseded documents N/A Action required N/A Timing N/A Contact details Dr Edward Wozniak Medical (...) iiiiv CriticalSickChild txt 26/10/06 16:46 Page ivThe child who develops a serious illness such as meningitis, or who sustains a serious injury, requires immediate highly skilled treatment. The logistical challenges in providing this care are greater if the child lives at a distance from a large children’s unit, particularly in a remote or rural area. The challenges are especially great for those health professionals who are less frequently faced with such emergencies, and for whom maintenance

2006 Royal College of Anaesthetists

1116. Nurse entrepreneurs - turning initiative into independence

be daunting. Fear of failure is inevitable.Y ou will probably need plenty of advice and assistance on a wide range of subjects, including getting started, growing your business, common pitfalls and how to avoid them. W ouldn’t it be good if you could talk to someone who knows your business extremely well, who wants you to succeed and who could advise you both initially and in the longer term? ‘Being in business for yourself but not by yourself’ is how franchising is often described. Franchising, where

2007 Royal College of Nursing

1117. Clinical practice guidelines for communicating prognosis and end-of-life issues with adults in the advanced stages of a life-limiting illness, and their caregivers

): S77. || doi: 10.5694/j.1326-5377.2007.tb01100.x Published online: 18 June 2007 Topics Contents Contributors Writing committee Dr Josephine M Clayton (Chair) — Head of Department of Palliative Care, Royal North Shore Hospital, Sydney, NSW; Senior Lecturer and Cancer Institute NSW Research Fellow, Faculty of Medicine, University of Sydney, Sydney, NSW. Dr Karen M Hancock — Project Coordinator and Research Associate, Medical Psychology Research Unit, University of Sydney, Sydney, NSW. Professor (...) Phyllis N Butow — Professor of Psychology, University of Sydney, Sydney, NSW. Professor Martin H N Tattersall — Professor of Cancer Medicine, University of Sydney, Sydney, NSW. Professor David C Currow — Professor of Palliative and Supportive Care, Flinders University, Adelaide, SA. Correspondence: Australian and New Zealand Expert Advisory Group Dr Jonathan Adler, Palliative Care Physician Professor Sanchia Aranda, Cancer Nursing Dr Kirsten Auret, Palliative Care Physician

2007 MJA Clinical Guidelines

1118. Breast fine needle aspiration cytology and core biopsy - a guide for practice

biopsy 9 Chapter 3 Communicating effectively with women undergoing FNA cytology and core biopsy 16 Chapter 4 Performing FNA cytology and core biopsy 20 Chapter 5 The specimen: request, preparation and processing 27 Chapter 6 Pathology reporting 34 Chapter 7 Common pitfalls in the interpretation of FNA cytology 44 Chapter 8 Common pitfalls in the interpretation of core biopsy 49 Chapter 9 Training and quality assurance 53 Chapter 10 New technologies and emerging trends 58 List of tables 61 Appendix (...) for Ultrasound in Medicine BIRG Breast Imaging Reference Group DCIS ductal carcinoma in situ ER oestrogen receptor FNA fine needle aspiration H&E haematoxylin and eosin IBUS International Breast Ultrasound School LCIS lobular carcinoma in situ NBCC National Breast Cancer Centre NHMRC National Health and Medical Research Council PPV positive predictive value PR progesterone receptor QA quality assurance RANZCR Royal Australian and New Zealand College of Radiologists RCPA Royal College of Pathologists

2004 Cancer Australia

1119. Interventions for Postpartum Depression

Nurse Maternal Child Family Centre St. Catharines General Site Niagara Health System St. Catharines, Ontario Judi DeBoeck, RN, BA CHPE Public Health Nurse Mother Reach Program County of Oxford Public Health & Emergency Services Woodstock, Ontario Marilyn Evans, RN, PhD Assistant Professor School of Nursing University of Western Ontario London, Ontario Denise Hébert, RN, BScN, MSc Family Health Specialist Healthy Babies, Healthy Children Program Ottawa Public Health Ottawa, Ontario JoAnne Hunter (...) , Regional Niagara Public Health Department, St. Catharines, Ontario Lorna Larsen, RN, BScN Manager, Health Promotion, Oxford County Public Health & Emergency Services, Woodstock, Ontario Nancy Lynch, RN, BScN Public Health Nurse, Healthy Babies, Healthy Children Program, Hastings & Prince Edward Counties Health Unit, Belleville, Ontario Iva MacCausland, RN, BScN Public Health Nurse, Oxford County Public Health & Emergency Services, Woodstock, Ontario Karen Mayer, RN Teacher and staff nurse, Picton

2005 Registered Nurses' Association of Ontario

1120. Promoting Asthma Control in Children

Association, Kingston and the Thousand Islands Kingston, Ontario Cynthia Phillips, RRCP, BA Clinical Leader, Respiratory Therapy Services Kingston General Hospital Kingston, Ontario Shelley Rochette, RN Team Leader – Emergency Department Queensway Carleton Hospital Ottawa, Ontario Darlene Roth, RPN Clinic Nurse Edward St. Medical Associates Toronto, Ontario Dale Smith, RN, ENC(c) Administrative Coordinator – Emergency Medicine Program, Medical Ambulatory Care York Central Hospital Richmond Hill, Ontario (...) Judy Smith, RN, BScN, ENC(c) Nurse Educator – Emergency Medicine Program, Medical Ambulatory Care York Central Hospital Richmond Hill, Ontario Dr. William Sprague, MD, FRCP(c) Paediatrician – Associate Professor Queen’s University Kingston, Ontario Pamela Wilton, RN, CAE Educator, The Asthma Centre of London St. Joseph’s Health Care London, Ontario7 Nursing Best Practice Guideline Disclaimer These best practice guidelines are related only to nursing practice and not intended to take into account

2004 Registered Nurses' Association of Ontario

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