Monday, September 30, 2013

Trick of the Trade: Website resource on HIV medications


At our department's first annual UCSF High Risk Hawaii Conference 2 weeks ago, Dr. Rachel Chin taught about complications from all of the HIV drugs on the market now. It's a virtual alphabet soup: EFV, TDF, FTC, oh my. How do you keep track of them all?

Trick of the Trade:
HIV InSite website

The website is actually hosted and constantly updated by the Center for HIV Information at UCSF. Take a few minutes to browse through the extensive website:

Specifically, I find the following sub-links most useful in the Emergency Department:

Read more

Trick of the Trade: Embedding Google Docs document in blog


Google Docs is constantly improving and growing. One of the cool features is that you can embed any document within your blog. Whenever you edit the Google Docs document, it automatically updates in your blog.

How do I do this?
  • Within your document in Google Docs, click on the upper right "Share" button and select "Publish to Web".
  • In the pop-up screen, select "Start Publishing".
  • Copy and paste the provided HTML code in your blog. 
  • With a little HTML editing, you can make the optimize the margins bigger than the teeny preset dimensions. To change the margins to 440-pixel width and 500-pixel height, add the extra text (in bold) into your code as follows:

And ta-da! Embedded is my handout from a recent talk on mobile apps in Medicine.

Read more

Hot off the press: Clinical practice guideline for ketamine in the ED


A 3 year old girl is brought into the ED with an abscess to her groin. Upon examination it is fluctuant and needs incision and drainage. Next door is a 5 year old boy, who fell off his bed and has an angulated radius fracture that needs reduction. to manage these patients? Local anesthesia? Hematoma block? Nothing (aka brutacaine)? What about ketamine, that seems popular these days. IV? IM? With or without atropine? So many decisions!

Luckily you were surfing the internet one night and came across the 2011 clinical practice guideline on ketamine in the ED, which was just published.
This practice guideline was updated from a previous 2004 version because of new research that proved/disproved the way ketamine was being utilized. It was compiled by four physicians that are experts in the field of ketamine sedation, two of which wrote the 2004 practice guideline. Updated research was found by performing a MEDLINE search from January 2003 to November 2010 using the search term "ketamine".


1. Adults have been included in the 2011 guidelines.

2. Adjunctive medications
  • Prophylactic ondansetron can help reduce vomiting. The number needed to benefit = 9.
  • No need to co-administer atropine or glycopyrrolate for oral secretions.
  • Prophylactic midazolam 0.3 mg/kg may prevent recovery reactions in adults (but not children). The number needed benefit = 6.
3. Contraindications
  • Age < 3 months because of risk of airway complications
  • Known or suspected schizophrenia (even if currently stable)
  • Head trauma has been removed as a contraindication.
4. Route of administration
  • IV administration appears to be preferred over IM, because of faster recover and fewer episodes of emesis.
  • IV route: Peak concentration and onset = 1 min, duration of dissociation = 5-10 min, time from dose-to-discharge = 50-110 min
  • IM route: Peak concentration and onset = 5 min, duration of dissociation = 20-30 min, time from dose-to-discharge = 60-140 min 
5. Complications
  • Laryngospasm has been reported to be around 0.3%. What do you do when this happens? You'll just have to read this previous post to find out.
Green SM, Roback MG, Kennedy RM, Krauss B. Clinical Practice Guideline for Emergency Department Ketamine Dissociative Sedation: 2011 Update. Annals of emergency medicine. 2011 - in press. PMID: 21256625

Read more

Sunday, September 29, 2013

Peak into the CORD Academic Assembly: A first-hand account


Be a fly on the wall!

March 3rd kicks off the 3-day CORD Academic Assembly in San Diego where educators, residency directors, and clerkship directors all assemble for a big pow-wow on all-things education in EM.

Keep checking back here for real-time accounts of the conference as I bounce from room to room and lecture to lecture. The most recent post will be at the top.

FYI, Dr. Horng emailed me the link to his CORD handout from the "Web 2.0" didactic session. Thanks!

Read more

Prezi: A new age for presentations?


Presentations are traditionally given using Powerpoint. Keynote is prettier alternative to Powerpoint but is only Macintosh-compatible. Both have the same antiquated structure such that content is presented only linearly.

The hottest presentation tool now is Prezi, a web-based tool, which allows the viewer to zoom in and out of sections. The visuals are more of a conceptual map of the content, where the viewer or speaker can zoom around any desired topic. Because it's online, you can easily embed YouTube videos.

Take a look at this Prezi demo advocating it as a tool for teaching.

To navigate, you can click on the gray arrows at the bottom to advance forward or backward, as pre-programmed. Alternatively, you can drag the display using your mouse. Or you can zoom in/out using the + or - tools on the right.

Read more

Tuesday, September 10, 2013

Wholesome way of living Can Reduce Cancer tumor Possibility


Having modernization in addition to westernization, China features surely lifted discos on the subject of "technology". Even so the introduction to these economical machines has left often the loads lethargic in addition to dependent upon these individuals. Often the customs connected with fastfood in addition to foremost an expensive life is on the list of excellent brings about that happen to be presenting grow to help numerous cancer tumor affected individuals on an annual basis.
Nevertheless , an up to date examine by Universe Cancer tumor Exploration Investment (WCRF) expresses this 39 per-cent connected with 14 important varieties of cancer is usually stopped by means of getting a nutritious way of living. It is important to guide your personal immunity mechanism considering that the solely matter located between you and often the profitable treat connected with cancer tumor is the best immunity mechanism. The skin is often a potent home treatment affected individual then you could initialize this by these kind of improvements.

There isn't any these matter for a sole cause for almost any health issue14921 like cancer tumor. Cancer tumor is often a slow-moving rising ailment at the beginning or any these kind of components give rise to the item. How many cancer tumor affected individuals with China is definitely soaring alarmingly, which contains given rise to the imperative ought to customize in addition to appreciate our self with wholesome way of living actions. Management and business customs, stressful way of living, poor diet regime, not any right fitness routine are classified as the components that lead to "Unhealthy lifestyle".

Consumers are acquiring enslaved by fantastic ways of life avoiding real do the job. You can find a small amount of living space to get training as well as jogging of their regular lifestyles, but they also have created many living space to get alcohol in addition to using tobacco. This indicates Indians pay money as a cancer tumor person their selves. With using tobacco, you will discover 500 cancer tumor compounds in addition to 5, 000 unsafe compounds although persons wish to obtain using tobacco solutions being affected individuals connected with lips as well as irritated cancer tumor.

As per Cancer tumor Exploration BRITAIN survey, using tobacco is a major primary cause, producing 23% connected with cancer tumor conditions with men and 18. 6% with women of all ages. The marriage concerning diet and wellbeing is accepted in the course of registered story. Morbid obesity in addition to absence of workout usually are connected to greater possibility on a variety of cancer tumor web-sites, like bust, large intestine in addition to endometrial cancer tumor.

In addition, often the number of cases connected with oesophageal cancer tumor (cancer connected with meal pipe) is definitely slightly substantial and is particularly connected to a number of diet and ways of life. It can be secondly nearly all cancer tumor within adult men in addition to to fruition nearly all cancer tumor within gals. It can be progressively more loved the fact that possibilities of getting cancer tumor usually are appreciably battling with the choice of all of our way of living. There are various big possibility components which will be aware of most marketers make no varieties of cancer, although we can easily customize all of our way of living to cut back boosted menace connected with cancer tumor.

Wholesome way of living conducts to get cancer tumor possibility lessen such as a proper dieting, weight loss, regular planned activity, lowering alcohol consumption in addition to cigarettes ordonnance. There is also a conception this cancer tumor is absolutely not curable, nevertheless it is very much curable when it's determined in early development. Although China is lacking a superb open medical process and the majority connected with cancer tumor affected individuals cease to live for the reason that find health easy access solely within the enhanced step.

A different issue this has effects on persons essentially the most is definitely "Stress". The system behaves to stress by means of launching strain the body's hormones, including epinephrine and as well delivers oxidative solutions which will finally brings about deterioration. These kind of strain the body's hormones raise hypertension, pulse, in addition to blood glucose.

Strain that is definitely continual can certainly enhance the potential for morbid obesity, a heart attack, major depression, in addition to some conditions. Strain in addition brings about poor conducts, including over-eating, cigarettes, as well as destroying prescription drugs as well as booze, that will have an impact on cancer tumor possibility.

Earnings connected with 16 way of living in addition to enviromentally friendly components have already been further down, many people add to get getting bust, hardworking liver, chest in addition to large intestine varieties of cancer.

Using tobacco
Some regions of eating habits (consumption connected with crimson in addition to manufactured various meat, absence of fruit and veg, fiber content in addition to way over salt),
Absence of physical exercises
Less active way of living (occupation)
HPV infections
Rayonnement (ionizing in addition to solar)
Make use of the body's hormones immediately after menopause (such just as HRT)
Absence of newborn
Fantastic position in life it isn't just connected to people but kids. The excitement connected with indoors video game titles in addition to absence of workout has not yet eventually left little ones in addition. Won't staying arised by means of cancer tumor.

Skilled advises many necessary lifestyle changes to counteract cancer tumor:

Change your eating habits to eat solely clean make rather then fully processed foods.
Feed on a number of tinted virtues of fresh fruit in addition to fresh vegetables (for case in point apple inc, carrot in addition to spinach) because the cancer tumor dealing with houses many people incorporate.
Keep away from preparing employing high heat just as with frying breadpan in addition to barbeques, many people make cancerous compounds.
Keep away from used with smokers in addition to pickled foodstuff, these kind of in addition make unsafe compounds.
Training day-to-day, it can be essential simply because it tone the immune system.
Use a constructive belief; mental poison has effects on the system simply because it weakens the immune system.
Not any prescription drugs, leisurely as well as medicamentoso, they are really man-made elements.
Fit dwell household crops in your residense, specifically in the suites you spend many of some time. Many people purify the oxygen effortlessly.
Don't neglect to remainder to get an adequate amount of get to sleep every night. The system should revitalise day-to-day. Want to do something you like it accomplishing and do the item day-to-day.
Find some good sunrays subjection as well as start using a vitamin supplements Deborah supplementation if that is very unlikely. A little bit hot sunshine isn't going to bring about cancer tumor although allows treat the item.
Hold a new work schedule, in addition to track record just about every make sure final result you have. Possibly be aggressive for your wellbeing.
Take in severely for 3 as well as 3 minutes day-to-day. Inhaling and exhaling thoroughly.
Supplementation having vitamin supplements H, many experienced counselors propose about 12 gary daily.
Find a new physical healthcare practitioner should you have a new strain similar challenge.
Possibly be content, come across activity generates you actually have fun. Joy possesses a physical outcome and may also energize the immune system.

 Here by, Lung Cancer for your enrichment of cancer.

Read more

Design by ThemeShift | Bloggerized by Lasantha - Free Blogger Templates | Best Web Hosting