Saturday, 23 October 2010

New CPR Guidelines 2010

The new CPR guidelines have just been published in Circulation and Resuscitation. They are open acces and can be read here

Saturday, 16 October 2010

Reviving the lost art of the physical examination

Teaching medical students how to do a physical exam
The New York Times reports on the remarkable medical education breakthrough of teaching the ancient and mysterious art of the physical examination. Stanford Medical School has employed Dr. Abraham Verghese solely to teach this skill. This is in an era when the first step in a neurosurgical examination is an MRI scan. Importantly, undertaking a physical examination helps develop rapport with your patient and getting to know them as an actual person. This is something the anesthesiologist should embrace.

Wednesday, 13 October 2010

The last round for codeine?

Codeine has been an historically popular drug. This has been particularly due to its availability in many over-the-counter combination analgesic drugs such as Panadeine and cold-and-flu remedies. The problem is that codeine is a pro-drug for morphine which depends on the highly variable pharmacokinetics of individual patients. This editorial from the CMJ argues that it is better and safer for patients to avoid codeine and just use a predictable opioid such as morphine or oxycodone.

Monday, 11 October 2010

Maybe too much pain relief is bad?

NEJM Sept 29. This recent drug trial and editorial show the outcome of too much analgesia when treating osteoarthritis of the knee. The study drug was Tanezumab, a monoclonal antibody that blocks nerve growth factor which then produces pain relief. Unfortunately the drug was too effective, which caused some patients to wear out their knees so badly they needed knee replacements. Consequently the FDA has put a halt on the studies with Tanezumab.

Tuesday, 5 October 2010

Transfusion and the microcirculation

This astounding video of a patient's microcirculation shows what happens when a blood transfusion is given. The results are not pretty.