Policy, Ethics, Education Archives - PulmCCM
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Policy, Ethics, Education Articles

Feb 232017
 
The Normalization Fallacy: why much of "critical care" may be neither

By Scott Aberegg, MD, MPH Like many starry-eyed medical students, I was drawn to critical care because of the high stakes, its physiological underpinnings, and the apparent fact that you could take control of that physiology and make it serve your goals for the patient. On my first MICU rotation in 1997, I was so swept [… read more]

Feb 022017
 
CDC Releases Ventilator-Associated Events Criteria

A new term has been coined by the Centers for Disease Control and Prevention, ventilator-associated events (VAEs)¹. In 2011, the CDC convened a working group composed of members of several stakeholder organizations to address the limitations of the definition of ventilator-associated pneumonia (VAP) definition². The organizations represented in the Working Group include: the Critical Care [… read more]

Feb 012017
 
Advanced Critical Care Simulation Conference: Feb 17-18 in Phoenix (Register)

Register Now! PulmCCM is not affiliated with Banner University or the University of Arizona. SHARPEN YOUR LIFE-SAVING CRITICAL-CARE SKILLS Focusing on the clinical situations of highest concern to bedside intensivists, including the emergency evaluation of the patient with undifferentiated shock, the failed airway, refractory ARDS and obstetrical code arrest, this conference will bring participants up-to-date [… read more]

Jan 282017
 
Last chance to apply for the ALiEM Faculty Incubator

Junior faculty members: Looking for a way to bolster your academic credentials and engage/network with an established community of medical educators? The ALiEM (Academic Life in Emergency Medicine) Faculty Incubator is a yearlong online faculty development program (limited to 30 participants yearly), nearly exclusively done with online asynchronous interactions through the Slack platform. The incubator [… read more]

Dec 162016
 
Inferior vena cava filters are overused. What's the harm?

Inferior vena cava filters (IVCF) are placed to prevent deep venous thromboses (DVT) from traveling to the heart and lungs, causing pulmonary embolism (PE). IVC filters’ rationale makes sense, but despite their wide use, the benefits and risks of IVCF remain unclear. With about 50,000 IVC filters placed annually in the U.S., that’s a lot of unclarity. [… read more]

Nov 252016
 
Life-sucking power of electronic health records measured, reported, lamented

Feel like you spend twice as much time on your electronic health record as you do with patients? You may be doing better than half of your colleagues. In a new work study funded by the American Medical Association, researchers observed 57 physicians in internal medicine, family medicine, cardiology, and orthopedics over hundreds of hours. They discovered [… read more]

Nov 092016
 
Almost half of intensivists feel severe burnout, report says

Almost half of critical care physicians report symptoms of severe burnout associated with their ICU work, according to a report and “call to action” from the Critical Care Societies Collaborative (CCSC). Symptoms of severe burnout were highest among pediatric critical care specialists, while 45% of intensivists caring for adults acknowledged severe burnout. Burnout symptoms include [… read more]

Aug 252016
 
FAQ: How To Study for the Critical Care Medicine Board Examination?

Jon-Emile S. Kenny [@heart_lung] “Let the wild rumpus start!” -Maurice Sendak Many of you are preparing for the Critical Care Medicine Board Examination; thank you to those who have downloaded my free review notes.  I often receive a question or two about the exam and how germane my notes were, in retrospect.  This is a [… read more]

Jul 152015
 
Medicare will pay for death panels, I mean end-of-life counseling

Medicare announced last week it will finally pay doctors for their time spent talking to patients about their end-of-life preferences, among the most important medical decisions most people will make. The decision overcomes years of setbacks brought about by Sarah Palin’s politicizing of the Affordable Care Act’s provision for end-of-life counseling as endorsing “death panels” of [… read more]

Jul 022015
 
Direct thrombin inhibitors associated with heart attack risk in multiple trials

Direct thrombin inhibitors (DTIs) are anticoagulants (blood thinners) most often used as alternatives to heparin and warfarin. DTIs are approved by the FDA for prevention and treatment of venous thromboembolism (deep venous thrombosis and pulmonary embolism) and to prevent blood clots in people with atrial fibrillation. But multiple randomized trials suggest these widely used anticoagulants might cause heart [… read more]

Jul 012015
 
Families stall end of life talks, say doctors. True?

Doctors and nurses said patients and their families created the largest obstacles to end-of-life decision making in the ICU, in a large survey published in JAMA Internal Medicine. About 1,300 staff at 13 academic hospitals in Canada rated barriers to end-of-life goals of care on a 1-7 scale. Doctors and nurses considered the largest barriers [… read more]

May 312015
 
SICU Basic Training (Video, Part 2 of 2)

Part 2 of a video lecture by Dr. Richard Savel, director of the surgical intensive care unit (SICU) at Maimonides Medical Center, Albert Einstein College of Medicine. Designed for an audience of SICU house staff, its content is applicable to non-surgical critically ill patients as well. Topics presented include shock; sepsis bundles; acid base status; [… read more]

May 172015
 
The only VAP prevention method that saves lives is the one you’re not using

There’s always been doubt about the efficacy of the numerous “ventilator bundles” hospitals use to prevent ventilator-associated pneumonia (VAP). A provocative new analysis concludes that none of these methods save lives — except the one that almost no ICUs are using today. Healthcare associated pneumonias (HAP), especially ventilator-associated pneumonias (VAP), are associated with increased mortality, excess antibiotic use, lengthened hospital [… read more]

May 062015
 
Is more than one patient per ICU nurse dangerous?

The fewer patients an ICU nurse has to juggle, the better those patients’ chances of making it out of the hospital alive, according to a large observational study published in Critical Care Medicine. Data from the large EPIC II study suggested that two patients per nurse may be too many for safe, high-quality critical care. Nurse-to-patient [… read more]

Apr 202015
 
FDA warns against use of OTC homeopathic asthma treatments

The US Food and Drug Administration (FDA) is advising the public not to use over the counter homeopathic asthma products. Thanks to protection from friendly legislators, the multibillion dollar homeopathic and supplement industry is allowed to mislead the public by labeling homeopathic products as “promoting lung health,” or even advertising them specifically as “providing relief [… read more]

Apr 122015
 
Antibiotics for community-acquired pneumonia: Is azithromycin out?

Is it time for a change in the standard treatment of community-acquired pneumonia? A new Dutch study says, maybe. The Infectious Diseases Society of America (IDSA) says, not so fast. IDSA’s guidelines for treatment of community acquired pneumonia were last updated in 2007. For patients admitted to the hospital but not needing the ICU, they have [… read more]

Mar 282015
 
Surviving Sepsis Says EGDT Not Needed in All Patients with Septic Shock

As regular PulmCCM readers know, the ProCESS, ARISE and ProMISe randomized trials showed no benefit of protocolized early goal-directed therapy as compared to usual conscientious care in the treatment of severe sepsis and septic shock. In response to ProCESS and ARISE, the influential Surviving Sepsis Campaign now advises that measurement of central venous pressure (CVP) and [… read more]

Mar 272015
 
Endovascular therapy helps in ischemic stroke, again (ESCAPE)

Endovascular Therapy Improves Outcomes from Ischemic Stroke By Parth Rali, MD and Igor Titoff, DO Endovascular therapy for ischemic stroke has long been an attractive treatment modality for ischemic strokes, but until recently large randomized trials have not confirmed a benefit [1,2,3]. Two of these—IMS III1 and SYNTHESIS2—failed to prove the benefit of endovascular therapy (with-or-without tissue plasminogen activator) [… read more]