Jones & Bartlett Learning Medicine Blog

    Bedside Ultrasound Increases the Success Rate for Difficult Lumbar Punctures

    Posted by Joseph Esherick on Jul 15, 2011 11:08:52 AM

    Dr. Joseph Esherick Monthly Blog – July 2011

    The traditional landmark-guided needle lumbar puncture technique was first described by Heinrich Quincke in 1891[1]This technique utilizes the iliac crest and the posterior lumbar spinous processes to determine the optimal sites for spinal needle introduction in either the L3-4 or the L2-3 interspinous spaces.  The landmark-guided technique of lumbar puncture is usually successful in experienced hands as long as the patient is not obese, pregnant, edematous, or have scoliosis, degenerative joint disease, or a history of lumbar spine surgery.  Patients who have any of these characteristics or conditions can lead to more difficult landmark-guided lumbar punctures.  It is in these cases when bedside ultrasound can increase the success rate of lumbar punctures.[2,3,4,5]    

    Ultrasound-guided regional neuraxial anesthesia has been described in the anesthesia literature since 1971.[6]   The literature reports a reduction in the number of attempts, need for repositioning, and interspaces accessed compared with landmark-guided spinal or epidural anesthesia.[7,8]  The use of bedside ultrasound to help guide difficult lumbar punctures has spread to the emergency room, ICU, and the hospital wards over the last 7 years.[9]   Observational studies have demonstrated that lumbar landmarks can be correctly identified using ultrasound about 76% of the time when they are difficult to palpate.[2,3,9]

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    Topics: Dr. Joseph Esherick, emergency physician, Heinrich Quincke, Authors, bedside ultrasound, Hospital Medicine Blog, emergency medicine, hospital medicine, hospitalist, landmark-guided, lumbar puncture

    Capgras Syndrome: Ever Thought Your Loved One Was an Impostor?

    Posted by admin on Jul 11, 2011 12:38:48 PM

    Reposted from Huffington Post:
    http://www.huffingtonpost.com/carol-w-berman-md/capgras-syndrome_b_888854.html
    article by Jones & Bartlett Learning Medicine Author, Carol W. Berman, MD

    ++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

    Did you ever look at your husband or wife and feel that person is an impostor? Janet, a 24-year-old graduate student, came home from a stressful day at school and found a man she thought was a stranger in her bed.

    "Who are you? How did you get into my apartment?" she asked.

    She was in no mood to fool around with a strange man who had somehow gained entrance to her apartment and was lounging on her bed in her husband's blue silk pajamas.

    "Very funny. And who are you?"

    The man countered. He looked similar to Dave, her husband. In fact, he had short brown hair, dark blue eyes and the same kind of round cheeks as Dave. However, Janet knew in her gut that it wasn't Dave. Maybe distant relatives or casual friends might believe the man was Dave, but Janet and Dave had been together practically every day for the last three years, and Janet could swear it wasn't her husband.

    As a psychiatrist I treat many bizarre conditions, but this case was one of the strangest. The movie "Invasion of the Body Snatchers," in which people correctly accuse their loved ones of being impostors, illustrates Capgras' syndrome. In the movie, the townspeople's loved ones were actually replaced by extraterrestrials who want to destroy humanity. In Capgras' syndrome, people falsely believe their loved ones are replaced by duplicates.

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    Topics: psychiatry, Capgras Syndrome, Carol W. Berman, Authors, Panic Disorder, psychiatrist, Pyschiatry & Mental Health, MD, NYU Medical Center

    A Simple Checklist for Central Lines Saves Lives and Money

    Posted by Joseph Esherick on Jun 28, 2011 8:28:07 AM

    Dr. Joseph Esherick Monthly Blog - June 2011

    Safety checklists have been adopted by numerous industries to prevent errors and save lives.  Checklists have been used for decades by industries as diverse as the aviation industry, construction companies, and professional chefs to prevent mistakes.  In medicine, checklists have been used in the operating room to prevent surgical errors and for central line placement to prevent catheter-related blood stream infections (CRBSIs).

    The pioneer of safety checklists in medicine is Dr. Peter Provonost who spearheaded the Michigan Keystone ICU Project that ended in 2006[1].   The checklist used for central venous catheter placement is simple and involves only five key steps that are rooted in evidence-based medicine:  wash your hands; cleanse the insertion site thoroughly with chlorhexidine; maximal barrier precautions (wear a mask covering the nose and mouth, a cap covering all your hair, sterile gown, sterile gloves and use a wide sterile drape over the patient); a nurse or observer is empowered to stop the procedure if there is any break in sterile technique; and there is a daily review of central line necessity.

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    Topics: medicine, Dr. Joseph Esherick, Authors, Keystone Project, CRBSI, Global Health Blog, Dr. Peter Provonost, hospital medicine, hospitalist, ICU, safety checklist

    Pre-Procedural Statins Reduce the Incidence of Peri-procedural Cardiac Events

    Posted by admin on May 20, 2011 2:07:07 PM

    Dr. Joseph Esherick Monthly Blog - May 2011

    Initiation of statins during the acute period has been shown to be beneficial during an acute coronary syndrome and immediately following an ischemic stroke. [1,2,3] It is believed that statins, HMG-CoA reductase inhibitors, have pleiotropic properties that have anti-inflammatory effects, improve endothelial function and inhibit the body’s thrombogenic response.  The properties are in addition to the lipid lowering effects of statins.  These pleiotropic effects are felt to be the principal mechanism by which statins decrease recurrent cardiovascular and cerebrovascular events when started acutely during an acute coronary syndrome or immediately after an ischemic stroke.  Statins have also been shown in two randomized controlled trials to decrease the incidence of peri-procedural myocardial infarction if started soon before percutaneous coronary intervention or before major vascular surgery. [4,5]

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    Topics: Cardiac Events, Authors, Statins, Cardiology, cardiology, Hospital Medicine Blog

    Lillie Shockney Featured in Breast Cancer Wellness Journal

    Posted by admin on Apr 15, 2011 6:26:41 AM

    Jones & Bartlett Learning Author profile for Lillie Shockney, RN, BS, MAS in this month's Breast Cancer Wellness Journal

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    Topics: oncology, patient education, Authors

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