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Study Investigates The Role Of Fluid Resuscitation In Treatment Of Life-Threatening Infections

Dehydration is a common phenomenon in those suffering from infectious diseases, particularly if the diseases cause vomiting and/or diarrhea. We are all familiar with having the “stomach flu,” “traveler’s diarrhea,” or food poisoning. However, severe infections of all sorts can cause profound illness, debilitation, and fluid losses. In many developing countries, very large numbers of small children are afflicted with non-gastrointestinal infectious diseases that rapidly cause relatively large fluid losses, and therefore profound, life-threatening dehydration, which is manifested in part by dangerously low blood pressure and subsequent failure to deliver precious liquid, nutrients and oxygen to the tissues of the body. This is called “shock.”

The following discussion is cutting edge information, but not simplistic or necessarily easy to understand or apply. However, I have learned that my readers are often volunteers in settings where intensive care medicine must be applied, and want to read more than simple approaches to therapy. So, I am going to do my best to interpret for you what has recently been published in the New England Journal of Medicine in an article entitled “Mortality after Fluid Bolus in African Children with Severe Infection” (N Engl J Med 2011; 364:2483-95) written by Kathryn Maitland and her colleagues.

The focus of their investigation was Read more »

This post, Study Investigates The Role Of Fluid Resuscitation In Treatment Of Life-Threatening Infections, was originally published on by Paul Auerbach, M.D..

Surgeons Should Understand What Type Of Patient They Have

Over the years, I have found that patients can be loosely grouped into 4 different types. Nothing particularly wrong with any type, but it does help me to approach patients appropriately if I can get a sense of what type they are.

The four types are:

Type A: If a surgery can “fix” or “cure” me such that I won’t have to take medications every day of my life, than let’s do it.

Type B: I will never consider surgery unless it is a life-threatening situation. If a medicine can help, why do it???

Type C: I will consider surgery only as a last resort when all else fails.

Type D: Read more »

*This blog post was originally published at Fauquier ENT Blog*

Is The Ironman Triathlon Safe For The Middle-Aged Heart?

Before I even start, let me say this to my triathlete friends…

I really like you all. And…I am sorry for how I feel about your sport’s pinnacle, the Ironman triathlon. But I was poked into writing this post. When asked the question of whether the Ironman is safe for the middle-aged heart, what was I to do? Lie?

Each August, my hometown, Louisville, KY, gets overrun, over-swum and over-ridden with “Iron people.” No, these humans aren’t rust colored, or all that hardened, but they are indeed a determined lot. Triathletes, or iron people if you will, wake up before sunrise to swim, bike or run. Then they eat; some go to work (barely), and then they do the training thing again in the evening. Calling these athletes focused would surely be an understatement.

So it is each summer that I endure the same question: “Dr. Mandrola, did you do the Ironman?”

“No…I just ride bikes.”

But this year was different. Before I could launch into my usual dissertation on how training for Ironman-length triathlons causes excess inflammation, coronary calcium, atrial fibrillation, divorce, etc., etc., another question quickly popped up.

“What did you think of that guy who died during this year’s race?” Read more »

*This blog post was originally published at Dr John M*

Do Speeding Ambulances Save More Lives?

How fast should an ambulance go? The stereotypical speeding ambulance with lights flashing and sirens blaring is the image that most conjure up. But recent data suggests that transport speed may be overstated.

In a fascinating piece from Slate, emergency physicians Zachary F. Meisel and Jesse M. Pines examine that very question. They cite a recent study from the Annals of Emergency Medicine, which concluded that a fast transport speed didn’t necessarily save lives. Read more »

*This blog post was originally published at*

Google’s Approach To Serious Health Searches

Now that Google has become a near-universal information provider for many people, it’s finding itself answering questions that need a little more of a nuanced approach.

Apparently prodded by a mother who was looking for poison control contacts in an emergency, Google is now providing relevant phone numbers at the top of search results for a few specific queries. Read more »

*This blog post was originally published at Medgadget*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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