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By Dr. Paul Kivela

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This is list of articles and thoughts that improve Emergency Medical Care

Medically Sound

With Dr. Paul Kivela

Capsaicin Cream Safe and Effective for Cannabinoid Hyperemesis...

  January 25, 2020

A review article published in February 2019 in the Annals of Pharmacology reviewed 241 articles including both full text and conference abstracts looking at the safety and effectiveness of capsaicin cream for treating marijuana hyperemesis syndrome.  Although there is little data, the article commented that capsaicin is recommended as a reasonable first-line treatment approach for CHS despite… Read More


Eskatamine is potentially prohibitively expensive

  August 16, 2019

There has been a tremendous number of articles and a lot of interest in the use of ketamine in the treatment of depression and chronic pain. This prompted many drug companies to invest and Johnson and Johnson developed a new product to treat depression. However there are always challenges with new products especially effectiveness, side… Read More


Where There’s Wildfire, There’s Smoke | NEJM

  March 11, 2018

A March 8, 2018 in NEJM looks at the potential health effects of the smokes form wildfires.  This Perspective article was entitield “The New England Journal of Medicine — Where There’s Wildfire, There’s Smoke.” This article looks at the increased number of wildfires and their potential health effects.  The recent Napa wildfires Fine particles are… Read More


Hyperkalemia may cause bradycardia and other arrhythmias

  February 23, 2018

This 10 July 2017 Article by Amal Mattu in Western Journal of Emergency Medicine warns that hyperkalemia might be a cause of bradycardia and to consider calcium in resistant bradycardia. The obvious answer to the question posed in the title is “yes,” but the actual ECG findings that predict adverse events are apparently not well… Read More


Cytokine storm & severe influenza: should we alter...

  February 1, 2018

This year’s deadly flu epidemic has led to a lot of questions of why we are seeing cardiac arrhythmias, myocardial infarctions, airway swelling, and increased deaths.  What is even more alarming is that these events are occurring in relatively young people. One of the the theories being put forth is that this is being caused… Read More


No change in physical activity after total hip...

  January 18, 2018

This September 2017 article by Hammett et al in Arthritis Care and Research found that although hip and knee replacement surgery decreased pain in did not change physical activity at 6 months after surgery The study found physical activity among patients undergoing total knee or hip arthroplasty was not increased 6 months after the surgery despite… Read More


Los Angeles County Department of Mental Health-Homepage Detail

  January 17, 2018

LA County Mental Health Resources are an important part of the solution to help prevent suicides in Southern California.  Is this a model system that is effective and also sustainable?  Is this a poison control model that might work in other parts of the country?  Is this like a trauma center referral solution? This a… Read More


DoD expands use of telehealth services 

  January 13, 2018

DoD takes steps to expand use of telehealth services By Fred Bazzoli Published January 11 2018, in Health Data Management The Department of Defense is expanding its ability to deliver telehealth services to active duty military personnel, veteran and their families by designating a provider of telemedicine services to operate on its networks. The agency… Read More


Efficacy and Safety of Intranasal Esketamine in Depression

  December 31, 2017

This small randomized double blind study examined the effects of intranasal ketamine in the treatment of resistant depression  published December 27, 2017  by Ella J. Daly, MD1 et al in JAMA Psychiatry and found significant improvement of depressive symptoms.  Depression was assessed by the Montgomery-Åsberg Depression Rating Scale total score, and was observed after 1 week with intranasal esketamine, and compared… Read More


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