Supraclavicular subclavian vein catheterization: the forgotten central line.

While the supraclavicular approach to the subclavian vein has been described since 1965, it is generally employed much less often than the "traditional" infraclavicular approach. Although randomized trials are lacking, the best evidence suggests that the supraclavicular approach has a number of important advantages to the infraclavicular approach. The landmarks and relative merits of the procedure are described in this paper.

Medical myth: Bimanual pelvic examination is a reliable decision aid in the investigation of acute abdominal pain or vaginal bleeding.

Reliance on the accuracy of the pelvic examination is upheld in many medical textbooks, but review of the literature does not support the accuracy or reproducibility of this examination. That this "test" is useful for ruling out serious disease will be exposed for the myth that it is.

Myth: Intravenous amiodarone is safe in patients with atrial fibrillation and Wolff-Parkinson-White syndrome in the emergency department.

Wolff-Parkinson-White (WPW) syndrome with atrial fibrillation (AF) is a potentially life-threatening problem requiring rapid conversion to sinus rhythm. The most recent American Heart Association guidelines for the treatment of patients with WPW, published in conjunction with the 2000 Advanced Cardiac Life Support (ACLS) guidelines, suggests that intravenous amiodarone is a first-line therapy for AF-WPW; however the evidence suggests this is a potentially dangerous myth.