A 40-something with chest pain. Is this inferior MI?
This was sent by a Saleh Hatem, an avid reader of the blog.The patient presented with chest pain:There is a narrow complex tachycardia.Is there inferior ST Elevation?Here was my interpretation:What appears to be ST Elevation in inferior leads is really a P-wave that is contiguous with the QRS. (The next bump over is a T-wave that looks like a P-wave!).Since the P-wave is not inverted, it is NOT retrograde, and therefore it is a native sinus beat. This sinus beat does conduct, but there is severely prolonged PR interval (severe first degree AV block), with a PR interval of over 400 ms.So: Sinus tachycardia with severe first degree AV block.Here is what he wrote:Her serial trop was negative. Later ECGs confirmed your interpretation, Dr. Smith. Thanks.The reader later sent these same followup ECGs:The sinus rate has slowed and now the P-wave is hidden in the T-wave.The sinus rate has slowed even more and now the P-wave comes after the T-wave, with a PR interval of just under 400 ms.===================================MY Comment by KEN GRAUER, MD (3/1/2020):===================================This is an insightful case succinctly explained by Dr. Smith. For the purpose of academic discussion — I will expand on a number of important points.For clarity — I have reproduced and labeled the ECG in this case in Figure-1.Figure-1: The ECG sent to Dr. Smith by a reader. The patient presented with chest pain. Presumably, this is her ini...
Do you guys think there is enough volume to support an outpatient interventional cancer pain &cancer rehab practice? I will be starting my PM&R residency training at one of the top programs in the country after this academic year (am an prelim medicine intern right now). And I ultimately want to help cancer survivors. I think with the continuing improvements with cancer treatments (most recently with immunotherapy), cancer will be/is a chronic disease with debilitating side effects that... cancer pain only practice
Perioperative Use of Gabapentinoids for the Management of Postoperative Acute Pain:A Systematic Review and Meta-analysis | Anesthesiology | ASA Publications In this new meta-analysis in this months’ Anesthesiology, the use of these drugs is very much called into question. Will this change your practice?
Publication date: September 2020Source: Social Science &Medicine, Volume 261Author(s): Vani A. Mathur, Theresa Morris, Kelly McNamara
Publication date: Available online 3 August 2020Source: Journal of Clinical Orthopaedics and TraumaAuthor(s): Salvador Israel Macías-Hernández, Jessica Rossela García-Morales, Cristina Hernández-Díaz, Irene Tapia-Ferrusco, Oscar Benjamín Velez-Gutiérrez, Tania Inés Nava-Bringas
CONCLUSIONS: To avoid running-related injuries, runners should be careful when increasing weekly mileage. Moreover, runners with previous exercise experience may need to approach running more cautiously. Setting goals and pursuing longer-distance running events may be motivating, but at the same time, can increase the risk of running-related injuries. PMID: 32744044 [PubMed - as supplied by publisher]
Authors: Sakamoto T, Ishio Y, Ishida Y, Mogi K, Kikusui T Abstract Deprivation of maternal care has been associated with higher pain sensitivity in offspring. In the present study, we hypothesized that the maternal licking/grooming behavior was an important factor for the development of the pain regulatory system. To test this hypothesis, we used male F2 offspring of early-weaned (EW) F1 mother mice that exhibit lower frequency of licking/grooming behavior. The formalin test revealed that F2 offspring of EW F1 dams showed significantly higher pain behavior than F2 offspring of normally-weaned (NW) F1 dams. We found...
Publication date: Available online 3 August 2020Source: Journal of Cranio-Maxillofacial SurgeryAuthor(s): Nermine Ramadan Mahmoud, Essam Mohamed Ashour
Condition: Musculoskeletal Pain Intervention: Behavioral: Emotion- and Relationship-Focused Therapeutic Interview Sponsor: Mark A. Lumley Not yet recruiting
Condition: Low Back Pain Interventions: Other: dry needling; Other: sham dry needling Sponsor: University of Haifa Not yet recruiting
Condition: Opioid Use Intervention: Sponsor: Hospital for Special Surgery, New York Active, not recruiting