A 50-something with chest pain.
This was sent by anonymous The patient is a 55-year-old male who presented to the emergency department after approximately 3 to 4 days of intermittent central boring chest pain initially responsive to nitroglycerin, but is now more constant and not responsive to nitroglycerin. It is unknown when this pain recurred and became constant.More past history: hypertension, tobacco use, coronary artery disease with two vessel PCI to the right coronary artery and circumflex artery several years prior. He reports feeling nauseated with emesis. He reports that this chest pain feels different than prior chest...
Source: Dr. Smith's ECG Blog - September 3, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
What's new in midwifery - 2nd August 2023 - Research
Some recent research you might like to know about. Payment, a subscription, or if you have one, a librarian, might be needed to get full text access.Acupuncture and doxylamine-pyridoxine for nausea and vomiting in pregnancy : a randomized, controlled, 2 x 2 factorial trial. Real-time imaging as visual biofeedback in active second stage of labor among nulliparas: a randomized controlled trial. The effect of virtual reality glasses applied during the episiotomy on pain and satisfaction: a single blind randomized controlled study.Efficacy of early intrauterine balloon tamponade for immediate postpartum hemorrh...
Source: Browsing - August 2, 2023 Category: Databases & Libraries Tags: midwifery Source Type: blogs
Blood Pressure Meds vs Blood Thinners: What ’ s The Difference?
Conclusion
In conclusion, while blood pressure medicines and blood thinners are both crucial to heart health, their roles and mechanisms of action are notably distinct. Blood pressure medication works primarily on the vascular system, aiding in reducing blood pressure by relaxing blood vessels or altering the heart’s function. On the other hand, blood thinners target the blood itself, working to prevent the formation of potentially dangerous blood clots.
Throughout this article, one thing becomes undeniably clear: the importance of regular consultations with your healthcare provider. When it comes to managing m...
Source: The EMT Spot - July 20, 2023 Category: Emergency Medicine Authors: Michael Rotman, MD, FRCPC, PhD Tags: Blood Pressure Source Type: blogs
I was reading ECGs on the system when I came across this one, called " normal " by the conventional computer algorithm
I come in early for every shift to read the ECGs on the system that have not yet been " confirmed " . I came across this one:The computer calls is: " SINUS RHYTHM. NORMAL ECG "What do you think? Be VERY careful when the computer calls the ECG " Normal " . I saw the inferior ST depression (which is reciprocal to subtle STE in aVL) and the subtle ST depression in precordial leads and thought:" If this patient came in with chest pain, then it is an acute OMI. "So I looked on the computer. Turns out that it was a 50-something patient with no previous cardiac history who had called 911 for chest pain...
Source: Dr. Smith's ECG Blog - July 12, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Data Democracy! ‘Dr. Google’ (2023) Vs. ‘Every Man His Own Physician’ (1767)
BY MICHAEL MILLENSON
In the 18th-century, a pre-Google guide offered democratization of medical information
In 1767, as American colonists’ protestations against “taxation without representation” intensified, a Boston publisher reprinted a book by a British doctor seemingly tailor-made for the growing spirit of independence.
Talk about “democratization of health care information,” “participatory medicine” and “health citizens”! Every Man His Own Physician, by Dr. John Theobald, bore an impressive subtitle: Being a complete collection of efficacious and approved remedies for every disease...
Source: The Health Care Blog - July 7, 2023 Category: Consumer Health News Authors: Ryan Bose-Roy Tags: Medical Practice Democritization of Care Healthcare Michael Millenson Participatory medicine Source Type: blogs
63 year old with " good story for ACS " but negative troponins.....
This was texted to me from a former resident, while working at a small rural hospital, with the statement:" I can ’t convince myself of anything here, but he’s a 63-year-old guy with prior stents and a good story for ACS. " (Chest pain or discomfort)What do you think?Here was my response:" Suspicious for inferior posterior OMI. Get serial ECGs "He then sent a previous from 4 years prior:" This is totally normal, which confirms that the first EKG does indeed represent OMI "Then the patient ' s chest pain resolved and he recorded another:The ST depression in aVL is gone and the T-waves are less hyperacu...
Source: Dr. Smith's ECG Blog - July 2, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
A man in his 50s with acute chest pain who is lucky to still be alive.
Sent by Magnus Nossen MD, written by Pendell MeyersA man in his 50s, previously healthy, developed acute chest pain. EMS was called, and they recorded the following ECG on scene at 13:16:What do you think?Below is the version standardized by PM Cardio appMeyers interpretation:Findings are specific for posterior (and also likely inferior) wall transmural acute infarction, most likely due to acute coronary occlusion (OMI). There is a relatively normal QRS yet there is STD maximal in V2-V4, which resolves from V4 to V6. The inferior leads may have a slightly full T wave (possibly hyperacute if compared to baseline which...
Source: Dr. Smith's ECG Blog - June 21, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
A man with chest pain off and on for two days, and " No STEMI " at triage.
Written by Kaley El-Arab MD, edits by Pendell Meyers and Stephen SmithA 61-year-old male with hypertension and hyperlipidemia presented to the emergency department for chest tightness radiating to the back of his neck that has been intermittent for the past day or two. Here is his triage ECG which was obtained at 20:34 during active pain.What do you think?This ECG was read as “No STEMI” with no prior available for comparison. It is true this ECG does not meet STEMI criteria (there is 1.0 mm STE in III, and possibly 0.5 mm in aVF), but there is clear evidence of OMI findings on this ECG. Leads II, III, and aVF hav...
Source: Dr. Smith's ECG Blog - June 19, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
A 40-something male with resolving chest pain and a " Normal ECG " by computer and cardiology overread
A 40-something male presented by ambulance with one hour of chest pain that was improving after sublingual nitroglycerine and 325 mg of aspirin, chewed. Here is his initial ED ECG:What do you think?I read this ECG without any history as reperfusing inferior and posterior OMI due to the Q-wave in lead III with minimal STE and reciprocal ST depression in V2-V4 (which should never be there). The large upright T-wave in V2 is consistent with reperfusion.Any ST Depression Maximal in V1-V4 is OMI until proven otherwiseI sent this ECG with no information to Pendell. We send each other EKG by the dozens...
Source: Dr. Smith's ECG Blog - June 5, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Another myocardial wall is sacrificed at the altar of the STEMI/NonSTEMI mass delusion (and Opiate pain relief).
I received the following text message with these 3 EKGs (providers text me ECGs all day every day; most are false positives; many are subtle true positives):" Hi Steve, here are 3 EKGs for you (my colleague ' s case). A 67 yo f developed chest pain this morning. "EKG #1Followed 15 minutes by this #2 EKG:Then the patient received aspirin andDilaudid (hydromorphone, same effect as morphine) and the pain went away and there was this 3rd ECG:Smith comment: hydromorphone will make any pain go away (or improve) without any improvement in the underlying pathology. Do NOT give it unless you are committed to t...
Source: Dr. Smith's ECG Blog - May 31, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
The cannabis education gap: Why patients are left in the dark
Imagine that you are suffering from chronic pain. The pain keeps you awake at night so you don’t get much sleep. Lack of sleep most nights and the ensuing chronic fatigue causes you some anxiety during the day. Your primary care physician suggests that she is concerned with the increasing amount of aspirin and ibuprofen
Read more…
The cannabis education gap: Why patients are left in the dark originally appeared in KevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - May 1, 2023 Category: General Medicine Authors: Timothy Byars Tags: Meds Hospital-Based Medicine Psychiatry Source Type: blogs
A man in his 60s with acute chest pain and high voltage
Sent by Anonymous, written by Pendell MeyersA man in his 60s with history of CAD and 2 prior stents presented to the ED complaining of acute heavy substernal chest pain that began while eating breakfast about an hour ago, and had been persistent since then, despite EMS administering aspirin and nitroglycerin. There was associated diaphoresis, but no dyspnea, nausea, or vomiting. He reported having covid 2 weeks ago, but had seemingly fully recovered.Triage 1104:What do you think?The triage ECG was sent to me with no history (I did not have access to baseline ECGs), and I said that I thought this was just LVH causing the an...
Source: Dr. Smith's ECG Blog - April 14, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
A 40-something woman with acute pulmonary edema -- see the Speckle Tracking echocardiogram.
A 49 year old woman with h/o COPD only presented with sudden dyspnea. She had acute pulmonary edema on exam. PrehospitalConventional algorithm interpretation: ANTERIOR INFARCT, STEMITransformed ECG by PM Cardio:PM Cardio AI Bot interpretation:OMI with High ConfidenceWhat do you think?There is STE and hyperacute T-waves in V2 and V3, with significant STE in I and aVL, and inferior reciprocal STD.This is proximal LAD Occlusion until proven otherwise.On arrival, lung ultrasound confirmed pulmonary edema (B lines). An ECG was recorded:ED ECG 1:The findings are still present but not nearly as profound now...
Source: Dr. Smith's ECG Blog - April 12, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
A 40-something with 100 minutes of chest pain
I was reading ECGs on the system, and saw this one:What do you think?I knew that, if the patient had presented with chest discomfort, that this ECG is diagnostic of inferior posterior OMI, even though it is not a STEMI.However, it is difficult to recognize for an interpreter who is does not have special expertise in OMI ECG diagnosis. We taught an AI system fromPM Cardio to recognize patterns of subtle OMI (beware: this version of the app is not available to the public yet). We named the AI app the " Queen of Hearts " This is what the Queen said about this ECG:" OMI with High Confid...
Source: Dr. Smith's ECG Blog - March 27, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
What's new in midwifery - 13th March 2023 - research
Some other recent papers and reviews of possible interest.AntenatalAntenatal dietary supplementation with myo-inositol for preventing gestational diabetes. (Cochrane review, update of a review previously published in 2015).Aspirin discontinuation at 24 to 28 weeks` gestation in pregnancies at high risk of preterm preeclampsia: a randomized clinical trial. (Aspirin reduces the incidence of preterm preeclampsia, but is also associated with peripartum bleeding). Development and psychometric properties of the sleep problems and coping with sleep problem scales for pregnant womenSerial plotting ...
Source: Browsing - March 13, 2023 Category: Databases & Libraries Tags: midwifery Source Type: blogs
