Chest pain and new regional/reciprocal ECG changes compared to previous ECGs: code STEMI?
Written by Jesse McLaren A 45 year old presented with two weeks of recurring
non-exertional chest pain, now constant for an hour. Below is old and then new
ECG (old on top; new below). What do you think?Both ECGs have normal sinus rhythm, normal conduction and
normal voltages. There ’s a change in axis that may interfere with direct
lead-to-lead comparison, but there appear to be larger T waves in I/aVL and new
TWI in III/aVF. But do they represent acute coronary occlusion? Because of the ECG changes in a patient with chest pain, and
with inferolateral hypokinesis on POCUS, the cath lab was activated. But...
Source: Dr. Smith's ECG Blog - November 27, 2023 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
What are the most commonly used pain self-management strategies?
This study also demonstrates how novel interventions can be examined in groups with small numbers, but still allowing us to measure important changes. As an exploratory design, single case study design replicated with several participants is a method we need to use more.
In a systematic review and meta-analysis, Blasco-Belled and colleagues (2023) found that positive psychology interventions do enhance positive affect and reduce anxiety but didn’t alter depression. There were not many studies included in this analysis suggesting that we still have a hang-up on promoting joy and compassion and all the good things i...
Source: HealthSkills Weblog - November 26, 2023 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Clinical reasoning Coping Skills Coping strategies Occupational therapy Resilience Resilience/Health Science in practice biopsychosocial pain management Research Therapeutic approaches Source Type: blogs
Infection and DKA, then sudden dyspnea while in the ED
To learn more about Occlusion MI, join us in thisFree Webinar on November 27 12 noon US Central Time:Sign up at this link: https://zoom.us/webinar/register/2216945975176/WN_7HuMRHNxREKifGgQvy70lg#/registrationInfection and DKA, then sudden dyspnea while in the EDA 63 year old male with a PMH of CAD and peripheral vascular disease from type 1 DM presented to clinic and was found to have a very high blood sugar and so was sent to the emergency department.Patient stated that he has had glucose over 400 even though he has not missed any doses of insulin. He also endorses fatigue, upset stomach, frequent urination, i...
Source: Dr. Smith's ECG Blog - November 22, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Will We All Have To Become Biologically Enhanced Superhumans?
Okay, hands up who can tell who’s the most famous biologically enhanced superhuman in the world? True, it’s a quite close call between Captain America and The Incredible Hulk (sorry Spidey, you’re not even close). But are human-invented superhumans just a thing of a Stan Lee comic, or is it an actual scientific idea from a real laboratory?
As a matter of fact, enhancing human capabilities has been on the minds of people for ages, but it has come a long way from ancient training methods to exoskeletons. Enhancing our abilities, be it permanently or temporarily is a tempting but risky matter. Will it be possibl...
Source: The Medical Futurist - November 21, 2023 Category: Information Technology Authors: berci.mesko Tags: Forecast Artificial Intelligence in Medicine Augmented Reality Bioethics Biotechnology Cyborgization Digital Health Research E-Patients Genomics Health Sensors & Trackers Healthcare Policy Medical Education Robotics Science Ficti Source Type: blogs
What are the most commonly used pain self-management strategies?
In a very unscientific vox populi survey conducted via my blog, I asked people with pain to tell me the FIVE self-management strategies they’d used over the week prior. If you’re interested in completing this yourself, click here: click. (Scroll down that page to the survey).
My reason for asking the question is that we have a list of self-management strategies, but the definitions and the way strategies are used in daily life are quite murky. For example, we don’t have a clear definition of ‘activity pacing’ though we are starting to investigate it. We also don’t know whether strateg...
Source: HealthSkills Weblog - November 19, 2023 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Coping strategies Research Resilience/Health pain management Therapeutic approaches Source Type: blogs
Acute Dyspnea and Right Bundle Branch Block
I was texted this ECG just as I was getting into bed.It is of an elderly woman who complained of shortness of breath and had a recent stent placed.I was told that the Queen of Hearts had called it OMI with high confidence.What do you think? Ken (below) is appropriately worried about pulmonary embolism from the ECG. What I had not told him before he made that judgement is that the patient also had ultrasound B-lines of pulmonary edema.Here is my interpretation:There is sinus rhythm with RBBB. If you jump to looking at ST segments, you see " coved " ST in V3, V4, V5, with subtle ST Elevation. This is HIGHLY ...
Source: Dr. Smith's ECG Blog - November 18, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?
A 70-something female with no previous cardiac history presented with acute chest pain. She awoke from sleep last night around 4:45 AM (3 hours prior to arrival) with pain that originated in her mid back. She stated the pain was achy/crampy. Over the course of the next hour, this pain turned into a pressure in her chest. She said this was midsternal and felt like a tightness. This originally radiated into her left arm. Over some time and the pain moved into her other arm as well as her jaw. She also had some shortness of breath. She was brought in by ambulance and re...
Source: Dr. Smith's ECG Blog - November 15, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Putting people in boxes
I just finished readingThe Invisible Kingdom: Reimagining Chronic Illness, by Meghan O ' Rourke. She lived for many years with a debilitating illness that went undiagnosed. She ultimately concluded that she had chronic sequelae of Lyme disease, likely complicated by autoimmune and other manifestations that may have been triggered by Lyme disease or possibly just co-occurring coincidentally. In her desperation to find relief, or at least answers, she saw innumerable physicians and other practitioners, ultimately resorting to people with, shall we say, unorthodox ideas who many people -- I included -- would classify as quack...
Source: Stayin' Alive - November 13, 2023 Category: American Health Source Type: blogs
Explain this ECG in the context of active chest pain, slightly elevated troponin without a delta, RCA culprit, and previous with LBBB
A 60-something yo female presented w/ exertional chest pain for 3 days. She had a recent positive stress test about one week ago. Pain was 8/10 and constant. She has been experiencing progressively worsening exertional dyspnea and chest tightness mostly when climbing up flights of stairs since early September. She underwent exercise echocardiogram in mid October where she exercised for nearly 7 minutes on the standard Bruce protocol and had typical anginal pain and shortness of breath. Baseline echocardiogram showed moderate LV systolic dysfunction with no wall motion abnormalities. Over the last...
Source: Dr. Smith's ECG Blog - November 9, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Do clinicians know how to help people develop pain self management?
In recent posts I’ve been discussing pain self management and why it’s not only necessary, but inevitable for people living with pain. Today I turn my gaze to health professionals, and the skills needed to support developing self management – because it’s not the same as ‘telling’, or ‘educating’, or even ‘advising’.
Firstly, let’s check out what people with pain want in self management. Lim and colleagues (2019) conducted a systematic review examining studies identifying ‘health information needs’ of people with low back pain. I put that tit...
Source: HealthSkills Weblog - November 5, 2023 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Coping Skills Low back pain Professional topics Science in practice Clinical reasoning healthcare pain management self-management Therapeutic approaches Source Type: blogs
See this " NSTEMI " go unrecognized for what it really is, how it progresses, and what happens
Written by Nathanael Franks MD, reviewed by Meyers, Smith, Grauer, etc.A man in his 70s with past medical history of hypertension, dyslipidemia, CAD s/p left circumflex stent 2 years prior presented to the ED with worsening intermittent exertional chest pain relieved by rest. This episode of chest pain began 3 hours ago and was persistent even at rest.Triage ECG at Time = 0: Smith: I am suspicious for posterior OMI due to ST depression in V2 and V3Baseline EKG (several months prior):Smith: Now I am even more suspicious of posterior OMI, as the baseline ECG has normal ST elevation in V2 and V3ECG Interpretation:The tri...
Source: Dr. Smith's ECG Blog - November 3, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
Rube Goldberg Would Be Proud
By KIM BELLARD
Larry Levitt and Drew Altman have an op-ed in JAMA Network with the can’t-argue-with-that title Complexity in the US Health Care System Is the Enemy of Access and Affordability. It draws on a June 2023 Kaiser Family Foundation survey about consumer experiences with their health insurance. Long stories short: although – surprisingly – over 80% of insured adults rate their health insurance as “good” or “excellent,” most admit they have difficulty both understanding and using it. And the people in fair or poor health, who presumably use health care more, have more problems.
Health insurance...
Source: The Health Care Blog - October 31, 2023 Category: Consumer Health News Authors: matthew holt Tags: Health Policy Employers Health system change Kim Bellard Medicare PBMs Source Type: blogs
Faculty Perspectives on Responding to Microaggressions Targeting Clerkship Students
On this episode of the Academic Medicine Podcast, Meghan O’Brien, MD, MBE, and Research in Medical Education (RIME) Committee members Tasha Wyatt, PhD, and Javeed Sukhera, MD, PhD, join host Toni Gallo to discuss new research into faculty perspectives on responding to microaggressions targeting medical students in the clinical learning environment. They explore several tensions that affected how faculty responded to the microaggressions in the study scenarios as well as some of the strategies the faculty used to respond effectively.
This episode is now available through Apple Podcasts, Spotify, and anywhere else p...
Source: Academic Medicine Blog - October 31, 2023 Category: Universities & Medical Training Authors: amrounds Tags: AM Podcast AM Podcast Transcript Academic Medicine podcast faculty development medical education medical students microaggressions RIME Source Type: blogs
Continuous prolonged generalized weakness, lightheadedness, and presyncope. What might you suspect from the ECG?
A young man presented with continuous prolonged generalized weakness, lightheadedness, and presyncope. There was some dyspnea but no chest pain. Here is his ECG. This shows LVH, with high voltage.LVH can have very thick-walled ventricles and a correspondingly small LV cavity. LVH is a common etiology of heart failure with preserved ejection fraction, as it may results in a stiff ventricle with poor diastolic relaxation.See this articles: Heart Failure with Preserved Ejection Fraction (NEJM review)One etiology of LVH on the ECG is Hypertrophic Cardiolmyopathy (HOCM), and sometimes ECGs in pa...
Source: Dr. Smith's ECG Blog - October 28, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Sunday Sermonette: Yet another blowhard
It seems that four endless yammerers isn ' t enough. Now we get a fifth. Elihu runs his mouth for the next six chapters and says approximately nothing. He spends the first chapter just blathering about how he is about to speak. Then he says that Job is wrong to claim he hasn ' t done anything to deserve his fate, but the other three Bozos are losers because they haven ' t been able to prove that he ' s wrong. But then Elihu spends the next four chapters equally failing to prove anything and just spewing more endless dreck about the greatness of God. This book could easily be one twentieth as long, probably a lot less, and ...
Source: Stayin' Alive - October 22, 2023 Category: American Health Source Type: blogs
