A 41 year old with chest pain and a Nondiagnostic Triage ECG. Thrombolytics prior to transfer for PCI.
Conclusion:Transfer for PCI without thrombolytics is best if PCI at receiving facility can be done in less than 120 minutes from first medical contact, or less than 90 minutes from STEMI diagnosis in first ED.Thrombolytics prior to Transfer to a PCI capable facility, then rescue PCI if no reperfusion for STEMITRANSFER AMI(Cantor et al. 2009).High risk STEMI: BP less than 100, HR greater than 100 Killip class II, III, ST depression of at least 2 mm in precordial leads, ST elevation in right precordial leads (right ventricular MIAll patients get TNK-tPA.80-90% received clopidogrel 300 mg (75 mg for age over...
Source: Dr. Smith's ECG Blog - November 7, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
Electronic Pill Popping to Detect GI Bleeds: Interview With EnteraSense
Getting a clear view of your GI tract typically involves the uncomfortable process of having a long endoscope snaked down the esophagus. Thankfully, capsule endoscopy technology is replacing many procedures that have required an endoscope. These swallow-able devices are able to withstand the harsh, acidic environment of the gut, and can provide high-resolution images, as well as temperature, pH, and pressure data.
EnteraSense, an early-stage startup based in Galway, Ireland, has developed a device that utilizes the “Pill Cam” form factor to detect upper GI bleeds. The technology is elegant, but challenging, ...
Source: Medgadget - November 4, 2019 Category: Medical Devices Authors: Scott Jung Tags: Exclusive GI Source Type: blogs
Plant-based diets are best … or are they?
This study is also a reminder that the health impact of a particular intervention (such as diet) may not be easy to predict or explain. In most cases, the risk of stroke and heart disease tend to rise or fall together, but that wasn’t the case in this research.
Beware the study’s limitations
This study linking a vegetarian diet with a higher risk of hemorrhagic stroke has a number of important limitations that should temper the concerns of vegetarians.
The study was observational. That means it simply observed what happened among different people who followed different diets over time, without being able to account fo...
Source: Harvard Health Blog - October 31, 2019 Category: Consumer Health News Authors: Robert H. Shmerling, MD Tags: Healthy Eating Heart Health Hypertension and Stroke Source Type: blogs
40-something male in a head-on Motor Vehicle Collision and Splenic Injury
A 40-something male presents to the stabilization room for evaluation following head on motor vehicle collision (MVC). Pt was reported restrained driver, hit at city speeds, with + airbag deployment.The MVC was unquestionably caused by the other car, not by this driver.The patient complained to EMS of chest pain and a prehospital EKG en route was concerning for STEMI.The patient was at all times hemodynamically stable, without evidence of any profuse bleeding.He had an ECG recorded on arrival to the ED:Anterior and Inferior STEMI with diffuse hyperacute T-waves. This ECG really can ' t be anything else.&nb...
Source: Dr. Smith's ECG Blog - October 26, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
Recurrent headaches in children: What to know and do
Headaches are very common in children. By the time they reach 18, essentially all kids will have had at least one. Most children get them rarely, usually with an illness. But some children get recurrent headaches. About 5% of kindergartners experience this problem, and the percentage goes up as children get older. By the time they get to the end of high school, that number is up to more than 25%.
Recurrent headaches often run in families. There are two types: primary and secondary. Primary headaches come from the nervous system itself, while secondary headaches are caused by something affecting the nervous system, such as ...
Source: Harvard Health Blog - October 18, 2019 Category: Consumer Health News Authors: Claire McCarthy, MD Tags: Adolescent health Children's Health Headache Source Type: blogs
Is there really a blood test to diagnose concussion?
In the past year and a half, various news stories may have led some people to believe that there are blood tests that can diagnose or unmask concussions with a single drop of blood. For individuals who have recently received a bump, hit, or jolt to the head and are wondering if they have sustained a concussion, this may sound like a simple way to find out. Unfortunately, for now it probably isn’t.
What do these blood tests actually do?
Simply put, these tests measure substances, such as proteins and enzymes, that are released into the blood within hours of a brain injury when there is intracranial damage (including bleed...
Source: Harvard Health Blog - October 17, 2019 Category: Consumer Health News Authors: Eve Valera, PhD Tags: Concussions Memory Neurological conditions Tests and procedures Source Type: blogs
Press Release: Tafida Raqeeb
Professor Dominic Wilkinson, Professor of Medical Ethics, University of Oxford. Consultant Neonatologist This morning, the High Court judgement around medical treatment for five-year old Tafida Raqeeb was published. Tafida sustained severe brain damage from bleeding in the brain eight months ago. Her parents wish to take her to a hospital in Italy to continue […] (Source: blog.bioethics.net)
Source: blog.bioethics.net - October 3, 2019 Category: Medical Ethics Authors: Dominic Wilkinson Tags: Clinical Ethics Decision making Health Care bioethics Children and Families Critical Care Disability, Chronic Conditions and Rehabilitation Dominic Wilkinson's Posts medical ethics syndicated Source Type: blogs
Look at this ST Depression
DiscussionAtrial repolarization waves are recognized by a downsloping PR segment and are a common cause of false positive stress tests. They are augmented by tachycardia.See this paper:Sapin PM et al. Identification of false positive exercise tests with use of electrocardiographic criteria: a possible role for atrial repolarization waves. JACC 18(1):127-35; July 1991. (link is full text)Link to abstract: http://www.onlinejacc.org/content/18/1/127.abstractHere is a schematic from my book,The ECG in Acute MI (this is a link to a free pdf)Learning Points:1. Recognize the atrial repolarization wave. ...
Source: Dr. Smith's ECG Blog - October 1, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
Disc Pump for Less Obtrusive Ambulatory Blood Pressure Systems
TTP Ventus, the UK-based developer of the Disc Pump, has recently begun working on a new application for this technology – ambulatory blood pressure systems. The company claims that the Disc Pump, which is a miniaturized, quiet, and highly efficient pump, could revolutionize ambulatory blood pressure measurements.
At present, 24-hour blood pressure monitors are commonly used to monitor blood pressure at regular intervals throughout the day and night. Such devices typically use motor-driven diaphragm pumps to inflate a cuff on the upper arm. However, these pumps are bulky and noisy, and affect airflow pulsation within...
Source: Medgadget - October 1, 2019 Category: Medical Devices Authors: Conn Hastings Tags: Anesthesiology Cardiology Diagnostics Exclusive Medicine Source Type: blogs
Figure-of-Eight Sutures for Bleeding Varicose Veins
The figure-of-eight suture is a fascinating technique, often used in unique cases. The stitch is extremely secure and easy to place. It can be used to save time during long, complicated repairs and to create additional strength in high-tension areas. The figure-of-eight stitch can be modified to bring skin edges together or close off small bleeding arteries, varicose veins, or even bleeding hemorrhoids. Multiple figure-of-eight sutures can be used in a row.The idea is to use a single suture to surround a small area of tissue in a box shape to close a laceration or put pressure on a small site. Figure-of-eight sutures ca...
Source: The Procedural Pause - October 1, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Avoid These Popular Scams
Are you getting phone messages from the IRS telling you that officers are on the way to arrest you within 45 minutes and that you will be spending five years in prison--unless you buy some gift cards and give them to the caller? Are you getting other calls from strange-sounding, computer-generated voices, also threatening you?There seems to be a recent increase in caller frauds, so here are some notes that will help you to deal with a few of them and not get suckered by them.1. IRS Scam.A caller says he is from the IRS and gives you a badge number. He says you made many mistakes on your previous income tax forms, or ...
Source: The Virtual Salt - September 20, 2019 Category: Neurology Authors: Robert Harris Source Type: blogs
Reviewing Changes in Platelet Function in Aging
Platelets are essentially structured chunks of cytoplasm shed by the megakaryocyte cells responsible for producing them, released into the blood stream. They are important in blood clotting and the innate immune response. Inappropriate blood clot formation known as thrombosis occurs more readily in later life, but it is unclear as to the degree to which age-related changes in platelets, versus other systems, are important to this process, or where platelets sit in the complex chains of cause and effect. The open access paper noted here reviews what is known of the aging of platelets and related mechanisms, a topic that is ...
Source: Fight Aging! - September 19, 2019 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
Early Bird, an Internal Bleeding Detector, Now Available In U.S.
Saranas, a Houston, Texas firm, is releasing its novel Early Bird bleeding monitoring system in the United States, following FDA de novo approval of the device.
Intended for use during minimally invasive vascular procedures, the Early Bird helps to identify dangerous events such as ruptured or dissected vessels. Such incidents can result from using large tools, such as those used during transcatheter aortic valve replacements, and they are often undetected for too long, leading to extensive internal bleeding or blood extravasation.
Currently the only device with this kind of capability, the Early Bird uses a vascul...
Source: Medgadget - September 18, 2019 Category: Medical Devices Authors: Medgadget Editors Tags: Cardiac Surgery Cardiology Radiology Vascular Surgery Source Type: blogs
