A man in his 60s with syncope and ST depression. What does the ECG mean?
Written by Sean Trostel MD, peer reviewed by Meyers, Smith, Grauer, etc.A man in his 60s with a history of severe alcohol use disorder and epidural abscess on long-term ciprofloxacin presented to the emergency department after an episode of syncope while standing in line at a grocery store.He did not have chest pain.Here is his triage ECG: What do you think?My interpretation:Sinus rhythm, normal QRS, widespread wavy ST depression leading into late T/U-waves with very prolonged QT. No evidence of OMI. QTc/QUc is in the range of 630 msec.What is the most likely cause of the patient ’s ECG findings, and wha...
Source: Dr. Smith's ECG Blog - October 25, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
When losing a patient is more than just a defeat: a doctor ’ s story
“I feel tired,” said Mr. T. Mr. T was a 72-year-old man who came to our ED. For the last three days, he had been passing reddish urine. Two weeks before this, he had a bout of bronchitis that did not require hospitalization, just ciprofloxacin. He had made a full recovery. The emergency department ordered
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When losing a patient is more than just a defeat: a doctor’s story originally appeared in KevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - April 2, 2023 Category: General Medicine Authors: Kenneth Salu, MD Tags: Physician Hospital-Based Medicine Source Type: blogs
We Shouldn ’t Tolerate Sloppy Allergy Lists
By HANS DUVEFELT
The medication and allergy lists seem like they would be the most important parts of a health record to keep current and accurate. But we all see errors too often.
I think it shouldn’t be possible to enter an allergy without describing the reaction. Because without that information the list becomes completely useless.
The other day I saw a patient who needed an urgent CT angiogram. The allergy list said “All Contrast Materials”, which isn’t even “structured data entry”, and thus not recognized by the computer if my EMR (Me again, Greenway!) would have been clever enough to check for al...
Source: The Health Care Blog - October 4, 2021 Category: Consumer Health News Authors: Christina Liu Tags: Medical Practice Primary Care Hans Duvefelt Source Type: blogs
The Art of the Chart: Documenting the Timeline
By HANS DUVEFELT
The timeline of a patient’s symptoms is often crucial in making a correct diagnosis. Similarly, the timeline of our own clinical decisions is necessary to document and review when following a patient through their treatment.
In the old paper charts, particularly when they were handwritten, office notes, phone calls, refills and many other things were displayed in the order they happened (usually reverse chronological order). This made following the treatment of a case effortless, for example:
3/1 OFFICE VISIT: ?UTI (where ciprofloxacin was prescribed and culture sent off)
3/3 Clinical note th...
Source: The Health Care Blog - April 7, 2021 Category: Consumer Health News Authors: Christina Liu Tags: Medical Practice Physicians Primary Care EHR Hans Duvefelt Source Type: blogs
Resolve Otitis Externa Fast with an Ear Wick
Emergency providers expeditiously sift and sort patients on their shifts and streamline procedures like how to place an ear wick in a patient with otitis externa, a quick and useful procedure for a patient who will reap the rewards.Standard ear wicks. The material is made from a dehydrated sponge composed of hydroxylated poly(vinyl acetate). It increases in size when liquid is applied. Photo by M. Roberts.Otitis externa can cause significant swelling, irritation, pruritis, and pain to the ear canal. Occasionally, the canal is so swollen it may be difficult to administer ear drops. An ear wick can be inserted between the...
Source: The Procedural Pause - June 2, 2020 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Antibiotic-resistant urinary tract infections are on the rise
There is a global crisis of antibiotic resistance, and urinary tract infections (UTIs) may be the canary in the coal mine. UTIs are one of the most common types of infections; at least one in two women and one in 10 men will experience a UTI in their lifetime.
Like many human infections, UTIs are usually caused by bacteria living on or in our bodies, and require treatment with antibiotics. What’s alarming the medical community now is that UTIs are becoming ever harder to treat with common antibiotics.
Antibiotic overuse leads to antibiotic resistance
At some point, most people have taken a course of trimethoprim/sulfamet...
Source: Harvard Health Blog - October 14, 2019 Category: Consumer Health News Authors: Lisa Bebell, MD Tags: Drugs and Supplements Health Infectious diseases Kidney and urinary tract Women's Health Source Type: blogs
Health Reform Job One: Stop the Gouging! | Part 2
By BOB HERTZ
We Need Legal Assaults On The Greediest Providers!
When a patient is hospitalized, or diagnosed with a deadly disease, they often have no choice about the cost of their treatment.
They are legally helpless, and vulnerable to price gouging.
We need more legal protection of patients. In some cases we need price controls.
Next in this three-part series, I discuss how we could challenge Big Pharma by lessening regulation of generic drugs, having the government take over production and establishing price review boards.
Assault Phase Three – Challenge Big Pharma
Step One – Less Regulation of...
Source: The Health Care Blog - July 25, 2019 Category: Consumer Health News Authors: Christina Liu Tags: Uncategorized Source Type: blogs
A physician ’s breakthrough against prior authorization
A few weeks ago, I saw a young patient who was suffering from an ear infection. It was his fourth visit in eight weeks, as the infection had proven resistant to an escalating series of antibiotics prescribed so far. It was time to bring out a heavier hitter. I prescribed ciprofloxacin, an antibiotic rarely used in pediatrics, yet effective for some drug-resistant pediatric infections.
The patient was on the state Medicaid insurance and required a so-called prior authorization, or PA, for ciprofloxacin. Consisting of additional paperwork that physicians are required to fill out before pharmacists can fill prescriptions for ...
Source: Kevin, M.D. - Medical Weblog - October 15, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/niran-s-al-agba" rel="tag" > Niran S. Al-Agba, MD < /a > Tags: Meds Infectious Disease Pediatrics Source Type: blogs
Part 2: Bypassing Prior Authorizations
By NIRAN AL-AGBA, MD
A few weeks ago, I saw a young patient who was suffering from an ear infection. It was his fourth visit in eight weeks, as the infection had proven resistant to an escalating series of antibiotics prescribed so far. It was time to bring out a heavier hitter. I prescribed Ciprofloxacin, an antibiotic rarely used in pediatrics, yet effective for some drug-resistant pediatric infections.
The patient was on the state Medicaid insurance and required a so-called prior authorization, or PA, for Ciprofloxacin. Consisting of additional paperwork that physicians are required to fill out before pharmacists can f...
Source: The Health Care Blog - October 4, 2018 Category: Consumer Health News Authors: matthew holt Tags: Medicaid Patients Pharmaceuticals Physicians Aetna andameds CVS health insurance companies Pharmaceutical companies Pharmacy Benefit Manager Washington state Source Type: blogs
Tropical Travel Trouble 009 Humongous HIV Extravaganza
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog
aka Tropical Travel Trouble 009
The diagnosis of HIV is no longer fatal and the term AIDS is becoming less frequent. In many countries, people with HIV are living longer than those with diabetes. This post will hopefully teach the basics of a complex disease and demystify some of the potential diseases you need to consider in those who are severely immunosuppressed. While trying to be comprehensive this post can not be exhaustive (as you can imagine any patient with a low ...
Source: Life in the Fast Lane - July 7, 2018 Category: Emergency Medicine Authors: Amanda McConnell Tags: Clinical Cases Tropical Medicine AIDS art cryptococcoma cryptococcus HIV HIV1 HIV2 PEP PrEP TB toxoplasma tuberculoma Source Type: blogs
MKSAP: 38-year-old man with ulcerative colitis
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 38-year-old man is evaluated in follow-up after a diagnosis of ulcerative colitis. Ten days ago he was started on prednisone, 60 mg/d, but his symptoms have not improved. He has six to nine bloody bowel movements per day and moderate abdominal pain. He has decreased his oral intake because eating exacerbates his pain and diarrhea.
On physical examination, temperature is 37.0 °C (98.6 °F), blood pressure is 110/56 mm Hg, and pulse rate is 96/min. He is pale but in no distress. The abdomen is diffusely tender ...
Source: Kevin, M.D. - Medical Weblog - May 5, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Gastroenterology Source Type: blogs
Tropical Travel Trouble 006 Watery Diarrhoea
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog
aka Tropical Travel Trouble 006
Our medical student who caught shigella on a Nepalese elective has a thirst for adventure. They plan to help at a Bangladesh refugee camp but the latest CDC report states there have been some cases of cholera. They’ve done a little bit of reading and want your help to teach them all about cholera and how they may prepare and best serve their new community.
Questions:
Q1. What is cholera and how is it transmitted?
Answer and interpreta...
Source: Life in the Fast Lane - March 27, 2018 Category: Emergency Medicine Authors: Neil Long Tags: Clinical Cases Tropical Medicine cholera diarrhoea john snow ORS rice water diarrhoea watery diarrhoea Source Type: blogs
Tropical Travel Trouble 004 Bloody Diarrhoea
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog
aka Tropical Travel Trouble 004
A medical student who has just returned from their elective in Nepal presents with 1 week of bloody diarrhoea. He has been in the lowlands and stayed with a family in the local village he was helping at. It started three days before he left and he decided to get home on the plane in the hope it would settle. He is now opening his bowels 10x a day with associated cramps, fevers and has started feeling dizzy.
Questions:
Q1. What is dysentery ...
Source: Life in the Fast Lane - March 12, 2018 Category: Emergency Medicine Authors: Neil Long Tags: Clinical Cases Tropical Medicine amoebic dysentery bacillary dysentery e.histolytica entamoeba histolytica shigellosis Source Type: blogs
Funtabulously Frivolous Friday Five 218
LITFL • Life in the Fast Lane Medical Blog
LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog
Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old fashioned medical trivia FFFF…introducing Funtabulously Frivolous Friday Five 218, all about colours.
Question 1
What colour are you if you are suffering from ‘argryia’?
+ Reveal the Funtabulous Answer
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Purple or Purple/Grey
Argyria is t...
Source: Life in the Fast Lane - December 15, 2017 Category: Emergency Medicine Authors: Mark Corden Tags: Frivolous Friday Five amphotericin B argryia black lung blue bloater ciprofloxacin coal workers pneumoconiosis COPD emphysema infantile acrodynia mercury pink disease pink puffer Red man syndrome rifampicin silver skin teic Source Type: blogs
MKSAP: 22-year-old woman is evaluated for a flare of Crohn disease
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 22-year-old woman is evaluated for a flare of Crohn disease. A colonoscopy performed 6 months ago showed moderate, patchy, left-sided colitis extending from the descending colon to the splenic flexure. She responded to therapy with prednisone but declined maintenance therapy in advance of conceiving. She is now 12 weeks pregnant and for the past 2 weeks has experienced bloody diarrhea and left-sided abdominal pain.
On physical examination, temperature is 37.2 °C (99.0 °F), blood pressure is 110/66 mm Hg, and...
Source: Kevin, M.D. - Medical Weblog - December 9, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Gastroenterology OB/GYN Source Type: blogs
