Instinct is Learned
Mr. Reynolds is a vivid 83 year old who lived alone at home. He walks everyday int he morning first thing before he has a small cup of coffee. His kids bought him an ipad and he uses it to browse the Washington Post, the Wall Street Journal, and the Pittsburgh Post Gazette while eating breakfast.
Every morning it’s the same breakfast…toast with honey and a small cup of yogurt. Then he’s ready to start the day, just when the rest of his neighbors are waking up.
Today however, he ate hist toast and his stomach grumbled, louder than usual. He thought to himself that he’d better get to the bathroom qu...
Source: Mr. Hassle's Long Underpants - November 10, 2017 Category: Emergency Medicine Authors: Doc Shazam Tags: Clinical Source Type: blogs
Instinct is Learned
Mr. Reynolds is a vivid 83 year old who lived alone at home. He walks everyday int he morning first thing before he has a small cup of coffee. His kids bought him an ipad and he uses it to browse the Washington Post, the Wall Street Journal, and the Pittsburgh Post Gazette while eating breakfast.
Every morning it’s the same breakfast…toast with honey and a small cup of yogurt. Then he’s ready to start the day, just when the rest of his neighbors are waking up.
Today however, he ate hist toast and his stomach grumbled, louder than usual. He thought to himself that he’d better get to the bathroom qu...
Source: Mr. Hassle's Long Underpants - November 10, 2017 Category: Emergency Medicine Authors: Doc Shazam Tags: Clinical Source Type: blogs
How can you persuade your cardiologist to take a Non-STEMI patient to the cath lab emergently?
This case was sent by Joseph Ryan (@DocJoseph08), chief resident from Corpus Christi ' s EM residency program. This middle-aged patient complained of acute chest pain and called 911.He had the following 12-lead ECG in the ED at time zero:There is ST depression diffusely.This is diagnostic of ischemia.There is a Q-wave in V2 and a possible hyperacute T-wave.It is now clear the patient has acute coronary syndrome.It is not clear that there is, or is not, a complete coronary occlusion.The patient was treated with aspirin and sublingual NTG on arrival, which did not relieve his pain.Cardiology was called but th...
Source: Dr. Smith's ECG Blog - November 6, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
12 Cases of Use of 3- and 4-variable formulas to differentiate normal STE from subtle LAD occlusion
Here are 12 Cases using the 3- and 4-variable formulas, which help to distinguish normal ST elevation in leads V2-V4 from that of subtle LAD occlusion.Instructions for using free subtleSTEMI iPhone app for the 3-variable formula. 4-variable version still to come.Here is a video lecture of subtle LAD occlusion: One hour lecture on Subtle ECG Findings of Coronary OcclusionThe 3-variable formula comes from this paper:Smith SW et al. Electrocardiographic Differentiation of Early Repolarization FromSubtle Anterior ST-Segment Elevation Myocardial Infarction. Annals of Emergency Medicine 2012;60:45-56....
Source: Dr. Smith's ECG Blog - November 3, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
Cardiology MCQ Test 2
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Source: Cardiophile MD - October 19, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
New Data Increase Caution on Left Atrial Appendage Occlusion
This study took data from more than 61 centers across the world.
The details of the studies are included in my column: Real-World Data on Left Atrial Appendage Closure Does Not Reassure
The gist of these studies was that clots on the device are not rare; potent clot-protecting drugs are likely required to prevent clots (at least for a period of weeks-months); the presence of clots increase the risk of stroke, and finally, major procedural complications are in the range of 4%.
These findings bolster my already cautions approach to this procedure.
Remember, left atrial appendage closure is a preventive procedure. Its benefi...
Source: Dr John M - June 27, 2017 Category: Cardiology Authors: Dr John Source Type: blogs
MKSAP: 57-year-old man is seen after results of a carotid ultrasound
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 57-year-old man is seen for follow-up evaluation after results of a carotid ultrasound obtained to investigate a left neck bruit show a mixed density plaque at the origin of the left internal carotid artery. Stenosis is estimated to be 60% to 80%. He has had no focal neurologic symptoms or visual loss. The patient has coronary artery disease (CAD) with stable angina, hypertension, dyslipidemia, type 2 diabetes mellitus, and mild kidney failure. He has a 30-pack-year smoking history but stopped smoking 7 years ...
Source: Kevin, M.D. - Medical Weblog - May 6, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Heart Source Type: blogs
SCOTUS Needs To Check the Long Arm Of State Court Jurisdiction
Many of the problems with litigation under our federal system, as I’venoted before, arise when state courts can reach out to project their power onto litigants and disputes outside their borders. Public choice economics suggests that when courts are answerable to the political and legal classes of a single state only –say, California or Montana–they might not be ideally responsive to the interests and due process rights of out-of-state parties who have been compelled by force to show up and defend a lawsuit. Even if state judges and juries manage to avoid the temptation of “home cooking”–dishing out ta stier...
Source: Cato-at-liberty - April 24, 2017 Category: American Health Authors: Walter Olson Source Type: blogs
New Tech Tonics Podcast: Jess Mega of Verily Actually Is Making the World a Better Place
This blog was originally posted on Venture Valkyrie.
Jessica Mega, an accomplished cardiologist and now Chief Medical Officer at Alphabet’s Verily (formerly Google Life Sciences), says she joined the venerable Silicon Valley company to help patients. According to Jess, physicians who love patients need to lean into the tech world because great tech that doesn’t actually change care doesn’t have much of a chance, implying also that it doesn’t have much of a point.
Very early to the concept of what is now called Precision Medicine, Jess helped pioneer the idea of large scale patient data collection (e.g., a study wit...
Source: Disruptive Women in Health Care - March 27, 2017 Category: Consumer Health News Authors: dw at disruptivewomen.net Tags: Uncategorized Source Type: blogs
MKSAP: 81-year-old man after a percutaneous coronary intervention
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
An 81-year-old man is evaluated in the office 3 days following a percutaneous coronary intervention with placement of a bare metal stent in the left anterior descending artery for angina refractory to maximal medical therapy. He indicates that he feels well except for palpitations that were not present before the procedure. Medical history is significant for hypertension and type 2 diabetes mellitus. He has no risk factors for or history of significant bleeding. Medications are aspirin, clopidogrel, lisinopril, ...
Source: Kevin, M.D. - Medical Weblog - March 25, 2017 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Heart Source Type: blogs
Genetic variants and the efficacy of clopidogrel in stroke and TIA
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - February 19, 2017 Category: Internal Medicine Tags: cardiovascular neurology pharmacology Source Type: blogs
Unexplained dyspnea post primary PCI : Never blame Ticagrelor !
Knowledge can be a dangerous asset sometimes . A modern day cardiologist reassured a patient who had an unusual dyspnea after a muti-vessel stenting for a not so complex lesions following an anterior MI.The doctor was not mystified when the patient uttered this complaint. In fact he was so cool , reassured the patient since he was taking Ticagrelor ,and it’s well recognised to cause dyspnea in some patients.
Few days later patient called again and informed that the dyspnea is getting more intense and ultimately he was rushed to hospital only to diagnose subacute stent occlusion and a fresh ACS.
What...
Source: Dr.S.Venkatesan MD - January 31, 2017 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized drug Induced dyspnea how does ticagrelor cause dyspnea mechanism of dyspnea with ticagrelor unusual causes of dyspnea Source Type: blogs
Understanding head injuries
Ski season is here, and I am reminded of the story of Natasha Richardson (Liam Neeson’s wife), who tragically died of a head injury while skiing without a helmet in 2007. Here in the emergency department, we see many patients with concern for head injuries. We factor what may have caused the injury, your age, what we find when we examine you, the timing of the incident, the medicines you take, as well as some other factors, when deciding whether to do a CT scan or admit you to the hospital.
When a head injury causes bleeding in the brain
Ms. Richardson died of an epidural hematoma, one of several types of brain bleeding,...
Source: Harvard Health Blog - January 18, 2017 Category: Consumer Health News Authors: Jonathan Nadler, MD Tags: Brain and cognitive health Injuries Prevention Safety Source Type: blogs
