Trocar during Times of Trauma
Seventy-five percent of trauma injuries involve some kind of thoracic insult, a quarter of which need a procedural intervention like a chest tube. (Surg Clin North Am 2007;87[1]:95; http://bit.ly/2HaoX90.) Long-term illness, lung disease, and post-operative complications may cause pleural effusions or a pneumothorax, so treating these conditions quickly can significantly decrease patient morbidity and mortality. Other indications for chest tube placement include:Trauma: Pneumothorax, hemopneumothorax, or tension pneumothoraxLong-term illness: Pleural effusion (cancer, pneumonia)Infection: Em...
Source: The Procedural Pause - April 1, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Three EKGs shown to me - which if any need emergent reperfusion?
Written by Pendell MeyersWe commonly get feedback from readers who are skeptical that we can pick out the subtle NSTEMI occlusions from the endless onslaught of triage/EMS EKGs. Some believe that one cannot learn to pick out subtle true positive STE or hyperacute T-waves without sacrificing specificity.We see countless EKGs constantly (as do all EM physicians) plus more because other providers constantly send us EKGs in addition. I see countless abnormal-looking EKGs to which I respond " I don ' t see any evidence of occlusion " , and only a tiny percentage of diagnostic EKGs among those shown to me.So take a look at ...
Source: Dr. Smith's ECG Blog - March 30, 2019 Category: Cardiology Authors: Pendell Source Type: blogs
Over-the-counter cold and flu medicines can affect your heart
As the cold and flu season continues this year, it is important to be aware that many of the most commonly used over-the-counter (OTC) remedies for congestion, aches, pains, and low-grade fevers contain medicines that can have harmful effects on the cardiovascular system. Chief among these medications are nonsteroidal anti-inflammatory drugs (NSAIDs) and decongestants.
NSAIDs and your heart
Certain NSAIDs are associated with a small increase in the relative risk for developing a heart attack, stroke, heart failure, atrial fibrillation, increased blood pressure, and blood clots. NSAIDs relieve pain and inflammation by inhib...
Source: Harvard Health Blog - March 20, 2019 Category: Consumer Health News Authors: Mark Benson, MD, PhD Tags: Cold and Flu Drugs and Supplements Health Heart Health Source Type: blogs
IV Acetaminophen prevents post op delirium
Intravenous acetaminophen (paracetamol) when added to a sedative has been found to reduce the risk of postoperative delirium in patients after cardiac surgery [1]. Post operative delirium is common after surgery in elderly persons. It often increases the length of hospital stay and naturally the expenses and has adverse effects on final outcome.
The DEXACET Randomized Clinical Trial randomized 120 elderly patients undergoing coronary artery bypass surgery (CABG) or combine CABG/valve surgery. Four groups received either intravenous acetaminophen or placebo and sedative IV propofol vs dexmedetomidine. Primary outcome measu...
Source: Cardiophile MD - February 24, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Simmons catheter (Sim catheter)
Simmons catheter (Sim catheter)
Simmons catheters (Sim catheters) have been used for cerebral angiography [1] as well as renal angiography [2]. They have 3 different varieties (Sim 1, 2 and 3). 4 French and 5 French sizes are available. Sim catheters can be used for transradial as well as transfemoral approaches. Possibility of engaging the left subclavian by the transradial route has made this an option for angiography of the left internal mammary artery (LIMA) when coronary artery bypass is the option after a diagnostic coronary angiography. Sim catheters comes in handy when there is difficulty in engaging the left subc...
Source: Cardiophile MD - January 26, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Angiography and Interventions Source Type: blogs
Considering Mesenchymal Stem Cell Therapy for Atherosclerosis
Mesenchymal stem cell (MSC) therapies as presently practiced, even given considerable differences in what exactly is meant by "mesenchymal stem cell", fairly reliably reduce the chronic inflammation of aging for an extended period of time. They are much less reliable at inducing regeneration of tissues, and where that does occur it probably results from dampened inflammation. One of the many detrimental consequences of the always-on inflammatory signaling that arises with age is a disruption of regenerative capacity. Given the ability of MSC transplantation to suppress inflammation, it is possible that this could be at lea...
Source: Fight Aging! - January 3, 2019 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
Can you see through this wide complex rhythm?
Written by Pendell MeyersA 76 year old man with history of CHF, moderate aortic stenosis, insulin-dependent diabetes, hypertension, stroke, CAD s/p stents, CKD, PVD, OSA presented to the ED with shortness of breath and chest pain off and on for 2 weeks. This afternoon his symptoms intensified so he called EMS.In the ED he appeared acutely ill, with HR 100-115, RR 20-25, BP 93/52, hypoxic to 88-92% on 5L nasal cannula, afebrile.Here is his presentation ECG, followed by his baseline ECG on file:Presentation ECG.Baseline ECG.The presentation ECG shows ventricular paced rhythm at rate of approximately 120 bpm. The J-point in V...
Source: Dr. Smith's ECG Blog - December 12, 2018 Category: Cardiology Authors: Pendell Source Type: blogs
MedPAC ’s Proposed “Reforms” Should Be Tested Before They’re Implemented: CMS’s Hospital Readmissions Reduction Program Is Exhibit A
This report card is grossly inaccurate even though it relies on medical records data as well as claims data.) By the late 1990s, conventional wisdom among health policy “thought leaders” had elevated readmission rates to the same status as mortality rates – it was a legitimate quality measure that could be safely administered to thousands of hospitals and millions of patients.
However, the conventional wisdom remained unproven by the early 2000s, and remains unproven to this day. “[T]he link between early readmission and quality of care is still uncertain,” is how five experts put it in a 2004 article. “[T]he a...
Source: The Health Care Blog - December 6, 2018 Category: Consumer Health News Authors: matthew holt Tags: Medicare Politics ACA Affordable Care Act CHIP CMS Congress hospital readmissions Kip Sullivan MACRA MedPAC P4P Pay for Performance Source Type: blogs
An elderly man with sudden cardiogenic shock, diffuse ST depressions, and STE in aVR
Written by Pendell Meyers84 yo M with history of a “valve problem” presented for sudden onset chest pain and trouble breathing while eating lunch.He was sitting bolt upright, diaphoretic, tachypneic, with bilateral crackles. Although his BP was 126/84, he was in acute cardiogenic shock.Here is his initial ECG:Sinus tach with occasional PACs. Relatively normal QRS complex with diffuse significant ST depression including leads V2-V6, I, aVL, II, III, and aVF, with ST elevation in aVR. The vector of ST depression is maximal in leads V5 and II, consistent with diffuse subendocardial ischemia. There is no evidence of any si...
Source: Dr. Smith's ECG Blog - October 31, 2018 Category: Cardiology Authors: Pendell Source Type: blogs
A dialysis patient with nonspecific symptoms and pseudonormalization of ST segments
This study from Herzog et al (from our own Hennepin County Medical Center) included patients from a national registry and compared 3049 patients on dialysis admitted and eventually found to have acute MI compared with 534,395 patients not on dialysis admitted with an eventual diagnosis of acute MI. Of these groups, only 22% of dialysis patients had an admission diagnosis consistent with acute MI while 43.8% of nondialysis patients had the correct admission diagnosis of acute MI. Dialysis patients had double the rate of cardiac arrest (11% vs 5%), were less likely to receive reperfusion therapy when eligible (47% vs. ...
Source: Dr. Smith's ECG Blog - September 29, 2018 Category: Cardiology Authors: Daniel Lee Source Type: blogs
Left main coronary artery disease on ECG
Left main coronary artery disease on ECG
ST segment elevation in aVR and diffuse ST segment depression in inferior and anterolateral leads is considered a feature of significant left main coronary artery disease. The ECG shown above, there is ST segment elevation in aVR and V1 along with ST depression in inferior and lateral leads. ST elevation in aVR more than that in V1 is also suggestive of left main disease. In a study comparing acute obstruction of left main, left anterior descending (LAD) and right coronary (RCA) occlusions, aVR ST elevation of more than 0.05 mV was noted in 88% of left main (LMCA) obstruction, 43% ...
Source: Cardiophile MD - September 21, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology ECG Library Source Type: blogs
Skeletonized internal mammary graft vs pedicled graft
Internal mammary artery (IMA) grafting is an important part of coronary artery bypass grafting. Arterial grafts give longer survival benefits compared to venous grafts. The conventional technique of IMA grafting uses pedicled grafts. Of late, skeletonized grafts are becoming more popular. The proposed advantage of skeletonized grafts is that when bilateral IMA grafts are used, there is less compromise on sternal vascularity and risk of deep sternal infections. Deep sternal infections are always a concern when using bilateral IMA grafts and can occasionally lead to sternal wound dehiscence.
Pedicled graft is harvested en-b...
Source: Cardiophile MD - September 17, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiac Surgery Pedicled internal mammary graft Skeletonized internal mammary graft Skeletonized LIMA graft Source Type: blogs
Coronary artery and veins are married life long . . . with a purpose !
Cardiologist are always worried about the supply side of coronary blood flow. It’s fair enough, we can condone our brain for this one way thinking , afterall arterial supply remain the life-line for the heart. Some of us could (should) realise the importance of these humble coronary veins which are anatomically and physiologically tied together.Its existence is as unique as their arterial counterpart.Coronary blood flow of about 250 ml traverses both the arms every minute.Imagine the scenario if the veins refuse to clear the blood from previous cardiac cycle . . . total hemodynamic chaos right ? Luckily such s...
Source: Dr.S.Venkatesan MD - September 9, 2018 Category: Cardiology Authors: dr s venkatesan Tags: cardaic physiology cardiology-Anatomy coronary sinus anatomy and physiology coronary sinus filling and emptying time drsvenkatesan coronary veno occlusive disorder coronary venous circulation acute coronary sinus syndrome coroanry vein cor Source Type: blogs
Type 4c myocardial infarction – Cardiology MCQ
Type 4c myocardial infarction as per the 4th universal definition of myocardial infarction:
a) Myocardial infarction related to percutaneous coronary intervention
b) Myocardial infarction due to stent thrombosis
c) Myocardial infarction due to restenosis
d) Myocardial infarction following coronary artery bypass surgery
Please post your answers below. Correct answer will be posted on: Aug 30, 2018 @ 01:31 (Source: Cardiophile MD)
Source: Cardiophile MD - August 28, 2018 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Uncategorized Source Type: blogs
An athletic 30-something woman with acute substernal chest pressure
Post by Smith, with short article by Angie Lobo (https://twitter.com/ALoboMD), a third year intermal medicine resident at Abbott Northwestern Hospital CaseA 30-something woman with no past history, who is very fit and athletic, presented with 1.5 hours of substernal chest pressure. It was non-radiating and without other associated symptoms except for nausea. She had zero CAD risk factors.Here was her ECG at time zero:What do you think?There is ST elevation in V2 with large fat T-wave. There is ST depression in II, III, and aVF, and V3 to V6.I saw this before any other information and k...
Source: Dr. Smith's ECG Blog - July 31, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
