" Are these hyperacute T-waves? " - what is your recommendation for the team in these two cases?
Written by Pendell Meyers, edits by Steve SmithWhen practitioners are learning a new ECG concept for the first time, they very appropriately must go through a stage where they titrate their mind to the new finding, going through stages of over and under-recognizing. In my experience this is a normal phenomenon in all of medicine, and especially in ECG interpretation.As I have recently been promoting recognition of hyperacute T waves among my group, I am getting more and more ECGs texted to me very appropriately asking "are these T-waves hyperacute?"So let ' s go over some hyperacute T-waves " ground rules " : - There ...
Source: Dr. Smith's ECG Blog - August 11, 2018 Category: Cardiology Authors: Pendell Source Type: blogs
Changing the treatment plan when covering for another doctor
I was a little taken aback when Dr. C. changed my patient from warfarin to one of the novel anticoagulants. And one I seldom use, at that.
I have only worked with her for about three years, and we seem to come from the same mold: seasoned family docs with a penchant for teaching and patient empowerment. I had not imagined she would step in and completely change my treatment plan when she was just covering for one day.
As far as which is safer, warfarin with variable therapeutic effect and fluctuating INRs or novel anticoagulants, which have hardly been studied at all in patients on dialysis, you won’t see test results th...
Source: Kevin, M.D. - Medical Weblog - August 8, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/a-country-doctor" rel="tag" > A Country Doctor, MD < /a > Tags: Physician Cardiology Medications Source Type: blogs
Ill-informed, Mission-Hostile Health Care Leadership... in the White House and the US Department of Health and Human Services
Introduction - What Has Gone Wrong with the Leadership of Health Care OrganizationsA major focus ofHealth Care Renewal has been problems in leadership and governance of health care organizations, which we believe became major causes of health care dysfunction. For example, we have discussed how leadership is oftenill-informed. More and more people leading non-profit, for-profit and government health care organizations have had no training or experience in actually caring for patients, or in biomedical, clinical or public health research as professional managers largely supplanted health care professionals as le...
Source: Health Care Renewal - August 5, 2018 Category: Health Management Tags: conflicts of interest crime DHHS ill-informed management mission-hostile management narcotics White House Source Type: blogs
Technique Keeps Blood from Touching Catheter ’s Surface to Make Dialysis Safer
Central venous catheters, such as those used during dialysis, have a nasty tendency of getting fouled up with proteins and bacterial deposits. Not only do the catheters end up having a short lifetime, patients are exposed to the potential for serious infections. At Draper, a research and development firm, a team has developed a way of keeping proteins from settling onto the insides of catheters, thereby avoiding a myriad of complications that can result from dirty catheters.
The method is called water-infused surface protection (WISP) and it results in a layer of pure, blood-free fluid gliding on the inside surface of the...
Source: Medgadget - July 25, 2018 Category: Medical Devices Authors: Editors Tags: Critical Care Medicine Surgery Source Type: blogs
Could you have prevented this young man's cardiac arrest?
Written by Pendell MeyersWe received a call from an outside hospital asking to transfer a " traumatic post arrest " patient. We were told that a young patient was brought in with altered mental status but complaining of right hip and/or leg pain after being found by his mother at the bottom of the stairs into the basement. His history was significant only for IV heroin abuse, but he denied any recent use. Apparently he had been confused about why he was at the bottom of the stairs, unsure if he had fallen, unsure whether there was any specific traumatic mechanism.The practitioner on the phone stated that he suddenly develo...
Source: Dr. Smith's ECG Blog - July 24, 2018 Category: Cardiology Authors: Pendell Source Type: blogs
Guidelines, multiple specialists, and the science versus the art of medicine
My 80-year-old patient presented with symptoms and signs of kidney failure. I hospitalized him and asked for the assistance of a kidney specialist. We notified his heart specialist as a courtesy. A complicated evaluation led to a diagnosis of an unusual vasculitis with the patient’s immune system attacking his kidney as if it was a foreign toxic invader.
Treatment, post kidney biopsy, involved administering large doses of corticosteroids followed by a chemotherapy agent called Cytoxan. Six days later it was clear that dialysis was required at least until the patient’s kidneys responded to the therapy and began working ...
Source: Kevin, M.D. - Medical Weblog - July 16, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/steven-reznick" rel="tag" > Steven Reznick, MD < /a > Tags: Physician Cardiology Hospital-Based Medicine Source Type: blogs
Surgery-Free Hemodialysis Fistula Creation With everlinQ endoAVF
TVA Medical of Austin, Texas, a newly acquired subsidiary of Becton Dickinson, won de novo marketing clearance from the FDA for its innovative everlinQ endoAVF system for creating arteriovenous fistulas for hemodialysis without relying on open surgery.
The system relies on catheters inserted into adjoining arteries and veins. When in proximity, built-in magnets within the catheters attract each other and snap the catheter pair together. A small electrode is then used to ablate the tissue between the catheters, creating a fistula.
The location of the catheters and whether they have snapped together can be seen under X-ra...
Source: Medgadget - July 10, 2018 Category: Medical Devices Authors: Editors Tags: Medicine Surgery Vascular Surgery Source Type: blogs
A bipartisan solution for Medicaid work requirements
When I hear pundits going on about the Medicaid work requirements, I think of my father.
He has worked in the United States for twenty-four years, taking on the role of a handyman, migrant farmer, truck driver, construction roofer, dialysis patient transporter, and elder transporter. His limited English and third-grade education land him in low-paying jobs with limited hours and an oversupply of workers — resulting in frequent periods of unemployment.
For 17 years, these moments of turmoil were partially assuaged by Medicaid. No job or scant hours meant little to no income, and in turn, health insurance. A safety-net sys...
Source: Kevin, M.D. - Medical Weblog - June 20, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/david-velasquez" rel="tag" > David Velasquez < /a > Tags: Policy Public Health & Washington Watch Source Type: blogs
An elderly woman found down with bradycardia and hypotension
Submitted by Alex Bracey, with edits by Pendell Meyers and Steve SmithA female in her 70s with PMH of hypertension, coronary artery disease, and a remote history of an aortic valve replacement was brought into the ED after being found down by her son. On arrival she was confused. Her initial ECG isshownbelow.What do you think? - Sinus bradycardia with HR of ~50 BPM (plus artifact that mimics PVCs) - Peaked T waves particularly visible in leadsV1-V3, I, and aVL - RBBB with QRS duration 152 ms (comparison to prior shows similar RBBB morphology but with QRS duration of 116 ms)In addition to being bradycardic as seen on this E...
Source: Dr. Smith's ECG Blog - June 6, 2018 Category: Cardiology Authors: Pendell Source Type: blogs
Health Technology Briefs from the ITF Demo Floor
Medgadget was recently invited to attend the imec Technology Forum (ITF) conference in Antwerp, Belgium. One of the highlights of the conference was the demo floor where imec, which is a non-profit R&D innovation organization, had the opportunity to show off some cool technologies from their research teams, spinoff companies, and partner organization.
While the event wasn’t purely health/medically focused, there was a significant emphasis on applications in these fields, both during the speaker sessions and on the demo floor. Here are some of the notable demos we saw from the floor:
Tetrahertz (THz) Spectrum Imag...
Source: Medgadget - June 5, 2018 Category: Medical Devices Authors: Scott Jung Tags: Cardiology Critical Care Diagnostics Emergency Medicine Exclusive Materials Pediatrics Radiology Surgery Source Type: blogs
A middle aged man with ST depression and a narrow window of opportunity
Written by Pendell MeyersI received a text at 18:13 of an ECG taken several minutes prior, with no clinical information and only the question " De Winters? "Here is the ECG:What would you tell the treating team???I responded at 18:14 PM:" I think it ' s posterior STEMI (OMI) instead of de Winter. Cath lab immediately is indicated. "I clarified further:" De Winter would need hyperacute T waves (not present here), and would indicate acute occlusion of the territory in the affected leads; so if there was de Winter in anterior leads, that would mean the anterior wall is the one involved. Here we have isolated posterior STD, wi...
Source: Dr. Smith's ECG Blog - May 19, 2018 Category: Cardiology Authors: Pendell Source Type: blogs
AI Predicts Which Patients Will Code, Allowing Early Intervention
I will occasionally report inLab Soft News about examples of artificial intelligence (AI) that are being introduced into healthcare because the use of such tools will radically change the way care is rendered. One such example is a recently developed algorithm that generates warnings about which patients are in imminent danger of"coding" in the hospital (see: Ochsner Health System: Preventing cardiac arrests with AI that predicts which patients will ‘code’). Such a warning enables physicians to intervene earlier for them. Below is an excerpt from the article:In modern hospitals, doctors and nurses are t...
Source: Lab Soft News - May 13, 2018 Category: Laboratory Medicine Authors: Bruce Friedman Tags: Healthcare Delivery Healthcare Information Technology Healthcare Innovations Medical Ethics Medical Research Quality of Care Source Type: blogs
The Alzheimer's Research Community is Increasingly Supportive of the Leucadia Therapeutics Approach to the Condition
The Leucadia Therapeutics team are developing a means to restore the pace at which cerebrospinal fluid drains from the brain. Atrophy of systems of drainage with age causes metabolic wastes such as amyloid and tau to accumulate, leading to Alzheimer's disease. In the past few years, a growing number of papers have emerged in support of this class of approach to the treatment of Alzheimer's. This one is a more general example, suggesting that any means of reducing protein aggregates in cerebrospinal fluid would help - though since a simple fluid flow mechanism already exists in the body, it seems like a good idea to get tha...
Source: Fight Aging! - May 4, 2018 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
The blood sample is hemolyzed. Twice. Is there hyperkalemia on the ECG?
The objective evidence of hyperkalemia on that top ECG is theprolonged PR interval. It is over 300 ms! (The PR in the previous is 218 ms) This prolonged AV conduction puts the patient at risk if his K were to rise further. Further, one might be tempted toblame a prolonged PR interval on vagal tone, especially at a slow heart rate of 60 beats per minute. But since the sinus rate in the old ECG is the same as the new ECG, there is no difference in vagal tone.So we ordered an admission bed and he underwent dialysis. A bit later, we obtained non-hemolyzed blood and the K was 5.5 mEq/L, which is ele...
Source: Dr. Smith's ECG Blog - April 22, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
‘ Going to Extremes ’ Hall of Fame
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog
In 2012, Greg Kelly suggested that LITFL collate the most extreme ‘medical extremes’.
This is how things currently stand:
ParameterLevelDiagnosisSubmitted by
Ammonia514 umol/LTorsten Behrens
Base excess (postive)40.6 mmol/LChronic Type 2 respiratory failureJakob Mathiszig-Lee
Bilirubin1113 umol/lDrug-induced hepatitis (anabolic steroids)Jurij Hanžel
Blood pressure345/245 mmHgDuring weightlifting (P. Palatini et al, 1989: https://www.ncbi.nlm....
Source: Life in the Fast Lane - April 21, 2018 Category: Emergency Medicine Authors: Chris Nickson Tags: Emergency Medicine Intensive Care Investigation extremes hall of fame Investigations parameters Physiology Source Type: blogs
