OMI Can be Diagnosed by " Pseudonormalization of ST Segments "
This post was written by Tarissa Lai, one of our outstanding EM residents at Hennepin County Medical Center, with comments by Steve Smith and Dan Lee.CaseA 30 something y.o. female with HTN, HLD, diabetes, ESRD on dialysis is brought in by EMS with sudden onset, left -sided chest pain for the past four hours.This is her pre-hospital ECG: This is her first ECG in the ED:What do you think?I interpreted this as normal sinus rhythm with LVH, but no significantly peaked T waves concerning for hyperkalemia. I did not appreciate any significant ST elevation.However, the prehospital ECG is more worrisome:the T-...
Source: Dr. Smith's ECG Blog - April 20, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
Potato Poisoning (Not due to Solanine in greens!). With Positive Modified Sgarbossa Criteria.
In this study of consecutive patients with LBBB who were hospitalized and had an echocardiogram, 13% had a QRS duration greater than 170 ms, and only 1% had a duration greater than 190 ms.Clinical CourseThe clinicians recognized this as hyperkalemia. The lab result was too high to measure (greater than 9.4 mEq/L).p.p1 {margin: 0.0px 0.0px 0.0px 0.0px; font: 11.0px Helvetica; background-color: #fefefe}The patient received albuterol x 6, calcium gluconate x 5 g, D50 (50 ml) x 2, 5 units regular insulin, 40 mg furosemide, and 50 mL of Na bicarb.It turns out he had been told several days earlier that his K was low a...
Source: Dr. Smith's ECG Blog - April 17, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
A middle aged man with unwitnessed cardiac arrest
Written by Pendell Meyers, with edits by Steve SmithThanks to my attending Nic Thompson who superbly led this resuscitationWe received a call that a middle aged male in cardiac arrest was 5 minutes out. He was estimated to be in his 50s, with no known PMHx. He arrived with chest compressions ongoing, intubated, and being bagged. EMS report was that the patient had unknown down time with unwitnessed arrest, found initially in VFib arrest, defibrillated x1 followed by PEA arrest alternating with asystolic arrest during transport.He arrived in PEA arrest with a slow and wide cardiac waveform during initial rhythm check, with ...
Source: Dr. Smith's ECG Blog - April 6, 2018 Category: Cardiology Authors: Pendell Source Type: blogs
Tropical Travel Trouble 007 Mega Malaria 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 007
When you think tropical medicine, malaria has to be near the top. It can be fairly complex and fortunately treatment has become a lot simpler. This post is designed to walk you through the basic principals with links to more in depth teaching if your niche is travel medicine, laboratory diagnostics or management of severe or cerebral malaria. If you stubbled on this post while drinking a cup of tea or sitting on the throne and want a few basi...
Source: Life in the Fast Lane - April 5, 2018 Category: Emergency Medicine Authors: Neil Long Tags: Clinical Cases Tropical Medicine malaria Plasmodium plasmodium falciparum plasmodium knowles plasmodium malariae plasmodium ovale plasmodium vivax Source Type: blogs
Splitting hairs with hypertension
By SAURABH JHA, MD
Intrigued by many things in my first few days in the U.S., what perplexed me the most was that there seemed to be a DaVita Dialysis wherever I went; in malls, in the mainstreet of West Philadelphia, near high rises and near lower rises. I felt that I was being ominously followed by nephrologists. How on earth could providers of renal replacement therapy have a similar spatial distribution as McDonalds?
After reading Friedrich Hayek’s essay, Use of Knowledge in Society, I realized why. In stead of building a multiplex for dialysis, which has shops selling pulmonary edema-inducing fried chicken, D...
Source: The Health Care Blog - April 4, 2018 Category: Consumer Health News Authors: at RogueRad Tags: OP-ED Patients Value-Based Care Source Type: blogs
The difficult conversations physicians have with patients
A 60-year-old lady came for follow-up after a recent stay in the hospital. She was diabetic — horribly uncontrolled — the result of which was that she had already been on dialysis for four years. She ended up in the emergency room with chest pain. Diabetic patients are at higher risk than the general population of having heart attacks.
She underwent studies to evaluate for blockages in her heart. The cardiologist found a significant blockage, but a stent could not be placed because of tricky anatomy. She was started on medicines for the blockage and for blood pressure.
At first glance on meeting her, I would never have...
Source: Kevin, M.D. - Medical Weblog - March 21, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/uzma-khan" rel="tag" > Uzma Khan, MD < /a > Tags: Physician Hospital-Based Medicine Nephrology Source Type: blogs
Do doctors see patients as machines?
An excerpt from Physician: How Science Transformed the Art of Medicine.
While working at a community hospital in the Midwest in the early 2000s, I came to know Walter Stephenson (name changed), who was under my medical care during a lengthy recovery from multiple complications related to Diabetes. 40-year-old Walter was going through a stressful phase of his life, which included a life-threatening infection in his leg that eventually required amputation, kidney failure necessitating dialysis, and other psychological problems including anxiety, depression, and insomnia.
Once a vivacious and lively patient, Walter seemed to...
Source: Kevin, M.D. - Medical Weblog - March 7, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/rajeev-kurapati" rel="tag" > Rajeev Kurapati, MD < /a > Tags: Physician Hospital-Based Medicine Source Type: blogs
Chronic disease is making medical education worse
Remarkable improvements in advanced life-saving therapies have brought chronic disease management to the forefront of American health care. Today, we see more patients that have complicated conditions. Often, these patients are admitted to the hospital with acute symptoms related to chronically managed conditions such as heart failure, lung diseases or cancer.
These patients can end up in the intensive care units and require critical care such as ventilators, dialysis and other support devices. Recovering from long-term dependence on these therapies could take months or even years, if patients are able to recover at all.
T...
Source: Kevin, M.D. - Medical Weblog - February 20, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/jason-j-han" rel="tag" > Jason J. Han, MD < /a > Tags: Education Medical school Public Health & Policy Source Type: blogs
To aspiring physician-writers: It ’s time to write that book!
In 2011, my first novel was published. It is a medical novel, and, unsurprisingly, since I practiced as a nephrologist for many years, it takes place in a dialysis unit. I learned a lot from writing this book, seeing it published and living with the consequences. Since its publication, many professionals have confided to me that they harbor a secret desire to write a book. I want to share my learnings with them. Here they are.
Writing confirmed for me that mindfulness — living in the moment — is a wonderful thing, and writing encourages it. When working on my book, I found it impossible to focus on anything else. My tr...
Source: Kevin, M.D. - Medical Weblog - February 12, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/robert-allan-bear" rel="tag" > Robert Allan Bear, MD < /a > Tags: Physician Practice Management Source Type: blogs
Fight Aging! Newsletter, February 12th 2018
In conclusion, most experimental data on immune changes with aging show a decline in many immune parameters when compared to young healthy subjects. The bulk of these changes is termed immunosenescence. Immunosenescence has been considered for some time as detrimental because it often leads to subclinical accumulation of pro-inflammatory factors and inflammaging. Together, immunosenescence and inflammaging are suggested to stand at the origin of most of the diseases of the elderly, such as infections, cancer, autoimmune disorders, and chronic inflammatory diseases. However, an increasing number of gerontologists have chall...
Source: Fight Aging! - February 11, 2018 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
A Few Recent Advances in Tissue Engineering and Regenerative Medicine
The tissue engineering and regenerative medicine communities are too large and energetic to do more than sample their output, or note the most interesting advances that stand out from the pack. The publicity materials I'll point out here are a recent selection of items that caught my eye as they went past. Dozens more, each of which would have merited worldwide attention ten or fifteen years ago, drift by with little comment every year. The state of the art is progressing rapidly towards both the ability to build complex tissues from a cell sample, such as patient-matched organs for transplantation, and the ability to cont...
Source: Fight Aging! - February 10, 2018 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs
A Whiff of Market-Based Health Care Change
By BRIAN KLEPPER
Tuesday’s announcement about Amazon, Berkshire Hathaway and JPMorgan (A/BH/JPM) was short on details. The three mega-firms will form an independent company that develops solutions, first, for their own companies’ health plans and then, almost certainly, for the larger health care marketplace. But the news reverberated throughout the health care industry as thoroughly as any in recent memory.
Health care organizations were shaken. Bloomberg Markets reported that:
Pharmacy-benefit manager Express Scripts Holding Co. fell as much as 11 percent, the most intraday since April, at the open of U.S. trading Tu...
Source: The Health Care Blog - February 2, 2018 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
Bizarre (Hyperacute??) T-waves
Thanks to one our great HCMC nurses, Ryan Burch. He figured this one out.A dialysis patient presented with dyspnea. He was a bit fluid overloaded and not hyperkalemic. This ECG was recorded:This was sent to me in a text that woke me from sleep, but not simultaneous with patient care.Truly bizarre T-waves in I, aVL, III, aVF, aVRLead II is unremarkable, and leads V3-V6 are also slightly bizarre.What do you think?My answer, as I looked with bleary eyes at my phone: " I have to say I ' ve never seen this one before. "Later, I looked into the chart and found an ECG from a few days before:I texted back:" Those ...
Source: Dr. Smith's ECG Blog - January 30, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
ST elevation in aVL with reciprocal ST depression in the inferior leads
Written by Pendell MeyersA male in his 50s with history of thyroid cancer was brought to the Emergency Department after being found minimally unresponsive with sonorous respirations on his couch at home. Blood glucose level was 76 mg/dL. EMS administered naloxone, which was followed quickly by hyperventilation but no improvement in mental status. EMS performed RSI at that time using etomidate and succinylcholine, but intubation was unsuccessful. Luckily, BVM ventilation was easy in this patient, and he was bagged on the way to the ED, with oxygen saturation maintained in the mid-90s.He was intubated immediately on arrival ...
Source: Dr. Smith's ECG Blog - January 5, 2018 Category: Cardiology Authors: Pendell Source Type: blogs
What I learned as a house call physician
As doctors, we simply want to spend more time with our patients. As a doctor for 13 years, and someone who now recruits doctors as a large part of my job, I’m witnessing the battle for more time with patients wage on, but there are no winners. Patients are waiting longer for hurried appointments. We spend more of what little time we have, prescribing and referring out because we’re racing to meet minimum visit numbers. Time is at the crux of so many of the issues we see in primary care, and throughout the care continuum.
In taking time with our patients to educate them, listen to them, connect with them, we can prescri...
Source: Kevin, M.D. - Medical Weblog - December 17, 2017 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/renee-dua" rel="tag" > Renee Dua, MD < /a > Tags: Physician Diabetes Endocrinology Primary Care Source Type: blogs
