Palpitations and presyncope in a 40-something
Discussion: Putting all of the information together this patient is most likely suffering from arrhythmogenic cardiomyopathy (AC) better known as ARVC. The medical hx is typical, with sudden onset tachydysrhythmia during physical exertion. It is not uncommon for the initial presentation to be sudden cardiac death (SCD). In fact it is one of the leading causes of SCD in people age less than 40 years. Thus it is very important to identify this disorder. AC is a disease in which myocardium is replaced by fibrofatty tissue. This usually and predominantly affects the RV free wall and apical regions, but it can affect the left v...
Source: Dr. Smith's ECG Blog - March 24, 2024 Category: Cardiology Authors: Magnus Nossen Source Type: blogs
All About Anesthesia
If you’ve ever had a surgery or even a minor procedure, you’ve probably benefited from the medical marvel of anesthesia—the treatment that doctors, called anesthesiologists, give to keep you from feeling pain. And it’s come a long way since the discovery of diethyl ether. Here we dive into the different types, its history, and the way it works.
The chemistry of anesthetics has advanced since the 1840s, producing different types of anesthesia depending on the compounds involved. See more chemistry infographics like this one in C&EN’s Periodic Graphics collection. Click to enlarge.
Types of A...
Source: Biomedical Beat Blog - National Institute of General Medical Sciences - July 6, 2022 Category: Research Authors: Chrissa Chverchko Tags: Chemistry, Biochemistry and Pharmacology Anesthesiology Source Type: blogs
Patients Occasionally Experience Sexual Hallucinations While Under Conscious Sedation
By Emma L. Barratt
Since anaesthetics were first used in 1846 there have been reports of sexual hallucinations during medical procedures. And, though there’s been much discussion about the relationship between anaesthesia and these hallucinations, awareness of this side effect amongst both clinicians and academics remains somewhat low. The consequences of clinicians being accused of sexual misconduct that was in actuality a hallucination can extremely be serious; some have lost their licenses to practice, despite being acquitted.
But even with the high-stakes consequences of sexual hallucinations, there has been r...
Source: BPS RESEARCH DIGEST - November 16, 2021 Category: Psychiatry & Psychology Authors: BPS Research Digest Tags: Health Perception Sex Source Type: blogs
Is this ST depression due to OMI or due to subendocardial ischemia? This is critical to distinguish, and this is a trick case!
We just today published this very important article in the Journal of the American Heart Association:Ischemic ST ‐Segment Depression Maximal in V1–V4 (Versus V5–V6) of Any Amplitude Is Specific for Occlusion Myocardial Infarction (Versus Nonocclusive Ischemia)full text: https://www.ahajournals.org/doi/pdf/10.1161/JAHA.121.022866However, if the patient has atrial fibrillation with RVR, one must first cardiovert and then re-assess. STD Max V1-V4 can be due to subendocardial ischemia (not OMI) when there is tachycardia, especially if due to atrial fibrillation with RVR.I have long noticed this (but have not f...
Source: Dr. Smith's ECG Blog - November 15, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
Agitation, Confusion, and Unusual Wide Complex Tachycardia. What is it, why did it occur, and how to treat?
A 50-something male ran a 10 mile race, after which he complained of a headache. The next day, he collapsed and had a witnessed seizure.He arrived agitated and the monitor showed a wide complex tachycardia. He was very hypertensive and tachycardic.A 12-lead ECG was obtained:What is it? What therapy?There are wide complex QRS ' s with 2 different morphologies:1. RBBB configuration with an axis of about 135 degrees (lower right axis toward III)2. IVCD (neither RBBB nor LBBB) with a " Northwest " (upper right) axis toward aVRThere appear to be 3 possible P-waves, but they are not consistent and not definitel...
Source: Dr. Smith's ECG Blog - November 6, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
It ’s time to redesign anesthesia care delivery
As we orient our brand-new, fresh-faced CA-1 residents to the operating room each year, I ask this question. Has anyone explained to them that much of what they ’ll need to learn in the first couple of months is how to be a nurse? We watch them struggle to draw up propofol into a syringe withoutRead more …It ’s time to redesign anesthesia care delivery originally appeared inKevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - September 26, 2021 Category: General Medicine Authors: < span itemprop="author" > < a href="https://www.kevinmd.com/blog/post-author/karen-s-sibert" rel="tag" > Karen S. Sibert, MD < /a > < /span > Tags: Physician Anesthesiology Source Type: blogs
Ischemic preconditioning
The concept of ischemic preconditioning is that multiple short episodes of ischemia can protect the heart from a later sustained ischemia later [1]. In an experimental study, 4 episodes of 5 minutes each, separated by 5 minutes of reperfusion followed by 40 minutes of occlusion showed 75% reduction in infarct size compared to controls. But this benefit was not there when the final occlusion time was 3 hours. Authors suggested that multiple pre-infarction anginal episodes may have a similar effect on limiting infarct size if myocardial infarction occurs subsequently. Others have suggested that similar mechanism might opera...
Source: Cardiophile MD - July 1, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Coming clean: Your anesthesiologist needs to know about marijuana use before surgery
Given the increasing prevalence and legalization of marijuana, many patients have come to think that marijuana use is not worth mentioning to their physicians. After all, they reason, I would not necessarily tell my doctor that I had a glass of wine last night, so why should I disclose that I smoked marijuana yesterday? Unfortunately, this reasoning is flawed. Because marijuana has a variety of effects on the body and on anesthesia medicines, it is crucial that anyone undergoing a preoperative evaluation disclose their marijuana use. Don’t worry that your anesthesiologist is judging you. That’s not our job! Our job is ...
Source: Harvard Health Blog - January 15, 2020 Category: Consumer Health News Authors: David Hepner, MD, MPH Tags: Health care Marijuana Prevention Safety Surgery Source Type: blogs
Concerning Findings About Cannabis Use
While recreational marijuana is legal in 11 states as of November 2019, more states gravitating toward legalizing the recreational use of the substance, and 33 states allowing medical marijuana, there’s apparently no stopping this trend. Cannabis, in the form of marijuana, hemp, and cannabidiol (CBD) is being used for pain relief, to alleviate stress, cope with anxiety, and a number of other mental health disorders and addictions.
Yet, there’s a dearth of clinical studies that have been conducted on the overall effects on a user’s health. Clearly, as Crain’s Detroit Business points out, more research on marijuan...
Source: World of Psychology - November 16, 2019 Category: Psychiatry & Psychology Authors: Suzanne Kane Tags: Medications Substance Abuse Cannabis Marijuana Source Type: blogs
An Overdose that Happens Hours Later
A 15-year-old girl was brought to the emergency department by EMS after a seizure witnessed by her mother. She admitted that she had ingested "a handful of pills" in a suicide attempt five hours earlier. The mother said her daughter had a history of cutting but no prior suicide attempts.Her past medical history was significant for depression, for which she took bupropion XL, and she reported past alcohol and marijuana use. Her initial vital signs were a temperature of 97.9°F, a pulse of 162 bpm, a blood pressure of 127/65 mm Hg, a respiratory rate of 14 bpm, and a pulse ox of 100% on room air. Her exam was si...
Source: The Tox Cave - November 1, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
5 hidden symptoms of physician burnout
As I lay there awaiting my shock, the doctors milled in and out of my room over the course of several hours. It was a normal but hectic morning in the emergency department with ambulances and code blues pulling my doctor away. Before pushing the Propofol and completing my cardioversion, the doctor flatly stated something […]Find jobs at Careers by KevinMD.com. Search thousands of physician, PA, NP, and CRNA jobs now. Learn more. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - October 16, 2019 Category: General Medicine Authors: < span itemprop="author" > < a href="https://www.kevinmd.com/blog/post-author/mitchel-schwindt" rel="tag" > Mitchel Schwindt, MD < /a > < /span > Tags: Physician Practice Management Source Type: blogs
An image that reminds us what life versus death looks like
This is what life versus death looks like. This is what medicine verses mortality looks like. This is what science verses humanity looks like. After a thoracotomy, a fellow ER doctor Dr. Mitch Li snapped this picture of the spilled blood and Propofol on the trauma bay floor. Blood courses through every on e of our veins to sustain life. Propofol courses through […]Find jobs at Careers by KevinMD.com. Search thousands of physician, PA, NP, and CRNA jobs now. Learn more. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - March 24, 2019 Category: General Medicine Authors: < span itemprop="author" > < a href="https://www.kevinmd.com/blog/post-author/amy-ho" rel="tag" > Amy Faith Ho, MD < /a > < /span > Tags: Physician Emergency Medicine 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
The Anoscope for Foreign Bodies in the Rectum
Rectal exams are difficult for the patient and require true expertise. You cannot expect to complete a good rectal exam or remove a rectal foreign body without the correct information, good bedside relationship, and the right equipment.Ensuring your patient has confidence in your ability is vital. Take the time to get to know what equipment is available in your ED. It's important to know what to do before a patient comes to your department with a rectal complaint.Most departments have a box dedicated to the anoscope. It typically will have two handles for light sources and two sizes of obturators with casing. The items ...
Source: The Procedural Pause - December 31, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Q & A with Dr. Daniel Rukstalis on prostatic urethral lift for enlarged prostates
A new procedure that relieves symptoms without causing sexual side effects
As men get older, their prostates often get bigger and block the flow of urine out of the bladder. This condition, which is called benign prostatic hyperplasia, causes bothersome symptoms. Since men can’t fully empty their bladders, they experience sudden and frequent urges to urinate. Treatments can relieve these symptoms, but not without troubling side effects: pharmaceutical BPH treatments cause dizziness, fatigue, and retrograde ejaculation, meaning that semen gets diverted to the bladder during orgasm instead of being ejected from the body. S...
Source: Harvard Health Blog - October 25, 2018 Category: Consumer Health News Authors: Charlie Schmidt Tags: BPH Prostate Knowledge Q & A HPK Source Type: blogs
