Does this T wave pattern mean anything?
Written by Michael Doyle DO and Timothy Palmieri MD. Edited by Bracey, Meyers, Grauer, and SmithA 50-something-year-old female with a history of an unknown
personality disorder and alcohol use disorder arrived via EMS following cardiac arrest with return
of spontaneous circulation. The described rhythm was an irregular, wide complex
rhythm. By EMS report, open pill bottles were found nearby at the scene, including quetiapine, fluoxetine, hydroxyzine, and gabapentin. She was successfully revived
after several rounds of ACLS including defibrillation and amiodarone.On arrival to the ED the patient was intubated with normal vi...
Source: Dr. Smith's ECG Blog - October 23, 2023 Category: Cardiology Authors: Bracey Source Type: blogs
Overcoming Barriers to Emergency Care During a Telehealth Appointment
The following is a guest article by Alexander Chiu, MD at Telemedicine911.
The COVID-19 pandemic brought a quick pivot to telehealth, where patients in any location can connect with a provider from any location. The rapid adoption of telehealth and virtual provider brought light to the following question – What happens during a telehealth visit if the provider recognizes that the patient needs urgent help due to an emergent situation?
Telling a patient to “hang up and call 911” or “hang up and go to the ER” is like telling a person who just walked into the provider’s office to leave and go somewhere else ...
Source: EMR and HIPAA - November 1, 2022 Category: Information Technology Authors: Guest Author Tags: Communication and Patient Experience Health IT Company Healthcare IT Hospital - Health System Telemedicine and Remote Monitoring 911 Dispatch Air®GeoLocate Alexander Chiu Emergency Medical Services EMS PSAP Public Safety Answering P Source Type: blogs
Xylological Delusions of Being a Tree
The mythology surroundingreverse inter-metamorphosis, a delusional syndrome that involves transformation into a beast, has frightened and fascinated for hundreds of years. A special instance of reverse inter-metamorphosis isclinical lycanthropy, the delusion that one has been transformed into a wolf (or another animal). A recent review identified 43 cases in the literature between 1852 and today (Guessoum et al., 2021). Psychotic depression and schizophrenia were the most common co-existing psychiatric diagnoses in these individuals.The article advocates a cultural and person-centered approach to treatment, as did many of ...
Source: The Neurocritic - October 31, 2021 Category: Neuroscience Authors: The Neurocritic Source Type: blogs
This man had uncontrollable itching – a case presentation in 3 parts – Part 1
The man, in his 60s, had enjoyed good health until 6 weeks ago. His symptoms started with modest itching, but over the past 2 weeks it had become unbearable. During this time, he had lost 20 pounds because he had both nausea and some post-prandial vomiting. A physician had tried hydroxyzine, without any symptom relief. He denied abdominal pain. He had never had similar symptoms. He was taking no new medications.
Over the past week relatives and friends told him that he was starting to look yellow.
On further questioning he told us that he had dark urine but chalky colored stools.
Part 1 – develop a...
Source: DB's Medical Rants - March 19, 2018 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Nobody wants the flu. But what happens if you get it and you ’ re pregnant?
First…
It’s strongly recommended that pregnant women get the flu shot. The flu vaccine is safe throughout pregnancy and is the first step to protecting you and your baby from it.
Of course even if you get the vaccine it is still possible to get the flu so make sure to get plenty of rest and use your frequent trips to the bathroom to wash your hands often throughout the day.
Second…
If you think you have the flu contact your doctor right away. Most healthy adults with the flu become mildly ill, and start to feel better in 7 to 10 days. However, if you catch the flu early, your doctor can prescribe an an...
Source: Cord Blood News - February 15, 2017 Category: Perinatology & Neonatology Authors: Maze Cord Blood Tags: babies pregnancy flu pregnancy health Source Type: blogs
Make Sleep Meds Work For You
I’ve been busier than I like, and haven’t had as much time for posting. But I spend a lot of time answering emails from my patients, and some of my responses may be useful for others. Below I’ll share my answer to a patient who has been unable to get quality sleep. Next week I’ll find another answer to share with readers.
This patient asked whether her insurance would cover Lunesta. She wrote at 2 AM that she is up most of the night tossing and turning. She now takes 10 mg of Ambien, and wrote that it ‘stopped working’. She doesn’t think 20 mg of Ambien would be covered b...
Source: Suboxone Talk Zone - November 27, 2016 Category: Addiction Authors: Jeffrey Junig MD PhD Tags: pharmacology Research ambien best sleep medication insomnia treatments lunesta sleep medication no working sleeping pills Source Type: blogs
Longing for the QT
A 58-year-old man presented to the ED with a reported overdose of an unknown medication. The patient was agitated, combative, and altered. Initial vital signs included a heart rate of 115 beats/min, blood pressure of 154/93 mm Hg, respirations of 22/min, and temperature of 99.5°F. The patient was difficult to evaluate because he was agitated, and he was given 5 mg of haloperidol IV and 2 mg of lorazepam IV. The patient continued to be agitated, and was given another 10 mg of haloperidol IV, followed by a repeat dose of 10 mg IV 15 minutes later. The patient then became unresponsive, and his cardiac monitor demonstrated th...
Source: The Tox Cave - March 1, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Delirium and Physostigmine: ECG helps in Management
This patient took an unknown overdose and was delirious. The axillae were dry. Due to delirium and dry skin, there was suspicion of anticholinergic toxicity.Here is his ECG:There is sinus tachycardia. There is also some QRS widening and a large R-wave in aVR, and an rSR' (RV conduction delay) in lead V1. The QRS duration is 107 ms. There is QT prolongation as well, with a computerized (Bazett) QTc of 480 ms (prolonged).The prolonged QRS and RV conduction delay make this very suspicious for Na channel blockade, and, most worrisome, for tricyclic antidepressant overdose (TCA).Do we treat the del...
Source: Dr. Smith's ECG Blog - March 7, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
MKSAP: 27-year-old woman is evaluated for a 4-week history of wheals
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.A 27-year-old woman is evaluated for a 4-week history of wheals, characterized by a burning sensation without pruritus. Each individual lesion persists for 48 hours and slowly resolves, leaving a bruise. Current medications are diphenhydramine, hydroxyzine, cetirizine, and oral contraceptives. The patient’s mother has systemic lupus erythematosus.On physical examination, vital signs are normal. She has scattered edematous indurated erythematous plaques consistent with wheals. There are scattered ecchymoses a...
Source: Kevin, M.D. - Medical Weblog - January 20, 2013 Category: Family Physicians Tags: Conditions Dermatology Source Type: blogs
