When the conventional algorithm diagnoses the ECG as COMPLETELY NORMAL, but there is in fact OMI, what does the Queen of Hearts PM Cardio AI app say? (with 10 case examples)
Conclusions Need Scrutiny.Proximal LAD Occlusion with STE in I and aVL, and hyperacute T-waves in V2-V6.Algorithm: Marquette 12 SL (GE)The Queen gets it rightCase 9 (prehospital and ED ECGs). Echocardiography, even (or especially) with Speckle Tracking, can get you in trouble. The ECG told the story. 30 yo woman with trapezius pain. HEART Pathway = 0. Computer " Normal " ECG. Reality: ECG is Diagnostic of LAD Occlusion.Prehospital ECG:There are hyperacute T-waves in V3-V5.The Queen gets it rightFirst ED ECG:Hyperacute T-waves persist. Called normal again! Algorithm: Veritas (on Mortara...
Source: Dr. Smith's ECG Blog - March 4, 2024 Category: Cardiology Authors: Steve Smith Source Type: blogs
How will you save this critically ill patient? A fundamental and lifesaving ECG interpretation that everyone must recognize instantly.
Written by Pendell MeyersA woman in her 30s called EMS for acute symptoms including near-syncope, nausea, diaphoresis, and abdominal pain. EMS arrived and found her to appear altered, critically ill, and hypotensive. An ECG was performed:What do you think?Extremely wide complex monomorphic rhythm just over 100 bpm. The QRS is so wide andsinusoidal that the only real possibilities left are hyperkalemia or Na channel blockade. Hyperkalemia is by far more common.Indeed, further history revealed two missed dialysis sessions. And of course on exam she has a dialysis fistula.EMS reportedly gave 4 grams of calcium (unknown w...
Source: Dr. Smith's ECG Blog - February 22, 2024 Category: Cardiology Authors: Pendell Source Type: blogs
Can we finally say goodbye to opioids? There may be new pain relief on the horizon.
In an article I recently wrote about a new calcium channel-blocking medication that could be effective in treating central chronic pain, I mentioned that medications like lidocaine block sodium channels to prevent the transmission of pain through the peripheral nervous system. I also said that these medications have limited use, usually just in the ER,
Read more…
Can we finally say goodbye to opioids? There may be new pain relief on the horizon. originally appeared in KevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - February 13, 2024 Category: General Medicine Authors: L. Joseph Parker, MD Tags: Meds Pain Management Source Type: blogs
A 50-something with chest pain.
This was sent by anonymous The patient is a 55-year-old male who presented to the emergency department after approximately 3 to 4 days of intermittent central boring chest pain initially responsive to nitroglycerin, but is now more constant and not responsive to nitroglycerin. It is unknown when this pain recurred and became constant.More past history: hypertension, tobacco use, coronary artery disease with two vessel PCI to the right coronary artery and circumflex artery several years prior. He reports feeling nauseated with emesis. He reports that this chest pain feels different than prior chest...
Source: Dr. Smith's ECG Blog - September 3, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
A young man with another episode of tachycardia. What is it? And why give adenosine in sinus rhythm?
Written by Bobby Nicholson MD and Pendell MeyersA man in his 30s presented to the ED for evaluation of chest pain and palpitations. He described it as a " jackhammering " sensation, associated with palpitations, diaphoresis, and shortness of breath, and he stated it started soon after consuming an " energy drink " (product/contents unknown).He stated these symptoms were the same as a prior episode which required cardioversion. He states that he has
a heart condition which he does not know the name of and that he has felt his
heart race like this once before and needed to be shocked. He was seen by a
cardiologist in fo...
Source: Dr. Smith's ECG Blog - June 11, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
Wrong Medicine
Some of the stacks of trip reports were nearing four feet high and they filled the musty closet. Dividing them up, we started sorting through them in earnest. The dates indicated that the calls had been run between 1972 and 1978. Most of the narratives were as brief as the treatment lists.
Hall Ambulance’s station one was an older house in an early residential area of Bakersfield, California. It had been, at one time, the residence of the company’s owner, Harvey Hall. In the early days of the ambulance service, Harvey had both lived in the home and run his fledgling ambulance service out of it.
One of the crews s...
Source: The EMT Spot - November 10, 2022 Category: Emergency Medicine Authors: Steve Whitehead Tags: EMT 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
poem
Burn OutOn call all the timeCan ’t remember the last dayI didn ’t go into the hospitalI think 21 days in a row Now, not sure, the suns and moonsRunning together you stop caringAbout the day, the time So much about yourselfAnd then everything elseExcept for the task at hand;An abscess to lanceA port to placeLeft colon to mobilize The perfectly arrayed meshNo before or afterEverything distilled down To the timeless immediacy Slicing my daysInto bracketed sliversEvery incision only happening nowThere are unintended side effects Of course, emotional detachmentDisengagement, psychic...
Source: Buckeye Surgeon - April 19, 2022 Category: Surgery Authors: Jeffrey Parks MD FACS Source Type: blogs
An asymptomatic man in his 50s with heart rate in the 160s - what is the diagnosis? How will you manage this?
Written by Pendell MeyersA man in his late 50s with history of CAD with CABG, COPD, smoking, cirrhosis, and other comorbidities presented for an outpatient scheduled stress test which had been ordered for some exertional shortness of breath, palpitations, and presyncopal episodes over the past few months. When he presented to the office for the stress test, his screening vitals before any test or intervention were remarkable only for a heart rate of 160 bpm. He denied any symptoms whatsoever.A 12-lead ECG was performed in the office:What do you think?The ECG shows a wide complex regular monomorphic tachycardia. I mea...
Source: Dr. Smith's ECG Blog - April 2, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
Painless Nasogastric Tube Placement
A 6-year-old boy presented with intermittent abdominal pain, nausea, and vomiting. Because his abdominal examination was unremarkable, the pain intermittent, and constipation a possibility, we provided an enema along with an abdominal pain workup but no radiographs. His pain improved, the abdominal labs were unremarkable, and the child tolerated an oral fluid challenge after treatment with ondansetron.The mother was advised at discharge to return if she became concerned about her child's condition. They did return a few hours later for increased vomiting and abdominal pain. A CT scan demonstrated multiple dilated loops ...
Source: M2E Too! Mellick's Multimedia EduBlog - March 1, 2022 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Natural remedies for hemorrhoids
Hemorrhoids are painful, unpleasant, and, um, well, difficult to talk about. But they actually are quite common: about half of people over age 50 have had them. However, they’re easy to treat and manage.
“Hemorrhoids can be troublesome and embarrassing, but they often shrink on their own with simple self-help care and over-the-counter remedies,” says Dr. Howard LeWine, assistant professor of medicine at Harvard Medical School.
What are hemorrhoids?
Hemorrhoids are swollen veins near the anus. Common symptoms are rectal pain, itching, bleeding, and occasional protruding veins outside the anus.
There are two types of h...
Source: Harvard Health Blog - February 23, 2021 Category: Consumer Health News Authors: Matthew Solan Tags: Digestive Disorders Health Inflammation Pain Management Source Type: blogs
Nasal Endoscopy for Urgent and Complex ED Cases
Fiberoptics and endoscopy have changed the way we treat patients in the emergency department. Endoscopes are relatively easy to use, and can aid your diagnosis and treatment plan. Endoscopy may be useful in urgent cases, such as epistaxis, nasal foreign bodies, and ear debridement. It may also be helpful when dealing with more complicated presentations and critically ill patients, such as those with Ludwig's angina, epiglottis, tracheostomies, or those who need intubation.Fiberoptic tools are not just for surgeons and consultants. The endoscope has many uses in the emergency department, and we have a few tips and tricks...
Source: The Procedural Pause - October 28, 2020 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Cardiac arrest with anterior-inferior STEMI: Guess the value of the initial ED high sensitivity Abbott troponin I
A ~40 year old woman started having chest discomfort. She called 911 after an uncertain amount of time. EMS arrived and recorded thisprehospital ECG:Obvious Anterior and Inferior STEMI, consistent with LAD occlusionAfter recording this ECG, the patient went intoventricular fibrillation.She was rapidly defibrillated.The cath lab was activated by the paramedics.She arrived complaining of chest pain, with a BP of 110/70.An ED ECG was recorded:It looks worse stillAside: Should the patient receive antidysrhythmics to prevent recurrent VT/VF? See discussion below on both beta blockers and other anti-dysrhythmic...
Source: Dr. Smith's ECG Blog - September 18, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
Restylane Kysse Now Available!
Christine Hamori, MD, FACS, has addedRestylane ® Kysse to her facial filler/injectable offerings at her plastic surgery practice on Boston ' s South Shore. Restylane Kysse is the first lip filler designed with XpresHAn Technology™allowing flexible movement and natural-looking volume that lasts for up to one year in clinical studies. " The Restylane Kysse formulation can provide results with less product than other lip injectables, " says Dr. Hamori, and we expect results to last up to a year. "In clinical studies,*:96% of subjects said their lips looked natural, and most had improved lip texture.100% said Restylane...
Source: What's New In Plastic Surgery? - September 16, 2020 Category: Cosmetic Surgery Source Type: blogs
Fishing Out the Fish Hook
Outdoor recreation has exploded since we all began social distancing for COVID-19, and EDs are seeing more camping and home improvement injuries from table saws, crafting projects, and even canning (burns). Boating and motorcycle accidents also seem to be on the rise. Many fisherfolk will be on and in the water using hooks, barbs, lines, and wires. Many of these anglers will arrive with a hook in the arm, hand, or scalp, unable to remove the hook themselves. In fact, their own attempts to remove the hooks may make matters worse. Fish hook injuries may seem simple at first, but can quickly get complicated, depending on t...
Source: The Procedural Pause - September 1, 2020 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
