How can Warfarin be safe “ even in ” first trimester of pregnancy ? The story behind the 5 mg cut-off !
The well known pro-coagulant state of pregnancy is an evolutionary protective process to make blood clot quicker, to save fetal loss in early pregnancy and mitigate postpartum bleeding. Still, in many women, this natural adaptive process confers an enhanced thrombotic risk. The molecular mechanisms for this pro-coagulant state are, there is increased factor VII, fibrinogen, reduced protein S. It is interesting to note, while plasminogen levels are elevated, D-dimer is also increased, indicating an ongoing fight between pro & anticoagulant forces, converting the physiological maternal- placental bed a mini harmless DIC ...
Source: Dr.S.Venkatesan MD - March 20, 2024 Category: Cardiology Authors: dr s venkatesan Tags: cardiology -pregnancy Pregnancy and heart pregnancy and heart disease Uncategorized carpreg registry zahara esc acc guidelines on pregnancy and heart disease first trmestr use of oac warfarin heparin switch over lmwh bridge in pregnancy Source Type: blogs
50 year-old in remote rural community with chest pain and ‘normal’ ECG
Submitted by anonymous, edited by Jesse McLarenThe first person " I " and " me " is this anonymous sender. A 50 year old presented to the emergency department of a
remote rural community (where the nearest cath lab is a plane ride away) with
one hour of mild chest pain radiating to the back and jaw, and an ECG labeled ‘normal’ by the computer interpretation. What do you think, and how would you
manage the patient?There ’s normal sinus rhythm, normal conduction, normal axis,
normal R wave progression and normal voltages. There’s clear T wave inversion
in III/aVF, which is reciprocal to subtle ST elevation and h...
Source: Dr. Smith's ECG Blog - September 8, 2023 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
What's new in midwifery - 27th September 2022
Some research you may find useful...Those marked L need payment or librarian intervention. Those marked OA are open access. One new Cochrane review: Maternal postures for fetal malposition in labour for improving the health of mothers and their infants. This is one of two new reviews replacing a review from 2007. The other is on maternal postures for fetal malposition in late pregnancy, but I can see no published review or protocol at the moment. (Access for free within the UK).Two on labour or delivery, possibly more obstetrics, but may be of interest:Weight-Based Compared With...
Source: Browsing - September 27, 2022 Category: Databases & Libraries Tags: midwifery Source Type: blogs
Wide Complex Tachycardia with Huge ST Elevation. What is going on?
This 70-something woman with no significant past history (no previous ECGs or cardiac history) presented by EMS with fairly acute chest pressure and shortness of breath, with nausea and diaphoresis. " Like an elephant sitting on my chest. " She had no history of atrial fibrillation and was not on any anticoagulants.She stated that she had had a similar episode a couple weeks earlier, lasting 24 hours, with rapid heart beat but without chest pain, that spontaneously resolved. She thought she was having a panic attack. Since then she has had " little spurts " of the same thing lasting 1-2 hours.E...
Source: Dr. Smith's ECG Blog - January 12, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
A man in his 60s woken from sleep by epigastric pain. Would you have been able to correctly diagnose him?
Written by Pendell MeyersA man in his mid 60s with history of CAD and stents experienced sudden onset epigastric abdominal pain radiating up into his chest at home, waking him from sleep. He called EMS who brought him to the ED. He had active chest pain at the time of triage at 0137 at night, with this triage ECG:I sent this ECG, without any text at all, to Dr. Smith, and he replied: " LAD OMI with low certainty. V3 is the one that is convincing. " After his response I sent him the baseline ECG (below), still with no context at all except that this was his prior ECG:Dr. Smith replied: " Now high certainty. By the way,...
Source: Dr. Smith's ECG Blog - October 5, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
A 52 year old female with chest pain
Written by Pendell Meyers, edits by Steve SmithA 52 year old female with history of hypothyroidism and smoking presented to the ED with an episode of chest pain that began suddenly around 1500 while sitting down at work. She states it felt like a central chest pressure that radiated to her jaw. The pain had been persistently present since since 1500 (seen at 1615 in the ED), but had waxed and waned in severity, with the initial onset of pain being the worst. She had dyspnea and diaphoresis when the pain began. Coworkers called EMS who administered aspirin and NTG, which the patient says did not relieve her pain. During ini...
Source: Dr. Smith's ECG Blog - August 16, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
A man in his 40s with a highly specific ECG
In conclusion, the presence of negative T waves in both leads III and V1 allows PE to be differentiated simply but accurately from ACS in patients with negative T waves in the precordial leads. "Witting et al. looked at consecutive patients with PE, ACS, or neither. They found that only 11% of PE had 1 mm T-wave inversions in both lead III and lead V1, vs. 4.6% of controls. This does not contradict the conclusions of Kosuge et al. that when T-wave inversions in the right precordial leads and in lead III are indeed present, then PE may indeed by more common. In m...
Source: Dr. Smith's ECG Blog - March 30, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
It Is A Pity That We Don ’t See More Balanced Views On Clinical Software Errors.
This appeared las week: Medical software blamed for fatal anticoagulant double-dosing error Hospital doctors relying on the Cerner system accidentally prescribed an additional dose of apixaban 11th March 2021 By Antony Scholefield A hospital software system has been blamed for a fatal anticoagulant double-dosing error after it displayed a prescribing icon so small that it could not be seen on a standard computer screen. In 2019, Ian Fraser was admitted to the Sunshine Hospital in Melbourne with an exacerbation of his congestive cardiac failure as well as community-acquired pneumonia. He had a comp...
Source: Australian Health Information Technology - March 17, 2021 Category: Information Technology Authors: Dr David G More MB PhD Source Type: blogs
Chest Pain and Ischemic ST Depression — but there is no Cath Lab available. Thrombolytics?
===================================MY Comment by KEN GRAUER, MD (7/14/2020):===================================This middle-aged man with hypertension and hyperlipidemia presented to the ED with 2 hours of new-onset chest pain — and the ECG shown in Figure-1. The patient was hemodynamically stable. No prior tracing was available for comparison.HOW would you interpret the ECG shown in Figure-1?Immediate cath lab activation was not an option in this hospital. Should acute thrombolysis be used?Figure-1: The initial ECG in the ED (See text).My THOUGHTS on ECG #1...
Source: Dr. Smith's ECG Blog - July 14, 2020 Category: Cardiology Authors: ECG Interpretation Source Type: blogs
Rationale for Testing Anticoagulants Against COVID-19
This article originally appeared on the Timmerman Report here.
The post Rationale for Testing Anticoagulants Against COVID-19 appeared first on The Health Care Blog. (Source: The Health Care Blog)
Source: The Health Care Blog - April 16, 2020 Category: Consumer Health News Authors: Christina Liu Tags: COVID-19 Patients Physicians anticoagulants cardiology coronavirus Ethan Weiss thrombosis Source Type: blogs
A 41 year old with chest pain and a Nondiagnostic Triage ECG. Thrombolytics prior to transfer for PCI.
Conclusion:Transfer for PCI without thrombolytics is best if PCI at receiving facility can be done in less than 120 minutes from first medical contact, or less than 90 minutes from STEMI diagnosis in first ED.Thrombolytics prior to Transfer to a PCI capable facility, then rescue PCI if no reperfusion for STEMITRANSFER AMI(Cantor et al. 2009).High risk STEMI: BP less than 100, HR greater than 100 Killip class II, III, ST depression of at least 2 mm in precordial leads, ST elevation in right precordial leads (right ventricular MIAll patients get TNK-tPA.80-90% received clopidogrel 300 mg (75 mg for age over...
Source: Dr. Smith's ECG Blog - November 7, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
Enoxaparin dose for VTE prophylaxis in obese patients
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - October 6, 2018 Category: Internal Medicine Tags: cardiovascular hematology hospital medicine pharmacology Source Type: blogs
Watch what happens when " pericarditis " and morphine cloud your judgment
Submitted and written by Alex Bracey with edits by Pendell Meyers and Steve SmithCaseA 50ish year old man with a history of CAD w/ prior LAD MI s/p LAD stenting presented to the ED with chest pain “similar to his prior MI, but worse.” The pain initially started the daypriorto presentation. The pain roused him from sleep but subsided without intervention. Around 19 hours later, he experienced the same pain, which prompted his presentation to the ED. By this time, three hours had passed from the onset of the pain but it was no longer present. Here is his initial ECG:00:04What do you think? - Sinus rhythm at ~70 bpmSTE in...
Source: Dr. Smith's ECG Blog - July 3, 2018 Category: Cardiology Authors: Pendell Source Type: blogs
Let's Stop Claiming That Palliative Care Improves Survival
by Drew RosielleHospice and palliative care community, I ' m calling for a moratorium on all blanket, unqualified claims that hospice and palliative care improve survival.Let ' s just stop doing this.There has never been any actual evidence that palliative care (PC) interventions improve survival in patients, but since thelandmark Temel NEJM 2010 RCT of early outpatient palliative care for lung cancer patients showed a clinically and statistically significant improvement in longevity in the PC arm, I have heard and all read all sorts of statements by palliative people and all sorts of others (hospital executives, poli...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 30, 2018 Category: Palliative Care Tags: lung cancer palliative palliative care quality of life rosielle temel The profession Source Type: blogs
Let's Stop Claiming That Palliative Care Improves Survival
by Drew RosielleHospice and palliative care community, I ' m calling for a moratorium on all blanket, unqualified claims that hospice and palliative care improve survival.Let ' s just stop doing this.There has never been any actual evidence that palliative care (PC) interventions improve survival in patients, but since thelandmark Temel NEJM 2010 RCT of early outpatient palliative care for lung cancer patients showed a clinically and statistically significant improvement in longevity in the PC arm, I have heard and all read all sorts of statements by palliative people and all sorts of others (hospital executives, poli...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 30, 2018 Category: Palliative Care Tags: lung cancer palliative palliative care quality of life rosielle temel The profession Source Type: blogs
