Morphine + OMI is a bad combination
This is written by Magnus Nossen, with some edits by SmithThis ECG diagnosis will be obvious to the majority of the readers of this blog. It is not obvious for the majority of doctors or even cardiologists. A 50 something male was seen in the emergency room due to typical chest pain. The pain had started the same day about two hours prior to medical contact. Previous medical hx notable for type II DM. The first ECG is shown below.The medical care providers ascribed the patient ' s chest pain to new onset atrial fibrillation with rapid ventricular response after having viewed the ECG. Do you agree?The presentation ECG ...
Source: Dr. Smith's ECG Blog - September 24, 2023 Category: Cardiology Authors: Magnus Nossen Source Type: blogs
Judge for yourself the management of this patient with " NSTEMI, multivessel disease "
DISCUSSION:The administration of
opioid analgesia prior to cath in patients with concern for ACS is associated
with longer door-to-balloon times, and greater peak troponin levels. The rate
of Occlusion MI in those who received pre-cath opioids was double the rate of
those without pre-cath opioids, and STEMI(-) OMI patients who received pre-cath
opioids waited 10 hours on average longer to get cath than those who did not
received opioids. These results add support to our hypothesis that a major
mechanism of harm caused by opioid medications in ACS patients involves delays
to the cath lab for patients with STEMI(-) OMI.=====...
Source: Dr. Smith's ECG Blog - September 10, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
Pump Up the Potassium
The element potassium plays a pivotal role in our bodies. It’s found in all our cells, where it regulates their volume and pressure. To do this, our bodies carefully control potassium levels so that the concentration is about 30 times higher inside cells than outside. Potassium works closely with sodium, which regulates the extracellular fluid volume and has a higher concentration outside cells than inside. These concentration differences create an electrochemical gradient, or a membrane potential.
Potassium is the primary regulator of the pressure and volume inside cells, and it’s important for nerve transmiss...
Source: Biomedical Beat Blog - National Institute of General Medical Sciences - June 21, 2023 Category: Research Authors: Chrissa Chverchko Tags: Chemistry, Biochemistry and Pharmacology Molecular Structures Cellular Processes Element Proteins Source Type: blogs
Another myocardial wall is sacrificed at the altar of the STEMI/NonSTEMI mass delusion (and Opiate pain relief).
I received the following text message with these 3 EKGs (providers text me ECGs all day every day; most are false positives; many are subtle true positives):" Hi Steve, here are 3 EKGs for you (my colleague ' s case). A 67 yo f developed chest pain this morning. "EKG #1Followed 15 minutes by this #2 EKG:Then the patient received aspirin andDilaudid (hydromorphone, same effect as morphine) and the pain went away and there was this 3rd ECG:Smith comment: hydromorphone will make any pain go away (or improve) without any improvement in the underlying pathology. Do NOT give it unless you are committed to t...
Source: Dr. Smith's ECG Blog - May 31, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Friends Beat Morphine For Killing Pain, Study Suggests
People who are less stressed tend to have more friends. (Source: PsyBlog | Psychology Blog)
Source: PsyBlog | Psychology Blog - May 17, 2023 Category: Psychiatry & Psychology Authors: Jeremy Dean Tags: Relationships Source Type: blogs
Words matter: Caring for pain patients with suspected opioid use disorder
“We need an urgent pain consult for patient Lucy Bee in room 5621. She’s a 17-year-old drug addict and is screaming and wanting morphine,” I was told. Lucy Bee is not a real patient, but a composite of patients I have cared for either when providing pain management services on our inpatient floors, or in
Read more…
Words matter: Caring for pain patients with suspected opioid use disorder originally appeared in KevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - April 20, 2023 Category: General Medicine Authors: Rita Agarwal, MD Tags: Physician Pediatrics Source Type: blogs
125 I ’m Sorry Quotes to Help You Apologize (and Forgive Someone)
You know you shouldn’t have said that. Or done that.
And now you know you’re in the wrong.
I have been there many times myself and it’s no fun. You feel guilty and stupid for what you did or said.
You’re afraid about how this will affect your relationship, no matter if it’s with a family member, a friend or someone at work or in school.
So in this post I’d like to share the best timeless wisdom about apologies. 125 of the most helpful I’m sorry quotes.
I hope you’ll find something helpful here, like I did.
And if you want more useful inspiration then check out this post with quotes on forgiveness and this ...
Source: Practical Happiness and Awesomeness Advice That Works | The Positivity Blog - April 13, 2023 Category: Consumer Health News Authors: Henrik Edberg Tags: Inspirational Quotes Personal Development Source Type: blogs
A man in his 50s with chest pain
Sent by anonymous, written by Pendell MeyersA man in his 50s with no prior known medical history presented to the Emergency Department with severe intermittent chest pain. He had episodes of chest pain off and on all night, until about 1 hour prior to arrival when the pain became constant, crushing, 10/10 chest pain that radiated to both arms. He denied any lightheadedness, shortness of breath, vomiting, or abdominal pain. Vitals were within normal limits.Here is his triage ECG at 0343:What do you think?Meyers interpretation: Diagnostic of LAD OMI, with hyperacute T waves in a large LAD distribution including precord...
Source: Dr. Smith's ECG Blog - March 9, 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
Rapid Diagnosis: Pinpoint Pupils
Abnormally constricted or “pinpoint” pupils are a great finding for our rapid diagnosis series. There are many things that can cause the pupil to abnormally dilate. Very few things will make the pupil abnormally constrict. Constricted pupils are a doorway to a very short list of ailments and with a bit of background you should be able to hang your hat on one fairly quick.
How So We Assess For “Pinpoint” Pupils?
Recall that the pupil should be mid-range and reactive under normal lighting conditions. When subjected to bright light, the pupil will constricted to reduce the volume of light entering the iris. In d...
Source: The EMT Spot - November 1, 2022 Category: Emergency Medicine Authors: Steve Whitehead Tags: EMT Source Type: blogs
President Biden Makes an Encouraging Announcement on Marijuana
Jeffrey A. SingerPresident Bidenannounced today that he is pardoning anyone convicted of federal crimes for simple possession of marijuana. The vast majority of such convictions happen at the state level. Therefore, the president asked states to consider pardoning their offenders.He also ordered the Department of Health and Human Services (HHS) to expedite a review of possibly rescheduling marijuana under theControlled Substances Act (CSA). Under the CSA, the Department of HHS, the Drug Enforcement Administration, or a petition from any interested party can start theprocess of rescheduling or de ‐schedu...
Source: Cato-at-liberty - October 6, 2022 Category: American Health Authors: Jeffrey A. Singer Source Type: blogs
Undisclosed Conflicts of Interest by Physicians Creating the CDC Opioid Prescribing Guidelines: Bad Faith or Incompetence?
We described above how changes in opioid policy aimed at reducing Washington State’s Medicaid and Workers Compensation costs contributed to an increase in methadone deaths between 2003 and late 2014 (23-25). Focusing on similar cost reductions, the Centers for Medicar e and Medicaid Services (CMS) proposed rules for 2019 including several directives intended to reduce " Opioid Overutilization, ” including adoption of the “90 morphine milligram equivalent (MME) threshold cited by the 2016 CDC Opioid Guideline (147, 148). Simply put, reduced prescribing reduces costs for prescribed medications.Chou received research fu...
Source: Pallimed: A Hospice and Palliative Medicine Blog - September 12, 2022 Category: Palliative Care Tags: health policy judy kollas opioids research schechtman Source Type: blogs
Weekly Australian Health IT Links – 05 September, 2022.
Here are a few I have come across the last week or so. Note: Each link is followed by a title and a few paragraphs. For the full article click on the link above title of the article. Note also that full access to some links may require site registration or subscription payment.General Comment-----There seems to be a good bit going on this week so lots to browse!The trial of AI in aged care was quite amusing in a sad sort of way ….-----https://medicalrepublic.com.au/whos-to-blame-when-the-software-gets-it-wrong/7586330 August 2022Who ’s to blame when the software gets it wrong?MedicolegalTechnologyByPursuitClinical deci...
Source: Australian Health Information Technology - September 5, 2022 Category: Information Technology Authors: Dr David G More MB PhD Source Type: blogs
September 2022: The Torsed Testicle Traction Technique
I asked in my May blog whether immediate attempts at manual reduction of a testicular torsion should be the standard of care. Without a doubt, timely manual detorsion of a torsed testicle saves the organ from death. (Pediatr Emerg Care. 2019;35[12]:821; Pediatr Emerg Care. 2012;28[1]:80; https://bit.ly/3T9W0N0.)The detorsion procedure is sometimes quick and easy, but other times it is technically difficult and even unsuccessful. Unfortunately, many physicians are hesitant to attempt manual detorsion because they lack procedural confidence or have anxiety about worsening the torsion.Testicles torsed for a prolon...
Source: M2E Too! Mellick's Multimedia EduBlog - August 31, 2022 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
