7 Christmas wishes for electronic medical records
Dear Santa,
I’ve been a very good doctor all year. I have checked all my boxes and aced all my meaningful use requirements. This year, I’m not asking you for anything fancy. I just thought you might be able to instill some kindness and good will into the people who designed the user interface of my EMR. Maybe, with your help, they would come to see how a few minor tweaks could make the practice of medicine safer and more efficient, and my day a lot more enjoyable than it already is:
1. I wish I could see a routine laboratory panel, like a CBC or a CMP, in one view without scrolling inside a miniature window. That would...
Source: Kevin, M.D. - Medical Weblog - December 23, 2015 Category: Journals (General) Authors: A Country Doctor, MD Tags: Tech Health IT Source Type: blogs
All I Want For Christmas: Seven Things I Wish My EMR Could Do
By HANS DUVEFELT, MD
Dear Santa,
I’ve been a very good doctor all year. I have checked all my boxes and aced all my Meaningful Use requirements. This year, I’m not asking you for anything fancy. I just thought you might be able to instill some kindness and good will into the people who designed the user interface of my EMR. Maybe, with your help, they would come to see how a few minor tweaks could make the practice of medicine safer and more efficient, and my day a lot more enjoyable than it already is:
1) I wish I could see a routine laboratory panel, like a CBC or a CMP, in one view without scrolling inside a miniatu...
Source: The Health Care Blog - December 19, 2015 Category: Consumer Health News Authors: Simon Nath Tags: THCB Hans Duvefelt Source Type: blogs
STE in aVR and diffuse ST depression: It can be ACS or demand ischemia. If ACS, either posterior STEMI or subendocardial ischemia!
A middle-aged male with a history of 2-vessel coronary bypass called 911 because of the relatively sudden onset of severe SOB. He had had more mild SOB for the past 2 days. The medics found him in respiratory distress with coarse breath sounds, a BP of 196/132, oxygen saturations of 90%, and a pulse of 130. They put him on CPAP for respiratory support. He denied chest pain.Here is his prehospital ECG:There is diffuse ST depression, with ST elevation in lead aVRThe patient arrived in the ED and was put on Noninvasive ventilation (BiPAP). Blood Pressure was 200/110. A nitroglycerin drip wa...
Source: Dr. Smith's ECG Blog - November 16, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
Head up tilt test (HUTT)
Brief Review
Head up tilt test (HUTT) or tilt table test is commonly done for the evaluation of neurocardiogenic syncope (e.g. vasovagal syncope). Various protocols are followed in different centres. One protocol is as follows: The subject is strapped to the tilt table after venous and arterial access is obtained. Radial arterial access is used for continuous blood pressure monitoring as non-invasive recordings are often inaccurate and difficult to make at the time of syncope. Infusion pump is also set up to give isoprenaline infusion if required. Resuscitation tray and personnel are at hand during the test. ECG, pulse oxi...
Source: Cardiophile MD - November 13, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: ECG / Electrophysiology HUTT HUTT protocol neurocardiogenic syncope Tilt table test tilt test Vasovagal syncope Source Type: blogs
Alcohol flushing syndrome – Cardiology MCQ
Alcohol flushing syndrome has been associated with:
a) Coronary vasospastic angina
b) Dilated cardiomyopathy
c) Metabolic syndrome
d) Both a and c
Correct answer: d) Both a and c
Alcohol flushing syndrome is due to due deficient activity of the enzyme aldehyde dehydrogenase 2 (ALDH2) which metabolizes acetaldehyde derived from alcohol. The syndrome is characterized by facial flushing, headache, nausea, and palpitation occurring even with intake of small amount of alcohol. It is more common in the East Asian population and is due to variant of ALDH2 known as ALDH2*2. ALDH2 is also involved in deactivation of other toxic ald...
Source: Cardiophile MD - November 6, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Paramedics make a great call
Conclusions. Prehospital ECGs diagnostic for STEMI can normalize or become nondiagnostic after NTG administration or due to spontaneous reperfusion or evolution. In the absence of a prehospital ECG, it is possible that 6 of 87 (7%) of STEMI patients in this study would have had reperfusion delayed due to a rapid change in their ECG. Limitations include no control group receiving NTG prior to the first ECG. (Source: Dr. Smith's ECG Blog)
Source: Dr. Smith's ECG Blog - November 2, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
Anterorlateral STEMI? Old Anterior MI? But cath shows RCA thrombotic stenosis.
This case is from a frequent contributor, Brooks Walsh. With additions and edits by me.A 68 year-old man had been having chest discomforts intermittently for the past 2 weeks. About 18 hours prior to presentation, his pain began to worsen. He developed nausea, and 911 was called after he vomited once. EMS obtained an ECG:There is subtle ST depression in II, III, and aVF. There is ST elevation in V2 – V5, with Q waves in V2 – V4. This is all but diagnostic of anterior MI.Is it acute? subacute? Old MI with persistent ST elevation?EMS requested cath lab activation. The patient was given nitroglycerin 3 times, ...
Source: Dr. Smith's ECG Blog - October 25, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
Research and Reviews in the Fastlane 096
This study assessed the speed and accuracy of medication administration in simulated pediatric resuscitations. 10 teams consisting of physicians and nurses participated in a cross over study, so that they did one simulation with the new syringes and one without. Time to delivery of medications was quicker with the new syringes (47 versus 19 seconds, a difference of 27 seconds; 95%CI 21-33 seconds). Teams were also more accurate using the new color-coded syringes, with dosing errors occurring 17% of the time with the conventional approach and 0% of the time with the new syringes (absolute difference 17%; 95% CI 4-30%). Obvi...
Source: Life in the Fast Lane - August 19, 2015 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Airway Anaesthetics Cardiology Education Emergency Medicine Pediatrics Resuscitation Trauma EBM Intensive Care literature R&R in the FASTLANE recommendations research and reviews Respiratory urology Wilderness Medicine Tagg Source Type: blogs
A Patient's Lie Masks the Cause of Chest Pain
A man in his 30s comes to your emergency department at 3 a.m. profoundly diaphoretic and reporting severe 10/10 chest pain. He has been at a party all night, and the chest pain started about 30 minutes earlier. He had a previous heart attack, but cannot remember many of the details. He reports no medication or drug use. No doubt this is a concerning presentation, and you immediately order an ECG, blood work, and an aspirin.
While this is in process, you review the electronic medical information, which reveals that the previous “heart attack” was actually observation for chest pain rule-out. The ECG showed nonspeci...
Source: Spontaneous Circulation - July 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
A Patient's Lie Masks the Cause of Chest Pain
A man in his 30s comes to your emergency department at 3 a.m. profoundly diaphoretic and reporting severe 10/10 chest pain. He has been at a party all night, and the chest pain started about 30 minutes earlier. He had a previous heart attack, but cannot remember many of the details. He reports no medication or drug use. No doubt this is a concerning presentation, and you immediately order an ECG, blood work, and an aspirin.
While this is in process, you review the electronic medical information, which reveals that the previous “heart attack” was actually observation for chest pain rule-out. The ECG showed nonspecifi...
Source: Spontaneous Circulation - July 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Rodent Control
A crotchety old fellow from the nursing home gets brought in for trouble breathing. After looking at the swelling in his legs and listening to the crackles in his lungs, it’s pretty obvious that he’s in congestive heart failure.
We started an IV, drew labs, and performed a chest x-ray. Then he got some nitroglycerin, some captopril, and he even got Lasix just to spite all of the #FOAMed wonks.
About 45 minutes later, the patient needs to go to the bathroom. We didn’t want him walking since he didn’t appear to be the steadiest on his feet, so he got a urinal. He grabbed the urinal and the nurse walked out of the roo...
Source: WhiteCoat's Call Room - May 26, 2015 Category: Emergency Medicine Authors: WhiteCoat Tags: Patient Encounters Source Type: blogs
Alcohol flushing syndrome and coronary spastic angina
Journal Review
Alcohol flushing syndrome is due to due deficient activity of the enzyme aldehyde dehydrogenase 2 (ALDH2) which metabolizes acetaldehyde derived from alcohol. The syndrome is characterized by facial flushing, headache, nausea, and palpitation occurring even with intake of small amount of alcohol. It is more common in the East Asian population and is due to variant of ALDH2 known as ALDH2*2. ALDH2 is also involved in deactivation of other toxic aldehydes generated by lipid peroxidation and even smoking. It is also involved in the bioactivation of nitroglycerin. A new study published in Circulation [1] has lin...
Source: Cardiophile MD - May 17, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs
Nitroglycerin in myocardial infarction – Cardiology MCQ
Nitroglycerin is contraindicated in myocardial infarction associated with:
a) Hypertension
b) Left ventricular failure
c) Angina
d) Right ventricular infarction
Correct answer: d) Right ventricular infarction
Nitroglycerin infusion is useful in the treatment of hypertension, left ventricular failure and angina in the setting of acute myocardial infarction. In inferior wall myocardial infarction associated with right ventricular infarction, nitroglycerin can lead to hypotension as it lowers the preload and thereby the right ventricular filling and output.
The post Nitroglycerin in myocardial infarction – Cardiology M...
Source: Cardiophile MD - May 10, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
A Case of Clinical Unstable Angina in the ED
A woman in late middle age with a history of a mild stenosis of the RCA seen on CT coronary angiogram 4 years prior presented 2 hours after the onset of nondescript substernal chest discomfort that radiated to both axillae. Her daughter was worried and brought her to the ED. This is her initial ECG:There is a suggestion of inferior MI: the T-waves in II, III, and aVF are slightly large. There is T-wave inversion in aVL, which is a soft sign of inferior MI.She received nitroglycerin, and the discomfort was relieved, but she attributed the relief to the removal of a tight-fitting garment. A repeat ECG was unchang...
Source: Dr. Smith's ECG Blog - April 30, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
Patch Down the Hatch
A 42-year-old man presented with somnolence. Initial vital signs include: heart rate 54 bpm, blood pressure 92/68 mm/Hg, temperature 37°C, respiratory rate 6, pulse oximetry 90% on room air. Physical examination is remarkable for depressed level of consciousness, miosis, and bradypnea. His mental status and respiratory rate temporarily improved with the administration of 0.04 mg naloxone. He reports swallowing several “patches” in a suicide attempt.
What are examples of medications available as a transdermal patch? Compare the dose of drug delivered and the patch content.
Popular transdermal patches are listed bel...
Source: The Tox Cave - March 31, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
