Proportionality and Serial ECGs Make the Diagnosis. What does the Queen say?
This case comes from Jason Winter, of The Facebook Clinical Electrocardiology ECG Page.
A 60-something woman called EMS for chest pain.
Here is her first prehospital ECG:What do you think?There is very low voltage in the precordial leads, with a total QRS amplitude of only 3.5 mm in V2 and 4 mm in V3. In spite of this low voltage, there is ST elevation (as measured at the J-point and relative to the PQ junction, and as measured by the computer and shown on the right), of 0.54 mm in V2 and0.65 mm in V3. The ST/QRS ratios in V2 and V3 are, respectively, 0.154 and 0.162. These are a hi...
Source: Dr. Smith's ECG Blog - September 29, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Wednesday Bible Study: My apologies
This endless yammering is totally frosting my pumpkin. I ' m not sure what to do about it, however, because these chapters are long and it seems like an awful lot to do two of them at once. But what the hell, we have to get this over with. In Ch. 15, Eliphaz castigates Job for complaining to God, basically, and just says, as MacLeish translates it, " In Adam ' s fall we sinned all/We ' re like the flies the creep and crawl/Across the dusty windowpanes, " IIRC, or something like that. In Ch. 16, Job essentially adds the would-be comforters to his afflictions, which is fair enough. What Job doesn ' t know, however, is that t...
Source: Stayin' Alive - September 27, 2023 Category: American Health Source Type: blogs
Very fast regular tachycardia: 2 ECGs from the same patient. What is going on?
This was written by Magnus Nossen, from Norway, with comments and additions by SmithA 50 something smoker with no previous medical hx contacted EMS due to acute onset chest pain. Upon EMS arrival the patient appeared acutely ill and complained of chest pain. An ECG was recorded immediately and is shown below. How do you interpret the ECG?ECG#1There is a regular tachycardia with a ventricular rate of about 180 bpm. Smith comment: When there is a regular wide complex tachycardia, first assess whether it is sinus or not. At a rate of 180, this is unlikely. The patient is unstable. Therefore, the first s...
Source: Dr. Smith's ECG Blog - September 27, 2023 Category: Cardiology Authors: Magnus Nossen Source Type: blogs
Debating the role of psychiatric assessments in medical decisions
I recently had an incident involving a long-time patient. This particular encounter proved to be challenging. The patient had chronic pain for years and had already exhausted all conventional treatment options. Ironically, he was otherwise healthy and fit. His recalcitrant condition made him a prime candidate to be treated with a spinal sord stimulator (SCS).
Read more…
Debating the role of psychiatric assessments in medical decisions originally appeared in KevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - September 26, 2023 Category: General Medicine Authors: Christian Youssef & Which patient has the more severe chest pain?
ConclusionOnly a weak association between pre-hospital chest pain severity and markers of myocardial injury was identified, supporting more judicious use of opioid analgesia with a focus on patient comfort.___________This article shows that pain intensity is associated with shorter door to balloon times and thus smaller infarcts. Having severe pain drives people to the ED for faster treatment! It is good to have terrible pain! And as we have shown before, morphine leads to slower times to treatment and worse outcomes.Chest Pain Severity Rating Is a Poor Predictive Tool in the Diagnosis of ST-Seg...
Source: Dr. Smith's ECG Blog - September 26, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
Dancing around the hexaflex: Using ACT in practice 6
Acceptance and commitment therapy (ACT) can be slippery to describe. It’s an approach that doesn’t aim to change thought content, but instead to help us shift the way we relate to what our mind tells us. It’s also an approach focused on workability: pragmatic and context-specific analysis of how well a strategy is working to achieve being able to do what matters. Over the next few posts I want to give some examples of how non-psychologists (remember ACT is open for anyone to use it!) can use ACT in session.
Actions: It’s what we’re about
You know the old saying “All talk, no action”? The...
Source: HealthSkills Weblog - September 24, 2023 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: ACT - Acceptance & Commitment Therapy Occupational therapy Pain conditions Physiotherapy Psychology Science in practice acceptance and commitment therapy biopsychosocial Chronic pain Clinical reasoning pain management Therapeutic app Source Type: blogs
Vague criteria can lead to misdiagnosis and prison
The definition of addiction, now called substance use disorder, has varied greatly over time. The first edition of the Diagnostic and Statistical Manual, from 1952, didn’t include specific diagnostic criteria for this condition. Over the next sixty years, the DSM went through six revisions, with a slow evolution of the terms “substance abuse” and “dependence.”
Read more…
Vague criteria can lead to misdiagnosis and prison originally appeared in KevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - September 24, 2023 Category: General Medicine Authors: L. Joseph Parker, MD Tags: Conditions Pain Management Source Type: blogs
Wound Bed Preparation is a Crucial Strategy to Heal Chronic Wounds
There are dozens of wound care products available, and the practitioner is often overwhelmed and confused by the variety of choices. The best way to choose the correct product is understanding the concept of wound bed preparation – a crucial aspect of wound care that creates a systematic approach to an optimal strategy for wound healing. It encompasses various actions to facilitate the healing process by addressing the condition of the wound bed. Wound bed preparation helps reduce the risk of infection, promotes tissue regeneration, and accelerates the healing process. The following 9 steps are key considerations i...
Source: Jeffrey M. Levine MD | Geriatric Specialist | Wound Care | Pressure Ulcers - September 24, 2023 Category: Geriatrics Authors: Jeffrey M Levine Tags: Featured Medical Articles Geriatric Medicine Long-Term Care Pressure Injuries & Wound Care Risk Management aging skin bedsore bedsores decubiti decubitus ulcer end-of-life care geriatrics gerontology Healthcare Quality Improvin Source Type: blogs
Bonus Features – September 24, 2023 – 72 percent of patients say affordability is the biggest challenge for paying medical bills
This article will be a weekly roundup of interesting stories, product announcements, new hires, partnerships, research studies, awards, sales, and more. Because there’s so much happening out there in healthcare IT we aren’t able to cover in our full articles, we still want to make sure you’re informed of all the latest news, announcements, and stories happening to help you better do your job.
News and Studies
The American Telemedicine Association released three tools aimed at addressing disparity and inequity in care: Digital Infrastructure Disparities Score and Map, Economic and Social Value-Added Calculator, and a...
Source: EMR and HIPAA - September 24, 2023 Category: Information Technology Authors: Brian Eastwood Tags: Healthcare IT ABOUT Accelecom Accenture Adriana Day AHA AMA Amazon Bedrock Angie Franks Arcadia ATA AVIA Babyscripts Biofourmis Cadence Cedar Censinet CirrusMD CliniComp ClosedLoop Collette Health CrowdStrike Da Source Type: blogs
Sunday Sermonette: Life sucks and then you die
Ch. 14 is yet more of the seemingly eternal lamentation and despair, now all about mortality. This does seem a bit ambiguous about the possibility of an afterlife. Job seems to be saying that there isn ' t one, but there is at least a hint of some sort of possible resurrection in the future, or anyway a question about the possibility. At least that ' s how I read it. But no, there really isn ' t any.14 “Mortals, born of woman, are of few days and full of trouble.2 They spring up like flowers and wither away; like fleeting shadows, they do not endure.3 Do you fi...
Source: Stayin' Alive - September 24, 2023 Category: American Health Source Type: blogs
Fight Aging! Newsletter, September 25th 2023
In conclusion, this individual patient data meta-analysis of longitudinal cohort studies found that antihypertensive use was associated with decreased dementia risk compared with individuals with untreated hypertension through all ages in late life. Individuals with treated hypertension had no increased risk of dementia compared with healthy controls.
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Results from Human Clinical Trials Do Not Support Metformin as a Longevity Drug
https://www.fightaging.org/archives/2023/09/results-from-human-clinical-trials-do-not-support-metformin-as-a-longevity-drug/
The SENS Research Fou...
Source: Fight Aging! - September 24, 2023 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
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
This ECG was texted to me: normal variant early repolarization, or LAD Occlusion MI (OMI)?
This ECG was texted to me with no other information. I assumed the presentation was consistent with acute MI.What did I say?" OMI. Activate the cath lab. " The T-waves in V2-V6 are diagnostic. It does, in fact, the STE meets STEMI criteria since there is 1 mm of in V4 and V5. There is also some non-diagnostic STE in inferior leads. There is zero reciprocal ST depression. 50% of LAD OMI have zero reciprocal ST depression!But it looks a lot like normal variant STE (also known as " early repolarization " .Then I sent it to the Queen of Hearts PMCardio AI Bot and she gave this...
Source: Dr. Smith's ECG Blog - September 22, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
“PictureWhat” ??? Super-Human Poison Ivy. What’s Going On?
By MIKE MAGEE
Connecticut loves its’ trees. And no town in Connecticut loves its’ trees more than West Hartford, CT. The town borders include an elaborate interconnected reservoir system that does double duty as a focal point for a wide range of nature paths for walkers, runners and cyclists.
While walking one path yesterday, I came a tree with the healthiest upward advancing vine I had ever seen. My “PictureThis” app took no time to identify the plant. To my surprise, it was Toxicodendron radicans, known commonly as Poison Ivy.
The description didn’t pull punches. It read, “In pop culture, poison ivy ...
Source: The Health Care Blog - September 20, 2023 Category: Consumer Health News Authors: matthew holt Tags: Non-Health Global Warming Mike Magee Poison Ivy Source Type: blogs
A 50-something with Regular Wide Complex Tachycardiaa: What to do if electrical cardioversion does not work?
Case submitted by anonymous. Written by Smith. Ken ' s piece at the bottom is excellent.A 50-something presented with sudden onset palpitations 8 hrs prior while sitting at desk at work. He had concurrent sharp substernal chest pain that resolved, but palpitations continued.Over past 3 months, he has had similar intermittent episodes of sharp chest pain while running, but none at rest. Past medical history includes coronary stenting 17 years prior. A brief chart review revealed his most recent echo in 2018, with LV EF 67%, “very small” inferior wall motion abnormality.Initial ED ECG:What do you think?This wa...
Source: Dr. Smith's ECG Blog - September 20, 2023 Category: Cardiology Authors: Steve Smith Source Type: blogs
