Shock, bradycardia, ST Elevation in V1 and V2. Activate the Cath Lab?
A 60-something with h/o cirrhosis and diabetes called 911 because he felt sick and wasunable to move his lower extremities. On arrival he was bradycardic and hypotensive.He stated that starting approximately 7 hours prior the he felt that he was unable to feel his extremities. At some point after that he contacted his neighbor who came to check on him and called 911. On arrival to the stabilization room he says he can feel his extremities and and states that he justgenerally feels unwell. He denies any chest pain or shortness of breath.p.p1 {margin: 0.1px 0.0px 0.1px 0.2px; font: 11.0px Calibri}EMS repo...
Source: Dr. Smith's ECG Blog - December 28, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
Severe shock, obtunded, and a diagnostic prehospital ECG. Also: How did this happen?
A middle-aged woman was found down in her apartment unconscious. She was in shock with thready pulses.A prehospital ECG was recorded:Limb leads:Precordial LeadsWhat is the therapy?This is pathognomonic of hyperkalemia (I suppose it could be due to a massive overdose of a sodium channel blocking drug, maybe).Is it ventricular tachycardia (VT) due to hyperK or is it a supraventricular rhythm with hyperK? ---I don ' t think that it is possible to say for certain, and it does not matter. The rate is not fast enough to be causing shock, so if it is VT, the priority is still to treat hyperK and secondarily to cardiove...
Source: Dr. Smith's ECG Blog - November 29, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
Breathtaking: The Future Of Respiratory Care And Pulmonology
Smoke-measuring smart shirts, breath sound analyzing
algorithms, and smart inhalers pave the way of pulmonology and respiratory care
into the future. As the number of patients suffering from asthma, COPD, or lung
cancer due to rising air pollution and steady smoker-levels will unfortunately
not decrease any time soon, we looked around what technology can do to help
both patients and caregivers. The results are breathtaking.
Attacks of
breathlessness are too common
The diseases which pulmonologists and respiratory care
specialists attempt to fight are among the most common conditions in the modern
world – and the n...
Source: The Medical Futurist - September 25, 2019 Category: Information Technology Authors: nora Tags: Artificial Intelligence Future of Medicine Health Sensors & Trackers AI asthma cancer cancer treatment care COPD diagnostics inhaler lung lung cancer management medical specialty pulmonology respiratory respiratory care Source Type: blogs
How Could Digital Health Fight Against The Climate Catastrophe?
Climate change is the
greatest health challenge of the 21st century, and threatens all aspects of society,
says
the WHO in its COP24 Special Report. What could digital health technologies
do to support the fight against the climate crisis? How could healthcare
processes, facilities, medical devices become more sustainable? As it is
humanity’s priority to mitigate the worsening as well as the impact of rising
temperatures and extreme weather events, we tried to figure out what role
digital health could assume here. We found many options – and even more
possibilities for future development.
The climate crisis is our ...
Source: The Medical Futurist - July 11, 2019 Category: Information Technology Authors: nora Tags: Future of Medicine air asthma climate climate catastrophe climate change climate crisis digital digital health efficient Healthcare mosquito optimize resilience solar sustainability technology Source Type: blogs
Racemic Epinephrine Deserves More Respect
Some medications enjoyed years of glory but later ended up on the trash heap of clinical medicine, often put there by a systematic review or small case series of adverse outcomes or complications that led to black box warnings and a culture of fear and rejection. Still, the heyday lasted for years for some medication outcasts, such as acetaminophen with codeine, promethazine (Phenergan), aminophylline, droperidol, and meperidine (Demerol).Of course, a few of these medications probably deserved their bad rap, but most of them served us well for many years when we had few other options. Medications like racemic epinephrin...
Source: M2E Too! Mellick's Multimedia EduBlog - May 1, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
MKSAP: 32-year-old man with an intermittent pruritic rash
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 32-year-old man is evaluated for an intermittent pruritic rash of 8 years’ duration. Medical history is significant for mild persistent asthma. His only medications are an albuterol inhaler and an inhaled glucocorticoid. On physical examination, vital signs are normal. There […]Find jobs at Careers by KevinMD.com. Search thousands of physician, PA, NP, and CRNA jobs now. Learn more. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - February 9, 2019 Category: General Medicine Authors: < span itemprop="author" > < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > < /span > Tags: Conditions Dermatology Source Type: blogs
Ask D'Mine: Bronchial Meds and Blood Sugar
Our weekly DiabetesMine advice column takes a question about how bronchial inhaler albuterol might impact diabetes management. (Source: Diabetes Mine)
Source: Diabetes Mine - February 1, 2019 Category: Endocrinology Authors: Wil Dubois Source Type: blogs
Teva ’s ProAir Digihaler FDA Approved to Monitor Asthma and COPD Treatment
Teva Pharmaceutical, based in Israel, landed the first FDA approval for a digital inhaler with built-in sensors. The ProAir Digihaler (albuterol sulfate 117 mcg) Inhalation Powder is indicated for people suffering from asthma & COPD as a way of preventing and treating bronchospasm, a tightening of the muscles that line the airways.
The ProAir Digihaler monitors how it’s used and uploads the data to an accompanying smartphone app via Bluetooth wireless connectivity. Specifically, the device detects every time it has been use to administer treatment, as well as the inspiratory airflow during each inhalation.
“...
Source: Medgadget - December 26, 2018 Category: Medical Devices Authors: Editors Tags: Cardiology Medicine Source Type: blogs
Found comatose with prehospital ECG showing " bigeminal PVCs " and " Tachycardia at a rate of 156 "
This patient with a history diabetes was found with a GCS of 4.Prehospital EKG and strips (not shown) had " heart rate 156 " (according to the computer interpretation) and " Bigeminal PVCs "The prehospital 12-lead looked just like the first ED ECG:What do you think?Answer: The " bigeminal PVCs " is really a QRS followed by a very narrow peaked T-wave, which was so narrow that it was mistaken for a separate QRS. The heart rate is 78, not 156. Notice also thevery long ST segment, most easily seen in inferior leads.This ECG is pathognomonic for severe hyperK, and the long ST segment is all but pathognomonic for hy...
Source: Dr. Smith's ECG Blog - December 11, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
Two cases of ST Elevation with Terminal T-wave Inversion - do either, neither, or both need reperfusion?
Written by Pendell Meyers with edits by Steve SmithI was sent these 2 ECGs with no clinical information other than chest pain:Do either or both of these ECGs show ischemic changes? If so, what should you do and why?Let ' s take them one at a time.What would your response be?I responded: " Awesome classic benign T wave inversion! That ' s the patient ' s baseline normal variant. ... But if it were a good story with exertional syncope or something you ' d have to treat it like it could be HOCM, etc. Tell me more. "There is sinus rhythm with very large voltage and associated repolarization abnormalities. In V3-V6 there are cl...
Source: Dr. Smith's ECG Blog - December 5, 2018 Category: Cardiology Authors: Pendell Source Type: blogs
AAP Bronchiolitis Guidelines a Mismatch with Clinical Practice
I recently met with a group from our children's hospital to standardize the hospital management of bronchiolitis according to the latest American Academy of Pediatrics guidelines. (Pediatrics 2014;134[5]:e1474; http://bit.ly/2QIGbMX.) Unfortunately, these guidelines seem to cause confusion for experienced and inexperienced emergency physicians alike.This confusion comes from the guidelines raising unaddressed issues and new questions, most importantly not tackling important aspects of frontline clinical practice. These guidelines were developed with the best evidence currently available, and their application mo...
Source: M2E Too! Mellick's Multimedia EduBlog - December 4, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Something Smells Fishy
A 32-year-old woman and her 36-year-old husband with no past medical history presented to the ED with palpitations, headache, a feeling of warmth all over, and a rash extending from their upper chests to their faces.The blood pressures of the wife and husband were 91/56 mm Hg and 93/61 mm Hg, respectively. Both were mildly tachycardic with heart rates of 112 bpm and 108 bpm. The patients described intense pruritus, and they had patchy blanching and erythema over their chests and faces with mild eyelid edema. They reported that their symptoms started five to 10 minutes after sharing an ahi tuna poke bowl.What Is the...
Source: The Tox Cave - November 1, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Live the Wheat Belly lifestyle, get off prescription medications
Take a look at the list of medications people have been able to stop by following the Wheat Belly lifestyle.
These represent medications prescribed by doctors to, in effect, “treat” the consequences of consuming wheat and grains. They prescribe drugs to treat inflammation, swelling, skin rashes, gastrointestinal irritation, high blood sugars, airway allergy, joint pain, high blood pressure, leg edema and other abnormal effects caused by wheat and grains.
The list includes anti-inflammatory and pain medication, acid reflux drugs, injectable and oral drugs for diabetes, numerous anti-hypertensive agents, asthma i...
Source: Wheat Belly Blog - October 27, 2018 Category: Cardiology Authors: Dr. Davis Tags: News & Updates autoimmune blood sugar bowel flora cholesterol Gliadin gluten-free grain-free grains Inflammation undoctored Weight Loss wheat belly Source Type: blogs
Two cortisone stories involving Peekaboo and yours truly …
First, the news about Peekaboo. When I met with the vet a few days ago, he repeated that we wouldn’t be able to give her the current anti-inflammatory drug forever. Too bad, since she eagerly takes it in her wet food in the morning, and it seems to have no side effects. Oh well.
He suggested I substitute it with a drug called Contramal, which is basically Tramadol, and with another one that contains quercetin (I checked it out, it’s okay, so she’s on that now).
Tramadol is a different story. That’s the drug that Piccolo was on for some time last summer, and I am CONVINCED (although I have no proof, ...
Source: Margaret's Corner - September 7, 2018 Category: Cancer & Oncology Authors: Margaret Tags: Blogroll cortisone Medrol Source Type: blogs
12 Year Old Asthmatic with Intermittent Dyspnea Unresponsive to Albuterol---What is it, and Why Now?
This case was written by one of ourgreat Hennepin 2nd year residents, Aaron Robinson, with lots of comments and edits by Smith.Thanks to Dr. Smith and Dr. Travis Olives for being part of this case. A 12 year old girl with a history of mild intermittent asthma presented to the emergency department with worsening shortness of breath over the past couple of days. She is up to date on her vaccinations and has no PMHx besides asthma and a noncontributory family history. She does not identify any specific triggers for her asthma. Initial screen in triage revealed normal vitals signs and a normal temperature. Upon interviewi...
Source: Dr. Smith's ECG Blog - August 7, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
