Right sided heart failure and tachycardia.
A middle-aged male presented with tachycardia, dyspnea, and 4+ bilateral leg edema.What is the rhythm?There had been an ice storm, and it was the busiest day in the history of our emergency department because of falls. I reduced 12 fractures that evening and was in constant motion. I looked at this and saw the negative component of the P-wave in V1, and immediately diagnosed sinus tachycardia.I did a bedside echo:There was good LV functionYou can see a very large RV (closest to probe) and RA (on far right).Lungs were clear to auscultation and there were no B-lines.Volume overload was confirmed with this:Th...
Source: Dr. Smith's ECG Blog - February 9, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
Medicine MCQ Test Series 1
This Medicine MCQ Test Series contains 20 questions which can be attempted over 40 seconds each. After submission, answers and discussion will be displayed.
Medicine MCQ Test Series 1
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Source: Cardiophile MD - January 27, 2019 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Medicine MCQ - CVS Source Type: blogs
A Digitally Caring Environment: The Internet of Things in Hospitals
What do hospital beds tell about patients? How does an „indoor GPS”-system work? How could sensors and connected devices enhance both patient experience and medical resource efficiency? Here, we tell you everything about IoT within the walls of health facilities.
Emergency drones, Fitbits, and chatty hospital-beds
In April 2045, Paul was walking down the street with her 4-year-old daughter, Lily, in downtown Boston. They were heading to the ice cream & deli at the corner of the square two minutes from their home. Suddenly, the man experienced chest pain, started to breathe heavily and collapsed. Lily looked shocked...
Source: The Medical Futurist - January 24, 2019 Category: Information Technology Authors: nora Tags: Future of Medicine Health Sensors & Trackers Healthcare Design AI connected digital digital health digital health sensors doctor future of hospital IoT patient smart smart algorithm Source Type: blogs
A Digitally Caring Environment: The Internet of Things in Hospitals
What do hospital beds tell about patients? How does an „indoor GPS”-system work? How could sensors and connected devices enhance both patient experience and medical resource efficiency? Here, we tell you everything about IoT within the walls of health facilities.
Emergency drones, Fitbits, and chatty hospital-beds
In April 2045, Paul was walking down the street with her 4-year-old daughter, Lily, in downtown Boston. They were heading to the ice cream & deli at the corner of the square two minutes from their home. Suddenly, the man experienced chest pain, started to breathe heavily and collapsed. Lily looked shocked...
Source: The Medical Futurist - January 24, 2019 Category: Information Technology Authors: nora Tags: Future of Medicine Health Sensors & Trackers Healthcare Design AI connected digital digital health digital health sensors doctor future of hospital IoT patient smart smart algorithm Source Type: blogs
Prognostic factors and length of stay in pulmonary embolism
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - December 17, 2018 Category: Internal Medicine Tags: cardiovascular pulmonary Source Type: blogs
The 4 Physiologic Etiologies of Shock, and the 3 Etiologies of Cardiogenic Shock
A 60-something presented with hypotension, bradycardia, chest pain and back pain.She had a h/o aortic aneurysm, aortic insufficiency, peripheral vascular disease, and hypertension. She had a mechanical aortic valve. She was on anti-hypertensives including atenolol, and on coumadin, with an INR of 2.3. She was ill appearing. BP was 70/49, pulse 60.A bedside echo showed good ejection fraction and normal right ventricle and no pericardial fluid. Here is the initial ECG:What do you think?This ECG actually looks like a left main occlusion (which rarely presents to the ED alive): ST Elevation in...
Source: Dr. Smith's ECG Blog - November 30, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
Pharmacogenomics: The Science of Personalizing Drugs Based On DNA
Individuals share about 99.97 percent of their DNA and only the remaining 0.03 percent is responsible for the differences in skin, hair or eye color, height, shoe size or sunspots. Scientists discovered somewhat recently that our bodies also metabolize drugs differently so it would make sense to prescribe medications based on the knowledge hidden in our DNA. In some cases, physicians already do that. Here’s what you need to know about pharmacogenomics and the future of prescription drugs.
It’s all in your genes
Why do some people eat creamy French cakes all the time, only do sports when they have to run after the bus a...
Source: The Medical Futurist - November 27, 2018 Category: Information Technology Authors: nora Tags: Future of Pharma Genomics Medical Professionals Patients Researchers DNA dna testing drugs genetics Health Healthcare Innovation medication pharmacogenetics pharmacogenomics precision health precision medicine technology Source Type: blogs
Thromboresistant Hydrogel Materials for Venous Catheters: Interview with CEO of Access Vascular
Access Vascular, based in Massachusetts, has developed a peripherally inserted central venous catheter (PICC) composed of a thromboresistant hydrogel material. The catheter could reduce the incidence of catheter-related thrombi and resulting adverse events.
When a catheter encounters blood, blood cells and proteins begin to accumulate on its surface. The surface material of the catheter, along with its shape, has a significant effect on the speed and magnitude of this process. Catheter-related thrombi can result in a variety of serious complications, including pulmonary embolism, infections, loss of venous flow, deep vein ...
Source: Medgadget - October 2, 2018 Category: Medical Devices Authors: Conn Hastings Tags: Anesthesiology Emergency Medicine Exclusive Materials Radiology Surgery Vascular Surgery Source Type: blogs
Expensive Hospitals: The Enemy Within
By ANISH KOKA MD
Everyone agrees that health care is bankrupting the nation. The prevailing winds have carried the argument that a system that pays per unit of health care delivered and thus favors volume over value is responsible. The problem, you see, was the doctors. They were just incentivized to do too much. This incontrovertible fact was the basis for changes in the healthcare system that favored hospital employment and have made the salaried physician the new normal. Yet, health care costs remain ascendant.
Why?
It turns out overutilization in the US healthcare system isn’t what its cracked up to be.
Figure 1...
Source: The Health Care Blog - October 1, 2018 Category: Consumer Health News Authors: anish_koka Tags: Finance Patients Physicians Anish Koka expensive health care finances health care finances Incentives Source Type: blogs
A 60 year old patient with large T-wave inversions
Written by Andrus Alian and Pendell Meyers, with edits by Steve SmithA female in her 60s with history of stage IV lung cancer presented to the ED with 3/10 chest pain and dyspnea waxing and waning for the last 24 hours. She had no personal or family history of coronary artery disease, drug use, HTN, or dyslipidemia. She did have a history of smoking. She recently had a 2 hour flight. She denied diaphoresis, nausea, or back pain. Vital signs were stable and she was afebrile.Here is her initial ECG (during persistent 3/10 active chest pain):Large T-wave inversions. What is their distribution? What is distinctive about them? ...
Source: Dr. Smith's ECG Blog - October 1, 2018 Category: Cardiology Authors: Pendell Source Type: blogs
Signposting Teaching Moments: Get Credit for What You Already Do
Hospitals around the country are struggling to accommodate the increasing number of patients requiring acute inpatient care while physician staffing remains relatively stagnant. Every time the emergency department goes into divert mode, the natural question is: “Why can’t the residents just take more patients? Can resident duty hours and teaching time preservation just be waived for a little while?” For clinical educators, the census and complexity of an inpatient service has a major effect on the time available for teaching. We ultimately want to provide the best learning experience for our students and resid...
Source: Academic Medicine Blog - September 25, 2018 Category: Universities & Medical Training Authors: Guest Author Tags: Featured Guest Perspective clinical educators rounds teaching strategies Source Type: blogs
A completely healthy 30-something woman with acute chest pain -- this post is loaded with info !!!
p.p1 {margin: 0.1px 0.0px 0.1px 0.2px; font: 11.0px Helvetica}A previously healthy young woman presented to the ED with one hour of acute onset right sided chest pain and pressure, very severe, radiating down the right arm. Here is her initial ED ECG (time 0):What do you think?My impression:without any other information, I looked at this ECG and 2 features stood out: 1) the T-wave in lead I is hyperacute. It is far too large for that QRS. 2) The T-wave in V6 is far too large; it is almost as tall as the R-wave, which is distinctly abnormal. 3) there is slight downsloping ST depression in V2 whi...
Source: Dr. Smith's ECG Blog - September 15, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
