Comatose after opiate overdose, with tachycardia and hypotension
I was texted this ECG with the info that a female patient in her 20s was found down with probable opiate overdose:What do you think?Here was my response:" It looks like a pulmonary embolism EKG. But if she was hypoxic for a variety of reasons, that could result in pulmonary hypoxic vasoconstriction, with resulting elevated pulmonary artery pressure and right heart strain on the EKG, mimicking PE. "Why did I say that? There is sinus tachycardia with T-wave inversions in V1-V3 and in lead III (also with an S1Q3T3, which is a less specific finding). This is a classic ECG for right heart strain.Here is the wh...
Source: Dr. Smith's ECG Blog - September 12, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
LITFL Review 344
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog
Welcome to the 344th LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chunk of FOAM.
The Most Fair Dinkum Ripper Beauts of the Week
Catch up with the Curbsiders and hear Renee Dversdal talk about her passion for IMPOCUS...
Source: Life in the Fast Lane - August 20, 2018 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: LITFL review LITFL R/V Source Type: blogs
My story isn ’t Serena Williams’ story, but some things sound the same
I’m not much of a tennis fan, but I am a fan of Serena Williams. Who wouldn’t be after hearing her story? Her rise to the upper echelon of athletics was remarkable, and her longevity is incomparable. All the while, she has challenged the sporting world’s notions about who and what an elite tennis player is supposed to be. I watched her interviews after this year’s Wimbledon finals and was once again in awe.
Less than a year prior to this championship, Ms. Williams delivered a baby girl and then suffered from a pulmonary embolism and other complications. What stuck with me most about her delivery sto...
Source: Kevin, M.D. - Medical Weblog - August 16, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/diana-cejas" rel="tag" > Diana Cejas, MD < /a > Tags: Conditions Cardiology Oncology/Hematology Source Type: blogs
Xarelto On Discharge for Pulmonary Embolism Decision Tree
Is Xarelto the right medication for you after a life threatening pulmonary embolism? This medicine is a great option, but how do you know if it is the right medicine for you? The Happy Hospitalist has provided a detailed flow chart decision tree for you to decide if Xarelto will work for your clotting disorder. Years of dedicated clinical experience can be summed up in this one simple graph. So, if you've got a big clot in your lungs and you want to know if you should take Xarelto, look no further. You have found the answer you've been searching for.Tweet!function(d,s,id){var js,fjs=d.getEleme...
Source: The Happy Hospitalist - August 2, 2018 Category: Internal Medicine Authors: Tamer Mahrous Source Type: blogs
Chest pain and T-wave inversion in lead V2
This is the ECG of a young man who complained of chest pain.Here is the computer interpretation:ATRIAL FLUTTER/TACHYCARDIA(this is obviously incorrect)LEFT POSTERIOR FASCICULAR BLOCK [QRS AXIS greater than 109, INFERIOR Q]MODERATE ST DEPRESSION [0.05+ mV ST DEPRESSION]ABNORMAL ECGI saw the ECG before seeing the patient, indeed before he was even in his room. I immediately saw that the computer was incorrect, but I found 2 abnormalities. What are they? I showed this to several physicians. They were worried about the T-wave inversion in V2.One mentioned " Wellens ' waves "Another asked: ...
Source: Dr. Smith's ECG Blog - July 29, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
RBBB. Is there ST Elevation in III and aVR, with reciprocal ST depression in I and aVL?
I received this ECG from someone who wishes to remain anonymous.Case" Last night we had a Stage 4 Lymphoma Cancer Patient presenting with this ECG above. Wife advised that he just woke up from a nap and was being assisted on a walk when he became dizzy and had a syncopal episode. Patient was A&O when EMS arrived. Patient seemed confused. Patient had shortness of breath when EMS got to him. Initial vitals as follows: "" Patient was cool to touch and dry, Lung sounds clear. "BP: 141/70HR: 139RR: 31SpO2: 79%ETCO2: 18" Patient denied any other complaint other than SOB. SpO2 improved to 97% on 15lpm on a non rebreather. "&n...
Source: Dr. Smith's ECG Blog - July 26, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
LITFL Review 341
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog
Welcome to the 341st LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chunk of FOAM.
Readers can subscribe to LITFL review RSS or LITFL review EMAIL subscription
The Most Fair Dinkum Ripper Beauts of the Week
PARAMEDIC-2 epi...
Source: Life in the Fast Lane - July 22, 2018 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: LITFL review LITFL R/V Source Type: blogs
Syncope in a 20-something woman
A 20-something was outside exerting herself. She states that it was hot outside and that she was probably dehydrated. At one point, she felt lightheaded and then can ' t remember anything until waking up in the ambulance. Her friends saw her lose consciousness and fall on the ground. She regained consciousness spontaneously before responders arrived. Fire department was on scene first, who noted a cyanotic color to the patient ' s face. EMS arrived and also noted cyanotic color which improved en route to HCMC. She denies head pain, neck pain, back pain, abdominal pain or any pain at this ...
Source: Dr. Smith's ECG Blog - July 17, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
LITFL Review 336
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog
Welcome to the 336th LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chunk of FOAM.
Readers can subscribe to LITFL review RSS or LITFL review EMAIL subscription
The Most Fair Dinkum Ripper Beauts of the Week
Jonny Wilkinson...
Source: Life in the Fast Lane - June 18, 2018 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: LITFL review LITFL R/V Source Type: blogs
Understanding and Creating Calculators for Medical Diagnoses: Exclusive Interview with MDCalc
MDCalc is a 13-year-old medical reference started by two practicing emergency medicine physicians, Dr. Joe Habboushe and Dr. Graham Walker. A recent survey by EB Medicine has shown that MDCalc’s 370+ tools are now used weekly by 65% of U.S. attending physicians and nearly 80% of U.S. residents, which may make it the most broadly used medical reference. It is still owned and run by the physicians who started it, without outside investment or outside corporate influence (just like Medgadget).
To better understand how new medical calculators are created and to gain more insight into what MDCalc has achieved, we are ...
Source: Medgadget - June 15, 2018 Category: Medical Devices Authors: Alice Ferng Tags: Cardiology Critical Care Emergency Medicine Exclusive Neurology Pediatrics Public Health Source Type: blogs
Patient with Paced Rhythm in Severe Cardiomyopathy Presents with SOB due to Acute Decompensated Heart Failure
This is a middle-aged male with h/o with a history ofheart failure with severely reducedejection fraction due to dilated ischemic cardiomyopathy (EF 5-10%), probably with some component of non-ischemic cardiomyopathy, with h/o CABG, who is status post ICD placement (and previous appropriate shocks for VT) and biventricular pacer ( " cardiac resynchronization therapy " ), who is on amiodarone for VT suppression, and has h/o LV thrombus and is on chronicanticoagulation with warfarin.He presented forparoxysmal nocturnal dyspnea that didn ' t resolve with use of his home prn diuretics. He was hyp...
Source: Dr. Smith's ECG Blog - June 9, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
Physicians Are Disappearing from the Front Line of Healthcare
A recent, longish article in theNew York Times discussed the"disappearing doctor" from the front line of healthcare by which is meant walk-in retail clinics in drug stores and urgent care centers (see:The Disappearing Doctor: How Mega-Mergers Are Changing the Business of Medical Care). People are flocking to these facilities because they are readily accessible, user-friendly, and efficient. Patients with the most serious injuries and diseases are triaged to hospital ERs so the patient mix at these walk-in centers is more homogeneous. Below is an excerpt from the article:...[The] reason big players like CVS ...
Source: Lab Soft News - May 30, 2018 Category: Laboratory Medicine Authors: Bruce Friedman Tags: Healthcare Business Healthcare Delivery Healthcare Information Technology Healthcare Innovations Hospital Financial Medical Consumerism Public Health Source Type: blogs
Chest pain, Ventricular Paced Rhythm, and a Completely Normal Angiogram 3 Months Prior.
One of our graduates, Rochelle Zarzar, who is now an education fellow, sent me this from one of the hospitals she works at now:An elderly woman presented with chest pain. She had been nauseous the night before and did not feel well, then awoke 2 hours prior with chest pain.She had had a completely normal angiogram 3 months prior.Here is that angiogram report:The left main coronary artery is normal.Left anterior descending is a type 3 vessel and is normal.Left circumflex is nondominant and normal.The right coronary artery is dominant and normal.The nurses immediately recorded an ECG. This was 2 hours after the o...
Source: Dr. Smith's ECG Blog - May 29, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
