Cardiology MCQ Test 6
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Source: Cardiophile MD - October 27, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Test almost all of your most important ECG rhythm interpretation skills with this case.
Sent by Anonymous, written by Meyers, edits by Smith:A female in her 70s with history of HTN woke up around 2am with severe shortness of breath. EMS found the patient in moderate respiratory distress, hypoxemic on room air, with diffuse rales. CPAP was initiated. The prehospital ECG is unavailable but reportedly showed a wide complex regular tachycardia at around 150 bpm. 150mg amiodarone was given for presumed VT with no obvious effect.She arrived at the ED at 2:52 AM. She had normal mental status, and was in moderate respiratory distress with diffuse rales, with respiratory rate 30/min, and initial blood pressure 129/60....
Source: Dr. Smith's ECG Blog - October 26, 2017 Category: Cardiology Authors: Pendell Source Type: blogs
Cardiology MCQ Test 5
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Source: Cardiophile MD - October 22, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Cardiology MCQ Test 4
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Source: Cardiophile MD - October 21, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Cardiology MCQ Test 3
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Source: Cardiophile MD - October 20, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Cardiology MCQ Test 2
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Source: Cardiophile MD - October 19, 2017 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Anticoagulation not useful in secondary AF? – New study
Anticoagulation in atrial fibrillation (AF) secondary to acute coronary syndrome, acute pulmonary disease or sepsis may not prevent stroke, but may increase risk of bleeding, says an new study published in JACC Clinical Electrophysiology [1]. The authors retrospectively evaluated a cohort of over 2300 patients aged 65 years or more who were hospitalized with acute coronary syndrome, acute pulmonary disease which included worsening of chronic obstructive pulmonary disease, pneumonia, influenza, pulmonary embolism and pleural effusion or sepsis associated with new onset AF during admission. Over a three year follow up, the...
Source: Cardiophile MD - October 17, 2017 Category: Cardiology Authors: Johnson Francis Tags: Cardiology ECG / Electrophysiology Source Type: blogs
Valuing Value-Based Payment
By ANISH KOKA, MD
The idea that payment should be linked to the value lies at the heart of most of the transactions we participate in on a daily basis. Yet, value based payment in healthcare has seemingly run into very rocky waters as of late. It is at this precarious time that stakeholders representing large employers and other purchasers of health care’ took to the Harvard Business Review to write in defense of value based payment reform. The authors pepper their article with cherry picked ‘successes’ of the value movement and urge the country to forge ahead on the current path. The picture that c...
Source: The Health Care Blog - October 16, 2017 Category: Consumer Health News Authors: anish_koka Tags: Uncategorized Value-Based Payment Source Type: blogs
Cardiology MCQ Test
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Source: Cardiophile MD - October 16, 2017 Category: Cardiology Authors: Johnson Francis Tags: Cardiology MCQ Source Type: blogs
What happens when you give adenosine to a patient with this rhythm?
A 40-something presented with palpitations and had a regular pulse at 170.Here is his 12-lead ECG:The computer reads supraventricular tachycardia.What is it?It is atrial flutter with 2:1 conduction. It is not PSVT and not sinus.There are clear flutter waves in lead II across the bottom. In V1, there are upright waves that appear to be P-waves but are not: they are atrial waves and it is typical for atrial flutter waves to be upright in V1, whereas sinus P-waves are biphasic in V1.The flutter rate is relatively fast at 334, such that the ventricular rate is 167 (one half the atrial rate).As easy as it may seem to ...
Source: Dr. Smith's ECG Blog - August 23, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
Atrial fibrillation with RVR: use POCUS to assess volume; then sinus vs. SVT: use of Lewis leads
An elderly man with a history of diabetes and HTN presented with lethargy and weakness, decreased urine output, and hypotension. There was no history of any GI bleeding or other hemorrhage. There was no fever. He had no CP or SOB, and it was unknown if there was a previous history of atrial fib. He was on atenolol, but it was not known if this was simply for hypertension, or for atrial fib.He was not anti coagulated.Blood pressures ranged from 83/45 to 125/83, lower than usual. HR ranged from 110 to 145.He had an ECG recorded upon arrival:There is atrial fibrillation with a rapid ventricular respon...
Source: Dr. Smith's ECG Blog - August 9, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
Thoughts on diagnostic errors in 2017
The Society to Improve Diagnosis in Medicine has on its website this quote:
Reducing Harm from Diagnostic Error
1 in 10 diagnoses are incorrect.
Diagnostic error accounts for 40,000-80,000 US deaths annually—somewhere between breast cancer and diabetes.
Chances are, we will all experience diagnostic error in our lifetime.
(US Institute of Medicine 2015, BMJ Quality & Safety 25-Year Summary of US Malpractice Claims, 2013.)
The current focus on diagnostic error raises an interesting question: Is this a larger problem in 2017 than in the 1970s and 1980s?
In this post, I postulate that the problem has increased. Se...
Source: DB's Medical Rants - August 7, 2017 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
An elderly woman with dyspnea, asystolic arrest, resuscitated
911 was called for a very elderly dialysis patient for acute onset of dyspnea.On arrival, medics found the patient with agonal respirations. Chest compressions were started and 2 doses of epinephrine givne, and she was found to be in asystole, which then changed to PEA at some point, then to ventricular tachycardia. A King airway was placed.This is her prehospital ECG:What do you think?My thoughts are below.On arrival, she was hypertensive and tachycardic. Due to concern for hyperkalemia, Calcium was given empirically. Cardiac ultrasound showed poor LV function and normal RV size. K returned at 5.8...
Source: Dr. Smith's ECG Blog - July 15, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
Research and Reviews in the Fastlane 189
This study compares emergency medical care statistics for an urban metropolitan community in Oregon before and after the implementation of the Affordable Care Act in the USA. With the incidence of cardiac arrest approximately 17 percent lower post ACA than before it certainly brings home the potential implications of repealing and replacing the ACA.
Recommended by: Virginia Newcombe
Emergency Medicine
van der Hulle T, et al; YEARS study group. Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): a prospective, multicentre, cohort study. Lancet 2017. PMID: 28549662
The largest demonstratio...
Source: Life in the Fast Lane - July 12, 2017 Category: Emergency Medicine Authors: Jeremy Fried Tags: Emergency Medicine R&R in the FASTLANE Resuscitation EBM Education recommendations research and reviews Source Type: blogs
Research and Reviews in the Fastlane 185
This article on remifentanyl tolerance and hyperalgesia is nerdy, focussed on perioperative anaesthesia, but good.
Recommended by: Matthew MacPartlin
Emergency Medicine
Verma AA et al, for the GEMINI Investigators. Pulmonary Embolism and Deep Venous Thrombosis in Patients Hospitalized With Syncope: A Multicenter Cross-sectional Study in Toronto, Ontario, Canada. JAMA Intern Med. PMID: 28492876
A quick update on PESIT. This retrospective chart review tried to replicate the PESIT inclusion criteria. They identified 1305 patients admitted with first time syncope. Ultimately, 11 were diagnosed with PE and 10 with DVT, re...
Source: Life in the Fast Lane - June 7, 2017 Category: Emergency Medicine Authors: Justin Morgenstern Tags: Anaesthetics Emergency Medicine Intensive Care R&R in the FASTLANE critical care EBM Education literature recommendations research and reviews Source Type: blogs
