Welcome To The Virtual Ward!
The expression ‘virtual ward’ is trending. But is it just the expression we hear about more often, or is there a real trend? And by the way: what is a virtual ward? And what is it good for?
It is yet difficult to find one, generally accepted definition for the new phenomenon. The same phrase is used for a number of quite different solutions. For the sake of understanding, here is what we think about when we speak of virtual wards.
“A virtual ward is a solution that supports patients who would otherwise be in hospital to get the acute care, remote monitoring and treatment in their own homes, with the use o...
Source: The Medical Futurist - April 5, 2022 Category: Information Technology Authors: Andrea Koncz Tags: TMF Artificial Intelligence in Medicine Digital Health Research E-Patients Future of Medicine Health Sensors & Trackers Healthcare Policy Telemedicine & Smartphones virtual ward Source Type: blogs
A woman in her 50s with shortness of breath
Case written by Neha Ray, MD, with edits by Meyers, Smith, GrauerA woman in her 50s presented for evaluation of multiple episodes of syncope with shortness of breath. On EMS arrival, she was GCS 15 with HR 110s. En route to the ED, the patient had 4 more episodes of syncope and became hemodynamically unstable with SBP in the 80s and HR 160s. The first recorded SpO2 was 73%. On arrival to the ED, patient was diaphoretic and in extremis. Her initial EKG is below. Paramedics arrive to the ED and state that they are worried about inferior STEMI. What do you see? What do you think?The ECG shows sinus tachycardia...
Source: Dr. Smith's ECG Blog - March 28, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
An elderly woman with shortness of breath and an ECG that helps understand it
Written by Pendell Meyers, edits by Smith and GrauerOne of my fantastic residents brought me an ECG on shift and asked for my interpretation without any context:What do you think?I responded that it looks like chronic right ventricular hypertrophy. This is due to the QRS morphology and axis including incomplete RBBB pattern in V1, precordial R wave progression reversal, matching deep S waves in leftward leads I and aVL, very rightward limb lead axis including R wave in aVR. See Ken Grauer ' s comments below where he points out that the tall P-wave in lead II is diagnostic of right atrial enlargement, which supp...
Source: Dr. Smith's ECG Blog - March 6, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
Patients are captive pharmacy benefits manager consumers
I still recall the ICU physician holding my hand and preparing me for the possibility I might not survive the blood clots in my lungs, pulmonary embolism. It was eighteen years ago when out of the blue, I found myself unexpectedly holding the hand of that gentle, concerned doctor, whose name I do not evenRead more …Patients are captive pharmacy benefits manager consumers originally appeared inKevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - February 16, 2022 Category: General Medicine Authors: < span itemprop="author" > < a href="https://www.kevinmd.com/blog/post-author/beth-waldron" rel="tag" > Beth Waldron < /a > < /span > Tags: Meds Medications Source Type: blogs
Wide Complex Tachycardia with Huge ST Elevation. What is going on?
This 70-something woman with no significant past history (no previous ECGs or cardiac history) presented by EMS with fairly acute chest pressure and shortness of breath, with nausea and diaphoresis. " Like an elephant sitting on my chest. " She had no history of atrial fibrillation and was not on any anticoagulants.She stated that she had had a similar episode a couple weeks earlier, lasting 24 hours, with rapid heart beat but without chest pain, that spontaneously resolved. She thought she was having a panic attack. Since then she has had " little spurts " of the same thing lasting 1-2 hours.E...
Source: Dr. Smith's ECG Blog - January 12, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
How to check for pulsus paradoxus?
Pulsus paradoxus is an exaggeration of the normal inspiratory fall in blood pressure. The paradox in pulsus paradoxus is that the pulse is not well felt when the heart sounds are still audible. The extent of fall in inspiratory pressure can be documented using a sphygmomanometer.
Pulsus paradoxus
Pulsus paradoxus is the typical finding in cardiac tamponade, though it can occur more commonly in obstructive airways disease. In obstructive airways disease, it is due to the wide swing in intrathoracic pressure. Other less likely causes are constrictive pericarditis and restrictive cardiomyopathy. It has also been reported in ...
Source: Cardiophile MD - December 31, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: General Cardiology Source Type: blogs
A presentation on atrial fibrillation : Old wine in Old bottle
Caution: 2008 Presentation
This one is from the archive, a presentation on Atrial fibrillation done 14 years ago at KG.hospital, Coimbatore.
Link to PDF download
Good news: Nothing much has changed since 2008
Recognizing the clinical importance of AF and the need to rule out a systemic cause is the key, Further, a genuine bedside debate about the pros and cons of simple vs aggressive treatment discussion is welcome.
The nomenclature issue of valvular vs non-valvular has finally seemed to have settled. The latter is banished for good reason. (Funny to note Aortic valve was conside...
Source: Dr.S.Venkatesan MD - December 12, 2021 Category: Cardiology Authors: dr s venkatesan Tags: Atrial fibrillation ACC AHA Atrial fibrillation affirm race af guidelines affirm trial atrial fibrillation Approach to atrial fibrillation a ppt presntation Source Type: blogs
A man in his 50s with acute chest pain, now resolved, has 2 undetectable troponins. CT Coronary Angiogram?
Written by Pendell MeyersA man in his 50s presented to the ED with chest pain described as pressure, without radiation, acute onset about three hours prior to arrival. He had had stuttering less severe versions of this pain all week that usually went away after a few minutes. He also had diaphoresis and dyspnea. He had extensive family history of CAD with CABG ' s in the mid 50s for multiple relatives, but he had no personal known history of CAD. It is unclear whether he had pain at the time of triage, but notes describe that his pain had subsided by the time of EM physician evaluation:Triage at approximately 21...
Source: Dr. Smith's ECG Blog - December 6, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
Even when the story is obvious, with intractable pain, the STEMI paradigm can cause preventable delays
Written by Pendell MeyersA man in his early 60s presented with acute chest pain rated 10/10 with associated nausea and vomiting with known history of multivessel CAD. He presented at 2300 with onset of symptoms at 2230. He was awoken from sleep by the symptoms, which were identical to prior MI for which he received a stent years ago. On arrival his heart rate was 43 bpm and blood pressure 91/62. Atropine and IV fluid was given.Here was his triage ECG:What do you think? Baseline below for comparison, but try first without it.His baseline ECG was available on file:The presentation ECG shows diagnostic evidence of poste...
Source: Dr. Smith's ECG Blog - December 1, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
Collapse, pulse present, ECG shows inferior OMI. Then there is loss of pulses with continued narrow complex on the monitor ( " PEA arrest " )
An elderly woman was witnessed to collapse. 911 was called and when EMS arrived, she was unresponsive with shallow respirations, a GCS of 3, pulse of 70 and BP of 78/67 by cuff pressure.3 prehospital ECGs were recorded:There is an obvious inferior OMI/STEMI, right?The patient then had a PEA arrest while on the cardiac monitor, and CPR was started.On arrival, all the usual things were done for cardiac arrest.Transthoracic cardiac POCUS was of low quality, and so after intubation aTEE probe was inserted.Aside: here is a recent report of our experience with over 550 TEE exams in the Hennpin ED: Feasibility, utility...
Source: Dr. Smith's ECG Blog - November 8, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
PEA cardiac arrest, ROSC, and no STEMI on ECG. Randomized trials say emergent reperfusion is not indicated, right?
This study had a fatal flaw: they did not keep track of all the " Non-STEMI patients " who were NOT enrolled, but instead were sent for immediate angiogram. It was done in Europe, where the guidelines suggest taking all shockable arrests emergently to the cath lab. So it is highly likely that physicians were very reluctant to enroll patients whom they suspected had Occlusion MI (OMI), even if they did not have STEMI. These physicians did not want a patient with an OMI that was not a STEMI to be randomized to no angiogram. This strong suspicion is supported by their data: only 22 o...
Source: Dr. Smith's ECG Blog - November 4, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
What's new in midwifery - 20th October 2021 - New research
Some recent research you might need to know about:A study ofsunflower seed oil to reduce neonatal sepsis and mortality, a study carried out in Uttar Pradesh. A systematic review of howsonographic knowledge can help decrease failed operative vaginal delivery.ThePregnancy Adapted Geneva score (PAG) to assess the probability of pulmonary embolism during pregnancy.A study looking at any association ofepidural anaesthesia with autism spectrum disorder in children.Three Cochrane systematic reviews:Paracetamol/acetaminophen for perineal pain in the postnatal periodInstruments for assisted vaginal birth Physiologica...
Source: Browsing - October 20, 2021 Category: Databases & Libraries Tags: midwifery Source Type: blogs
I thought the ECG diagnosis was obvious. But many missed it. So I'm showing it.
I was reading ECGs in the system and came across this one:What do you think?Computer diagnosis: --ST DEVIATION AND MARKED T-WAVE ABNORMALITY, ANTEROLATERAL ISCHEMIA --ST DEVIATION AND MODERATE T-WAVE ABNORMALITY, CONSIDER INFERIOR ISCHEMIA I thought the ECG diagnosis was obvious, but no comment was made by the providers who ordered it. That could be because they never saw it, as the patient eloped before full evaluation. But then I showed it to multiple smart providers and not a single one saw it. So I thought it would be good to show it to blog readers.Everyone went straight to the ST...
Source: Dr. Smith's ECG Blog - October 18, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
A man in his late 40s with chest pain
Written by Pendell MeyersA man in his late 40s with no known medical problems was at work when he suddenly experienced midsternal chest pain radiating down both arms. Approximately 1 hour after onset of symptoms he was triaged at the ED, with ongoing chest pain, normal vitals, and this triage ECG:What do you think?Twice, months apart, I sent this ECG to Dr. Smith without any context or other information (I do this many times per day, with many normal or false positive cases mixed in). The first time he responded " acute ischemia but not active occlusion " . The second time he responded " LVH and subendocardial ischem...
Source: Dr. Smith's ECG Blog - September 13, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
Fight Aging! Newsletter, September 13th 2021
In this study, mature DCs (mDCs), generated from the GM-CSF and IL-4 induced bone marrow cells, were intravenously injected into wild-type mice. Three days later, assays showed that the mDCs were indeed able to return to the thymus. Homing DCs have been mainly reported to deplete thymocytes and induce tolerance. However, medullary TECs (mTECs) play a crucial role in inducing immune tolerance. Thus, we evaluated whether the mDCs homing into the thymus led to TECs depletion. We cocultured mDCs with mTEC1 cells and found that the mDCs induced the apoptosis and inhibited the proliferation of mTEC1 cells. These effects were onl...
Source: Fight Aging! - September 12, 2021 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
