Mechanism of Troponin release in “ Marathon runners ” ?
Can you believe that 68% of marathon runners show elevated Troponin levels after crossing the finish line? . 11% of them have significant levels that could lead to a diagnosis of ACS if they experience chest pain and end up in the hospital. (Fortescue EB 2007 ) Clinical experience suggest, that it doesn’t require a marathon race to bring troponins into the bloodstream. Any heavy, prolonged physical exertion can potentially release these biomarkers. How much Troponins are released in these runners ? (Ref 3) Most runners (68%) had some degree of  troponin increase (troponin T > or = 0.01 ng/mL or t...
Source: Dr.S.Venkatesan MD - October 6, 2023 Category: Cardiology Authors: dr s venkatesan Tags: Uncategorized cardaic biomarkers free cytosolic troponin mechansim troponin release non cardiac troponin troponin in marathon runners troponin t vs i Source Type: blogs

Another deadly and confusing ECG. Are you still one of the many people who will be fooled by this ECG, or do you recognize it instantly?
Submitted and written byDestiny Folk MD, peer reviewed by Meyers, Smith, Grauer, McLarenA man in his early 30s with no significant past medical history was brought to the ED by EMS after being found unresponsive by a friend. EMS arrived and found him awake and alert. He complained of generalized weakness and left lower extremity numbness. He reported that 12 hours prior to arrival he used fentanyl and cocaine. He reported difficulty walking and felt as if his left leg was “asleep.” He denied any chest pain or shortness of breath and stated he felt at his baseline yesterday prior to drug use. On arrival in the ED, he wa...
Source: Dr. Smith's ECG Blog - May 5, 2022 Category: Cardiology Authors: Pendell Source Type: blogs

What are these ST elevations, ST depressions, and tall T waves diagnostic of?
 Written by Pendell MeyersLet ' s see this presentation ECG without any context first (no baseline ECG was available)What do you think? What will you do?The ECG is diagnostic of severe hyperkalemia. There is sinus tachycardia, the beginning of QRS widening, tall pointy peaked T waves with little area compared to their height. There is STE in V1-V3, aVR, and aVL, with STD in II, III, aVF, V4-V6. The appearance in V1 is similar to the Brugada morphology (as is often the case in hyperkalemia and Na channel blocker effects causing STE). Together these ST elevations in the right precordial leads and aVL are classic pseudoS...
Source: Dr. Smith's ECG Blog - May 14, 2021 Category: Cardiology Authors: Pendell Source Type: blogs

Opioid Overdose: Causes, Signs, and What to Do
Opioid Overdose: Signs, Symptoms, and What to Do Any individual who uses opioids runs the risk of overdosing. Overdoses can be fatal. In fact, more than 130 people in the United States die after overdosing on opioids every day. This makes it important to know what causes an opioid overdose, the signs that an opioid overdose is occurring, and what to do in the event of an opioid overdose. Opioid Overdose Causes In 2017, the CDC reported that more than 15,000 individuals died from drug overdoses involving heroin in the United States. That’s almost 5 deaths for every 100,000 Americans. However, there are some people who may...
Source: Cliffside Malibu - December 27, 2019 Category: Addiction Authors: Jaclyn Uloth Tags: Detox Resources for Alcohol and Drugs/Opiates Painkiller drug overdose opiate addiction opioid opioids 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

A Sting, then Blisters and Pain
​A 25-year-old woman presented with a rash, and reported that she was in South Carolina when she felt a stinging sensation. That was followed by blisters on her foot.She noticed swelling of her foot, and had continued pain. She took pictures of the bite on days two and six. (Below.) She reported that she had a similar sting the previous summer. She said she had no fever, shortness of breath, or dizziness. Her vital signs were a temperature of 98.6°F, a heart rate of 80 bpm, a blood pressure of 100/60 mm Hg, a respiratory rate of 16 bpm, and an SPO2 of 100% on room air.She was alert and in no distress. Her oropharynx was...
Source: The Tox Cave - September 3, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Could you have prevented this young man's cardiac arrest?
Written by Pendell MeyersWe received a call from an outside hospital asking to transfer a " traumatic post arrest " patient. We were told that a young patient was brought in with altered mental status but complaining of right hip and/or leg pain after being found by his mother at the bottom of the stairs into the basement. His history was significant only for IV heroin abuse, but he denied any recent use. Apparently he had been confused about why he was at the bottom of the stairs, unsure if he had fallen, unsure whether there was any specific traumatic mechanism.The practitioner on the phone stated that he suddenly develo...
Source: Dr. Smith's ECG Blog - July 24, 2018 Category: Cardiology Authors: Pendell Source Type: blogs

Weird and Wild: The Hidden Compartment Syndrome
​Compartment syndrome made it on our weird and wild list not only because it is uncommon but also because it is difficult to identify. It presents in strange ways, and is often missed the first time a patient seeks care. This rare but serious condition may result in permanent contractures or even loss of a limb. Complications from compartment syndrome escalate quickly if they're not treated promptly. Early recognition and treatment of this problem is imperative.The increased pressure in the space around certain muscles that creates compartment syndrome can be caused by fractures, bleeding, recent surgeries, burns, rhabdo...
Source: The Procedural Pause - April 2, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Rhabdo: A rare but serious complication of … exercise
It’s a new year, the gyms are unusually busy, and many of us started a new physical activity. Several health clubs are offering fun, interactive, and dynamic exercises such as whole-body workouts, functional training, CrossFit, high-intensity interval training, spinning, etc. Some of these classes are incorporating intense workouts, which was a hot topic in exercise physiology in 2017. There is significant enthusiasm around these programs among my friends, family, and patients. Some of these classes have loud music, lights, and trainers whose job is to push you to a new level. Increasing the intensity of a workout may br...
Source: Harvard Health Blog - January 11, 2018 Category: Consumer Health News Authors: Marcelo Campos, MD Tags: Exercise and Fitness Health Source Type: blogs

Health Care Needs Its Rosa Parks Moment
BY SHANNON BROWNLEE On Wednesday, October 25, 2017 I was at the inaugural Society for Participatory Medicine conference. It was a fantastic day and the ending keynote was the superb Shannon Brownlee. It was great to catch up with her and I’m grateful that she agreed to let THCB publish her speech. Settle back with a cup of coffee (or as it’s Thanksgiving, perhaps something stronger), and enjoy–Matthew Holt George Burns once said, the secret to a good sermon is to have a good beginning and a good ending—and to have the two as close together as possible. I think the same is true of final keynotes after a...
Source: The Health Care Blog - November 22, 2017 Category: Consumer Health News Authors: Matthew Holt Tags: OP-ED Patients Physicians Lown Institute Overtreatment Right Choice Alliance Shannon Brownlee Society for Participatory Medicine Source Type: blogs

LITFL Review 307
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 307th 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 Here’s a series of integrated Sepsis lectures from the Maryland CCProject. [SO]   Th...
Source: Life in the Fast Lane - November 19, 2017 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: LITFL review LITFL R/V Source Type: blogs

How to Be Cool
​A 27-year-old man with an unknown past medical history presented with altered mental status. Bystanders found him on the sidewalk acting strangely, according to EMS. The patient was drowsy with incomprehensible speech on arrival. He was diaphoretic, tachycardic, and combative. No signs of trauma were noted. His heart rate was 130 bpm, blood pressure 169/90 mm Hg, respiratory rate 30 bpm, SPO2 98% on room air, and temperature 105.3°F. His blood glucose was 150. The patient continued to be minimally responsive.​Etiologies of HyperthermiaNeuroleptic malignant syndromeSerotonin syndromeAnticholinergic syndromeSympathomim...
Source: The Tox Cave - September 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

When a drug does serious harm, the FDA wants to hear from you
I frequently lecture to physicians, pharmacists, and other healthcare professionals on drug safety, and I often start by asking how many people have ever observed a serious adverse drug event. Almost everyone in the room raises his or her hand. I then ask how many have ever reported a serious adverse drug event to the US Food and Drug Administration (FDA) or to a drug company, and almost all of the hands go down. Often, healthcare providers do not know the important role that they can play in drug safety surveillance. Even less well known is that consumers can also contribute directly to enhancing drug safety surveillance ...
Source: Harvard Health Blog - August 24, 2017 Category: Consumer Health News Authors: Joshua Gagne, PharmD, ScD Tags: Drugs and Supplements Health Managing your health care Source Type: blogs

What it ’s like to be a doctor in the heroin capitol of the U.S.
I am a practicing hospitalist physician in Dayton, Ohio. Dayton has emerged in the last year as the city with the highest per capita death rate from opioid overdoses. When we measure the number of deaths here we talk about how many there are per day, not per week or month. We have been inundated with heroin and other products laced with fentanyl or carfentanil. Every other drug, including marijuana, is laced with an opiate in this city. Dealers stand on street corners and throw baggies of heroin into passing cars who have the windows open — free of charge — to get new customers hooked. A routine dose of Narcan ...
Source: Kevin, M.D. - Medical Weblog - July 19, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/jenny-hartsock" rel="tag" > Jenny Hartsock, MD < /a > Tags: Physician Medications Source Type: blogs