Young Man with a Heart Rate of 257. What is it and how to manage?
A 30-something was in the ED for some minor trauma when he was noted to have a fast heart rate. He acknowledged that he had palpitations. but only when asked. He had a history heavy alcohol use. Blood pressure was normal (109/83).Here is his 12-lead:There is a wide complex tachycardia with a rate of 257, with RBBB and LPFB (right axis deviation) morphology.The Differential Diagnosis is: SVT with aberrancy(#) [AVNRT vs. WPW (also called AVRT*)] Atrial flutter with 1:1 conduction, with aberrancy VT coming from the anterior fascicle (fascicular...
Source: Dr. Smith's ECG Blog - September 6, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
World ’s First Portable MRI Cleared by FDA
Magnetic resonance imaging (MRI) has revolutionized medicine, but MRI scanners are so demanding that access to them is still a challenge. MRI machines typically require specially built rooms with magnet quench vent pipes, entry systems that check people for metals attracted to magnets, and specific protocols to ensure safety. Patients, therefore, have to be brought to the MRI scanners rather than the other way around.
This is about to change in many cases, as Hyperfine, a company with offices in New York City and St Guilford, Connecticut, won FDA clearance for the first MRI scanner that can be wheeled to the patient bed...
Source: Medgadget - February 17, 2020 Category: Medical Devices Authors: Medgadget Editors Tags: Emergency Medicine Neurology Neurosurgery Radiology Source Type: blogs
How would you manage this patient?
A woman was found outside with altered mental status.She was GCS 3. BP 80/40Here is her ECG:Diagnosis?Sinus bradycardia with Osborn waves. Temperature was 24.3 degrees Celsius.She was intubated (carefully, so as not to irritate her heart into ventricular fibrillation).She requiresinternal rewarming at this temperature. External rewarming would be dangerous, as it results in both rewarming shock (hypotension/shock due to shunting of core blood flow to the surface) and " core afterdrop " (shunting of cold surface blood to the core, dropping core temperature).Because she has an appropriate blood pressure and...
Source: Dr. Smith's ECG Blog - January 1, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
Fight Aging! Newsletter, December 16th 2019
This study shows that CA are released from periventricular and subpial regions to the cerebrospinal fluid and are present in the cervical lymph nodes, into which cerebrospinal fluid drains through the meningeal lymphatic system. We also show that CA can be phagocytosed by macrophages. We conclude that CA can act as containers that remove waste products from the brain and may be involved in a mechanism that cleans the brain. Moreover, we postulate that CA may contribute in some autoimmune brain diseases, exporting brain substances that interact with the immune system, and hypothesize that CA may contain brain markers that m...
Source: Fight Aging! - December 15, 2019 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
A man in his 50s with witnessed arrest and ST elevation in aVR
Written by Meyers, edits by SmithA 50-ish year old man was working construction when he suddenly collapsed. Coworkers started CPR within 1 minute of collapse. EMS arrived within 10 minutes and continued CPR and ACLS, noting alternating asystole and sinus bradycardia during rhythm checks. He received various ACLS medications and arrived at the ED with a perfusing rhythm.Initial vitals included heart rate around 100 bpm and BP 174/96. Here is his initial ECG, very soon after ROSC:What do you think?Sinus tachycardia. There is incomplete RBBB (QRS duration less than 120 ms). There is diffuse STD, maximal in V4-V5 a...
Source: Dr. Smith's ECG Blog - November 2, 2019 Category: Cardiology Authors: Pendell Source Type: blogs
Snake Bite and Radiology
Discussion-Local manifestations of snake bite are soft-tissue swelling from edema, necrosis, and hemorrhage. Common long-term sequelae of envenomation is soft-tissue atrophy distal to the bite, particularly in the digits.-Systemic signs and symptoms after a venomous snake bite are due to anticoagulant/procoagulant activity or neurotoxicity. Cerebral hypoxia can occur due to hypotensive shock that may accompany some snake bite envenomations. Neuromuscular disorders with damage of the peripheral nervous system can with blockage of synaptic transmission, at either presynaptic or postsynaptic levels.Common neuro...
Source: Sumer's Radiology Site - March 21, 2019 Category: Radiology Authors: Sumer Sethi Source Type: blogs
Pseudo subarachnoid hemorrhage in post anoxic brain injury
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - March 15, 2019 Category: Internal Medicine Tags: critical care neurology Source Type: blogs
Perimesencephalic SAH: DAMS Unplugged
Perimesencephalic subarachnoid haemorrhage implies subarachnoid haemorrhage (SAH) centred on the basal cisterns around the midbrain. Here is a brief teaching video explaining the sameFamous Radiology Blog http://www.sumerdoc.blogspot.com
TeleRad Providers at www.teleradproviders.com Mail us at sales@teleradproviders.com (Source: Sumer's Radiology Site)
Source: Sumer's Radiology Site - April 9, 2018 Category: Radiology Authors: Sumer Sethi 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
How To Clear Four Common Roadblocks to Coverage of Stuttering Treatment
Dealing with fluency issues can be confusing and frustrating for the client and family. Navigating health insurance reimbursement for stuttering treatment can also present challenges for them. In our extensive work with clients who stutter, we’ve learned several tips for getting treatment covered—either initially or through an appeal if the insurance company denies coverage.
Ease your clients’ and your own anxiety by learning how to navigate through (or around) these four common insurance roadblocks.
Does the policy cover stuttering treatment?
Become familiar with an insurance company’s specified benefits to determ...
Source: American Speech-Language-Hearing Association (ASHA) Press Releases - September 19, 2017 Category: Speech-Language Pathology Authors: Brooke Leiman Tags: Speech-Language Pathology Fluency Disorders Speech Disorders stuttering Source Type: blogs
Notes to myself – 2
Pentobarb coma – BIS should be 10-20 and SR (suppression ratio) should be 70-80
Consider lev albuterol
Should give vaccines after coiling of spleen or before if possible
No calcium channel blockers post MI definitely and post op in general
Toradol inhibits spine healing
Don’t do endoscopes with patients in supine position
don’t ambulate patients with known dvt’s. wait 2-3 days until clots get stuck.
dvt’s even with filter get heparin as much as possible for post phlebitic syndrome and to retard new clot formation
diffuse alveolar hemorrhage – secondary to chemo, goodpasture’s, wege...
Source: Inside Surgery - December 31, 2016 Category: Surgery Authors: Editor Tags: General Source Type: blogs
Research and Reviews in the Fastlane 148
Welcome to the 148th edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.
This edition contains 6 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Justin Morgenstern and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R project or check o...
Source: Life in the Fast Lane - August 24, 2016 Category: Emergency Medicine Authors: Justin Morgenstern Tags: Education Emergency Medicine Infectious Disease Neurosurgery R&R in the FASTLANE EBM literature recommendations research and reviews Source Type: blogs
Research and Reviews in the Fastlane 144
Welcome to the 144th edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.
This edition contains 6 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Justin Morgenstern, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R ...
Source: Life in the Fast Lane - July 28, 2016 Category: Emergency Medicine Authors: Jeremy Fried Tags: Cardiology Education Intensive Care Neurology R&R in the FASTLANE EBM Emergency Medicine literature recommendations research and reviews Source Type: blogs
DM / DNB Cardiology Entrance Mock Test 26
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Source: Cardiophile MD - May 10, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs
Giant wide T inversion – Cardiology MCQ
Giant wide T inversion may be seen in all except:
a) After a cardiac arrest
b) Subarachnoid hemorrhage
c) Hyperkalemia
d) Takotsubo cardiomyopathy
Correct answer: c) Hyperkalemia
Giant T wave inversion can be broad and deep or just deep T inversions. A depth of T wave of 10 mm or above is generally considered as deep T inversion [1]. Giant T wave inversions with depth of 35 mm have also been described in literature [2]. Deep T inversions without gross increase in width can occur in ischemia and hypertrophic cardiomyopathy. In a study involving 864 patients with hypertrophic cardiomyopathy, 15% had giant T wave inversion ...
Source: Cardiophile MD - May 10, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance ECG / Electrophysiology Source Type: blogs
