Welcome to my World: Perpetual Alarm Fatigue
By HANS DUVEFELT, MD
Part of a series on primary care challenges and their solutions.
I missed a drug interaction warning the other day when I prescribed a sulfa antibiotic to Barton, a COPD patient who is also taking dofetilide, an uncommon antiarrhythmic.
The pharmacy called me to question the prescription, and I quickly changed it to a cephalosporin.
The big red warning had popped up on my computer screen, but I x-ed it away with my right thumb on the trackball without reading the warning. Quite honestly, I am so used to getting irrelevant warnings that it has become a reflex to bring the cursor to the spot where I can ...
Source: The Health Care Blog - August 15, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
Welcome to My World: Med Wreck
By HANS DEUVEFELT, MD
Part of a series on primary care challenges and their solutions.
Medication reconciliation is something we do every day, in the clinic and in the hospital. It shouldn’t be as hard as it is.
A patient with multiple medical problems returns for a fifteen minute quarterly visit. He saw his cardiologist three weeks ago and was told to double his metoprolol.
There are two ways to catch this change: when the cardiologist’s office note comes in, or as we check the patient in for his visit.
The cardiologist’s office note, generated by one of the leading EMRs, runs seven pages and contains entries a...
Source: The Health Care Blog - August 10, 2016 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs
DM / DNB Cardiology Entrance New Test Series 5
Time limit: 0
Quiz-summary
0 of 30 questions completed
Questions:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
...
Source: Cardiophile MD - August 6, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs
Beta-Blockers for Cocaine and other Stimulant Toxicity
Dogma: “a belief or set of beliefs that is accepted by the members of a group without being questioned or doubted; a point of view or tenet put forth as authoritative without adequate grounds.”
Years ago I treated a university student who presented to the emergency department (ED) after drinking several cans of a popular caffeinated energy drink to “pull an all-nighter” during final exam week. He was tremulous, agitated, and pale, with sinus tachycardia ranging from 140 to 160 bpm and normal blood pressure (BP). The house officer (registrar) working with me that night proposed treating him with a benzodiazepine, bu...
Source: Life in the Fast Lane - July 4, 2016 Category: Emergency Medicine Authors: John Richards Tags: Toxicology and Toxinology alpha stimulation amphetamines Beta Blockers cocaine dogma John Richards Stimulant Toxicity Stimulants Source Type: blogs
STEMI with Life-Threatening Hypokalemia and Incessant Torsades de Pointes
Conclusions: In the select group of hypokalemic patients studied, potassium infusions of 20 to 40 mmol delivered over 1 hr were safe to administer and effectively increased serum potassium levels in a dosedependent and predictable fashion. Furthermore, these results were independent of the patient's underlying renal function or associated diuretic administration. (Crit Care Med 1991; 19:694)Concentrated Potassium Chloride Infusions in Critically Ill Patients with HypokalemiaThe Journal of Clinical Pharmacology. Volume 34, Issue 11, pages 1077–1082, November 1994Although concentrated infusions of pota...
Source: Dr. Smith's ECG Blog - April 7, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
Melinda loses weight despite metoprolol
I’ve talked previously about how some drugs, both prescription and over-the-counter, can block weight loss. Metoprolol, a beta blocker prescribed to treat heart rhythm disorders, hypertension, coronary disease, migraine headaches, and other conditions, is on that list. But Melinda succeeded in losing an impressive amount of weight despite taking this drug.
“I have lost a 110 pounds over the last two and a half years. I still need to lose another 90 pounds. I just found an article written by you saying that metoprolol may prevent weight loss. This is very disheartening, as I have worked hard to lose weight and t...
Source: Wheat Belly Blog - April 1, 2016 Category: Cardiology Authors: Dr. Davis Tags: Wheat Belly Success Stories gluten grains metoprolol Weight Loss Source Type: blogs
DM / DNB Cardiology Entrance Mock Test 19
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled.
If loading fails, click here to try again
Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test.
Start
Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 19.
You scored %%SCORE%% out of %%TOTAL%%.
Your performa...
Source: Cardiophile MD - February 25, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
What Accounts For The Lower Growth In Health Care Spending?
Several recent studies have examined the factors accounting for the recent slowdown in growth in real per capita health care spending. The most recent entrant to this literature is the newly published work of Dunn, Rittmueller, and Whitmire. Earlier work has identified two large categories of change as contributors to slower growth: the 2007-2009 recession, and other structural changes in the delivery and payment of health care. Understanding the relative role of these two factors is important in determining whether the slowdown is temporary or will be sustained.
The new paper by Dunn and colleagues builds on a framework t...
Source: Health Affairs Blog - February 18, 2016 Category: Health Management Authors: Kenneth Thorpe Tags: Costs and Spending Drugs and Medical Technology Featured Organization and Delivery Diabetes hyertension off patent drugs Prescription Drugs Source Type: blogs
Things of which I will never tire, part three thousand and forty-six:
1. The look on an attending's face when the nursing staff in the NCCU actually knows something. We read our patients' charts before the shift begins, we review lab results, we read EKGs and check out the results on CT scans and EEGs. Yet, for some reason, the attendings will never get over that first, pure shock of a simple nurse knowing something he (usually "he") doesn't about a patient.(Nota bene: this is not all attendings, just a couple. Dr. Vizzini and Dr. Manbags come to mind.)2. Pure thankfulness from a resident when we solve a problem or save them from a hideous fate. Dude/ette, that's what we're here for. You got...
Source: Head Nurse - February 14, 2016 Category: Nursing Authors: Jo Source Type: blogs
The Electrocardiographically Silent Circumflex Artery
A 39 yo otherwise healthy man with no risk factors was walking at the mall when he developed chest pressure. He presented to the ED after 30 minutes, now also feeling weak. He was diaphoretic. Here was his initial ECG:There is sinus rhythm. There is abnormal T-wave inversion in V2 which is abnormal and very suspicious There is minimal, nondiagnostic ST elevation in inferior leads with possibly a suggestion of reciprocal ST depression in aVL. There are thin and normal inferior Q-waves. Thus, there are some suspicious abnormalities, but no definite signs of ischemia. There is a...
Source: Dr. Smith's ECG Blog - January 31, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
The Electrocardiographically Circumflex Artery
A 39 yo otherwise healthy man with no risk factors was walking at the mall when he developed chest pressure. He presented to the ED after 30 minutes, now also feeling weak. He was diaphoretic. Here was his initial ECG:There is sinus rhythm. There is abnormal T-wave inversion in V2 which is abnormal and very suspicious There is minimal, nondiagnostic ST elevation in inferior leads with possibly a suggestion of reciprocal ST depression in aVL. There are thin and normal inferior Q-waves. Thus, there are some suspicious abnormalities, but no definite signs of ischemia. There is a...
Source: Dr. Smith's ECG Blog - January 31, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
MKSAP: 59-year-old woman with continued substernal chest pain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 59-year-old woman is evaluated for continued substernal chest pain. She presented with exertional chest pain 6 months ago that occurred with minimal ambulation. She was evaluated with a stress nuclear medicine myocardial perfusion study that showed no ST-segment changes but a small area of inducible ischemia in the lateral area of the left ventricle and an ejection fraction of 45%. She was initially treated medically but has continued to have chest pain with exertion despite the addition of multiple antiangina...
Source: Kevin, M.D. - Medical Weblog - January 30, 2016 Category: Journals (General) Authors: mksap Tags: Conditions Heart Source Type: blogs
DM / DNB Cardiology Entrance Mock Test 7
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled.
If loading fails, click here to try again
Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test.
Start
Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 7.
You scored %%SCORE%% out of %%TOTAL%%.
Your performan...
Source: Cardiophile MD - January 23, 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
DM / DNB Cardiology Entrance Mock Test 6
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled.
If loading fails, click here to try again
Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test.
Start
Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 6.
You scored %%SCORE%% out of %%TOTAL%%.
Your performan...
Source: Cardiophile MD - January 22, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
DM / DNB Cardiology Entrance Mock Test 5
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled.
If loading fails, click here to try again
Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test.
Start
Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 5.
You scored %%SCORE%% out of %%TOTAL%%.
Your performance...
Source: Cardiophile MD - January 20, 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
