Research & Reviews in the Fastlane 107
This study suggests we’re even worse at it when the ED is busy. Researchers looked at 1116 hand hygiene opportunities presented to nurses, physicians and other healthcare professionals and used time to physician assessment as a marker of ED crowding. Mean hand hygiene compliance was only 29% but more worryingly longer mean time to physician assessment and higher nursing hours were associated with even lower compliance (24%). The bottom line? No matter how busy you are, WASH YOUR HANDS!
Recommended by Lauren Westafer, Natalie May
Emergency Medicine
Tseng HJ et al. Imaging Foreign Bodies: Ingested, Aspirated, and...
Source: Life in the Fast Lane - November 4, 2015 Category: Emergency Medicine Authors: Jeremy Fried Tags: Cardiology Education Emergency Medicine Infectious Disease Intensive Care Neurology Pediatrics R&R in the FASTLANE Respiratory Resuscitation clinical critical care EBM FOAM literature recommendations research and reviews Source Type: blogs
Research & Reviews in the Fastlane 103
This study is quite limited as it doesn’t include potential recommendations for these over the counter medications but is a good reminder to prescribe stool softeners/laxatives with opioids.
Recommended by Lauren Westafer
Emergency medicineRodrigo GJ et al. Assessment of acute asthma severity in the ED: are heart and respiratory rates relevant? Am J Emerg Med 2015. PMID 26233619
The authors of this paper want to tell us that vitals signs aren’t helpful in asthma, but I think their conclusions are entirely backwards.
This is a retrospective look at data that was collected prospectively as part of 7 other asth...
Source: Life in the Fast Lane - October 7, 2015 Category: Emergency Medicine Authors: Soren Rudolph Tags: Airway Anaesthetics Education Emergency Medicine Immunology Infectious Disease Intensive Care Pre-hospital / Retrieval R&R in the FASTLANE Resuscitation Trauma critical care Review Source Type: blogs
Long QT Syndrome with Continuously Recurrent Polymorphic VT: Management
A young woman presented with intermittent shocks from her implantable defibrillator. She was intermittently unconscious and unable to give history. The monitor showed intermittent polymorphic ventricular tachycardia. The physician was presented with this ECG at the same moment he was observing the repeated syncope:Time zeroIt is a bigeminal rhythm with a very bizarre PVC. The PVC has an incredibly long QT, but the intervening native rhythms do not. However, when I saw this (it was texted to me), it immediately reminded me of this case, so I knew by sheer recognition that it was lo...
Source: Dr. Smith's ECG Blog - July 8, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
Cardiology MCQ: Drug not useful for treatment of HOCM
Which of the following is not useful in the treatment of hypertrophic obstructive cardiomyopathy (HOCM)?
a) Verapamil
b) Metoprolol
c) Isoprenaline
d) Disopyramide
Correct answer: c) Isoprenaline
Isoprenaline is an inotropic agent which will increase the myocardial contractility and thereby the obstruction in hypertrophic obstructive cardiomyopathy.
The post Cardiology MCQ: Drug not useful for treatment of HOCM appeared first on Cardiophile MD. (Source: Cardiophile MD)
Source: Cardiophile MD - May 13, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Antihypertensives in heart failure – Cardiology MCQ
Antihypertensives to be avoided in heart failure include all of the following except:
a) Verapamil
b) Moxonidine
c) Diltiazem
d) Enalapril
Correct answer: d) Enalapril
Enalapril is one of the recommended drugs for hypertension in heart failure. All the other drugs have been shown to produce worsening of heart failure.
The post Antihypertensives in heart failure – Cardiology MCQ appeared first on Cardiophile MD. (Source: Cardiophile MD)
Source: Cardiophile MD - May 10, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Drug contraindicated in HOCM – Cardiology MCQ
Drug contraindicated in hypertrophic obstructive cardiomyopathy (HOCM):
a) Digoxin
b) Metoprolol
c) Disopyramide
d) All of the above
Correct answer: a) Digoxin
Digoxin should be avoided in HOCM because of its positive inotropic effect, which can exacerbate the left ventricular outflow tract obstruction. Metoprolol and disopyramide are useful in alleviating symptoms of HOCM due to their negative inotropic effect. Caution has to be exerted while using verapamil for its negative inotropic effect in this situation as its vasodilatory effect can sometimes be deleterious in those with dynamic left ventricular outflow tract obs...
Source: Cardiophile MD - April 30, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Does Insurance Cover Botox Injections for Migraine Headaches?
Unfortunately no insurance company covers Botox therapy for generic headaches. Many will cover Botox for chronic migraines, which have been unresponsive to standard preventative therapies. In 2011, the FDA approved Botox for treating chronic migraines which have been unresponsive to an adequate trial of preventative medications. Preventative medications do not include the use of any narcotic pain killers. Insurance companies have made it difficult for patients to obtain Botox payment authorization, by putting in place numerous qualification barriers – if they cover Botox at all.
Insurance companies do require e...
Source: Sarasota Neurology - March 3, 2015 Category: Neurology Authors: Dan Kassicieh, D.O. Tags: Migraines / Headache Boto for headaches Botox covered by insurance botox for headaches Botox Headaches Insurance Source Type: blogs
ED Case of Catecholaminergic Polymorphic Ventricular Tachycardia
This article only comments on chronic management, not acute management. (Source: Dr. Smith's ECG Blog)
Source: Dr. Smith's ECG Blog - February 6, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
What is Belhassen’s VT?
Belhassen’s VT: Idiopathic Fascicular Ventricular Tachycardia
Heart Disease FAQ / Brief Review
Abstract: Belhassen’s VT is idiopathic fascicular ventricular tachycardia originating from the left posterior fascicle. It is responsive to verapamil and is an ablatable VT.
On Belhassen’s VT for Heart Disease FAQ
Belhassen’s VT is a fast rhythm originating from the left ventricle. VT is short for ventricular tachycardia. It is named after the person who described it. Belhassen’s VT originates from a branch of the left bundle branch known as the posterior fascicle. Hence it is also known as poste...
Source: Cardiophile MD - January 25, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: ECG / Electrophysiology Heart Disease FAQ Source Type: blogs
Medications After a Heart Attack
From: www.secondscount.orgYour heart attack recovery will include medications. Taking these medications exactly as prescribed is one of the best tools at your disposal for avoiding death in the months following a heart attack. According to an article published in Circulation, the journal of the American Heart Association, heart attack patients who had not filled any of their prescriptions within 120 days of being discharged from the hospital had 80 percent greater odds of death than those who filled all of their prescriptions.Medications you are likely to be prescribed after a heart attack fall int...
Source: Dr Portnay - January 23, 2015 Category: Cardiology Authors: Dr Portnay Source Type: blogs
A Young Woman with A Wide Complex Regular Tachycardia.
A woman in her early 30s with no past medical history presented with palpitations. She had no chest pain, SOB, shock, hypotension. She felt otherwise well.Here is her 12-lead ECG:How would you treat this patient?Far less important: What kind of regular wide complex tachycardia is it?First, the patient is otherwise healthy and in no distress. She tolerates this very well. Thus, whether it is 1) Ventricular Tachycardia (VT), 2) SVT (AVNRT) with aberrancy, or even 3) antidromic AV reciprocating tachycardia (AVRT) does not matter for the emergency management. (Atrial flutter and atrial tach ...
Source: Dr. Smith's ECG Blog - January 7, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
MKSAP: 55-year-old man with nonischemic cardiomyopathy
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 55-year-old man is evaluated during a routine examination. He has a 2-year history of nonischemic cardiomyopathy. (Echocardiogram 2 years ago demonstrated a left ventricular ejection fraction of 35%.) He is feeling well and reports no shortness of breath; he walks 2 miles daily without symptoms. Medical history is remarkable for hypertension. Medications are lisinopril, carvedilol, and chlorthalidone.
On physical examination, blood pressure is 150/90 mm Hg and pulse rate is 50/min. No jugular venous distention...
Source: Kevin, M.D. - Medical Weblog - November 15, 2014 Category: Journals (General) Authors: mksap Tags: Conditions Heart Source Type: blogs
Cardiology MCQ 284: ECG Quiz
(Click on the image for an enlarged view)
ECG Quiz: What is the rhythm?
a) Sinus bradycardia
b) Idioventricular rhythm
c) Junctional rhythm
d) None of the above
["Click here for the answer with explanation", "Correct Answer:"]
c) Junctional rhythm
Regular narrow QRS rhythm at 60 per minute is seen with normal QRS and T waves. P waves are not seen. The first possibility is a junctional rhythm. In a mid junctional rhythm the P waves will be within the QRS and not visible. In a high junctional rhythm the P waves will be inverted in leads II, III and aVf, occurring with a short PR interval. In low junctional rhythm the P ...
Source: Cardiophile MD - August 25, 2014 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
Poor Microvascular Reperfusion ("No Reflow"): Best Diagnosed by ECG
This study demonstrates the importance of frequent static ECG’s and the insensitivity of using only 2 static ECG’s to detect reperfusion. In 58% of patients, ST segments were unstable, rising and falling, before final resolution.Infrequent static ECG’sCaliff RM et al., Failure of simple clinical measurements to predict perfusion status after intravenous thrombolysis, 1988. Methods: Califf et al. (339) performed angiography on 386 TAMI patients at 60 and 90 minutes post-administration of tissue plasminogen activator (tPA). They recorded a baseline ECG and another at 90 minutes post-tPA, before ...
Source: Dr. Smith's ECG Blog - August 9, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
