A female in her 60s who was lucky to get expert ECG interpretation
Submitted and written by Alex Bracey, with edits by Pendell Meyers and Steve Smith:I was walking through the critical care section of the ED when I overheard a discussion about the following ECG. I had no history on the case and no prior ECG for comparison.What do you think?Here are inferior leads, and aVL, magnified:A closer inspection of the inferior leads and aVLSinus bradycardia. The T-wave in lead III is slightly tall and broad (increased area under the curve) compared to its QRS complex. In isolation, this probably could not be called a hyperacute T-wave, but you may suspect it. There is T-wave invers...
Source: Dr. Smith's ECG Blog - February 15, 2018 Category: Cardiology Authors: Pendell Source Type: blogs
Research and Reviews in the Fastlane 191
This article has spawned a lot of controversy. It is worth reading to understand why.
Recommended by: Justin Morgenstern
Emergency Medicine
Samuels EA, et al. “Sometimes You Feel Like the Freak Show”: A Qualitative Assessment of Emergency Care Experiences Among Transgender and Gender-Nonconforming Patients. Annals of emergency medicine. 2017. PMID: 28712604
This is a qualitative study of transgender patients who visited an ED in the US. This article is a must read as providers often lack insight into the complexities of caring for transgender patients and systemic barriers to conscientious care. This arti...
Source: Life in the Fast Lane - January 10, 2018 Category: Emergency Medicine Authors: Justin Morgenstern Tags: Emergency Medicine Gastroenterology R&R in the FASTLANE Respiratory Resuscitation EBM Education recommendations research and reviews Source Type: blogs
So I ’ m a fellow now
I always “knew” that I was going to be the nice fellow. Partly because I’ve had some terrible experiences with fellows during residency (which I’m still salty about, by the way. I mean, listen, there is never a scenario where I, as an intern, am ‘deciding’ to consult you. The intern is just doing what they were damn well told) – but mostly because I figured I didn’t know anywhere near enough about pediatric neurology to be mean or even a wee bit testy.
… I was perhaps wrong.
This gradual realization reminds me of being an intern and “knowing” that I was goin...
Source: Action Potential - December 15, 2017 Category: Universities & Medical Training Authors: Action Potential Tags: Uncategorized Source Type: blogs
So I ’m a fellow now
I always “knew” that I was going to be the nice fellow. Partly because I’ve had some terrible experiences with fellows during residency (which I’m still salty about, by the way. I mean, listen, there is never a scenario where I, as an intern, am ‘deciding’ to consult you. The intern is just doing what they were damn well told) – but mostly because I figured I didn’t know anywhere near enough about pediatric neurology to be mean or even a wee bit testy.
… I was perhaps wrong.
This gradual realization reminds me of being an intern and “knowing” that I was goin...
Source: Action Potential - December 15, 2017 Category: Universities & Medical Training Authors: Action Potential Tags: Uncategorized Source Type: blogs
An August Appendectomy
In August, (one month ago today)I had an appendectomy. There was very little drama involved, the doctors office visit led straight to a same day CT scan and an emergency review with the radiologist who informed me the appendix couldn ' t be seen but the colon was most definitely inflamed and I should go to the ER if it got worse. To the ER I went that night, to a hospital where the D Care is very good (had that going for it). They admitted me under observation, coursing enough pain medications through me to make me sick for the next 14 hours. The plan was to do another CT the next day. In observation, as I was trying not t...
Source: The D-Log Cabin - September 20, 2017 Category: Endocrinology Authors: HVS Source Type: blogs
As US Attorney, Labor Secretary Nominee Enabled Drug and Biotechnology Executives' Impunity
The new Trump administration nominee for US Secretary of Labor is a former US Attorney for the southern district of Florida. In that role, he seemed to uphold the ideas that certain big corporations, particularly big pharmaceutical and biotechnology corporations, are too big to jail, and that top executives of big corporations should not be held accountable for their corporations ' actions.He had central involvement in three bigsettlements of charges of corporate misbehavior which held no individuals accountable for enabling, authorizing, directing or implementing the bad behavior. The settlements imposed only ...
Source: Health Care Renewal - February 21, 2017 Category: Health Management Tags: bribery Bristol-Myers-Squibb deception Donald Trump Genzyme GlaxoSmithKline impunity kickbacks legal settlements manipulating clinical research Sanofi-Aventis Source Type: blogs
Another Case of Vomiting
A 26-year-old man presented to the emergency department with nausea, vomiting, and abdominal pain. He said he had had the pain, which he said encompassed his entire abdomen, for three days.He had been unable to tolerate anything by mouth. His vitals on presentation included a heart rate of 115 bpm, blood pressure of 126/70 mm Hg, respiratory rate of 22 bpm, and pulse oximetry of 100% on room air.Physical examination revealed dry mucus membranes, dry skin, tachycardia without murmurs, and clear lungs. Abdominal examination demonstrates hyperactive bowel sounds without pain on palpation or hepatosplenomegaly. The patie...
Source: The Tox Cave - December 1, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Lieutenant Lumpy: An Update.
Another year, another clean set of scans and a pristine checkup with Dr. Crane and his Irrepressibly Cheerful Staff. (They always seem happy to see me? I guess because I don ' t look like Frankenstein ' s Monster?)Next year, because the lung nodule I have has not changed in six years, I can start getting annual chest x-rays rather than an annual chest CT, along with my usual head/neck/orbits MR. I ' ll have to get all that every year for the foreseeable future, because (as Dr. Crane said), " These stupid salivary gland tumors have a really long fuse. " And they tend to recur in both the original spot and met to really weir...
Source: Head Nurse - October 5, 2016 Category: Nursing Authors: Jo Source Type: blogs
What truly palliates? Do we choose or do we allow the patient to choose?
The day I met Mr. Lightfoot, he was a medical curiosity on teaching rounds, “a great example of a Sister Mary Joseph’s Nodule,” a sign of metastatic stomach cancer. Earl was lying in a hospital bed in the cancer unit of the hospital, his stomach completely distended, nauseous and vomiting, unable to eat anything. He had undergone a cycle of chemotherapy only days before.
I organized Mr. Lightfoot into a problem list:
1. Nausea / vomiting. Zofran and Compazine
2. Diet. IV fluids, PO intake as tolerated
3. Gastric cancer. Status post cycle of chemotherapy, hold for now.
The plan seemed simple.
Continue reading ...
You...
Source: Kevin, M.D. - Medical Weblog - September 21, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/divya-yerramilli" rel="tag" > Divya Yerramilli, MD < /a > Tags: Physician Cancer Source Type: blogs
On the Worst Healthcare Experience of My Life
By JESS JACOBS
This has been a very sad weekend for me personally, the wider health care community and for anyone who knew Jess Jacobs, who died on Saturday. She was only 29 years old, and was smart, funny, enthusiastic, and brave well beyond her years. She suffered from two very rare diseases, but was also working to push health policy forward at ONC, FDA and Aetna, and she really knew her stuff. Jess was a marvel and a rarity in more ways than one. She was #UnicornJess. (That link will take you to the twitter memorial on Sunday night, but also check out remembrances from Ted Eytan & Carly Medosch). I’m as...
Source: The Health Care Blog - August 15, 2016 Category: Consumer Health News Authors: Matthew Holt Tags: THCB #UnicornJess Hospital Care Jess Jacobs Source Type: blogs
Research and Reviews in the Fastlane 142
This study demonstrated that very early administration (pre-hospital) did not change outcomes in terms of infarct size. There was also no reduction in ventricular dysrhythmias. Once again we see that earlier is not always better.
Recommended by Anand Swaminathan
The R&R iconoclastic sneak peek icon key
The list of contributors
The R&R ARCHIVE
R&R Hall of famer You simply MUST READ this!
R&R Hot stuff! Everyone’s going to be talking about this
R&R Landmark paper A paper that made a difference
R&R Game Changer? Might change your clinical practice
R&R Eureka! Revolut...
Source: Life in the Fast Lane - July 13, 2016 Category: Emergency Medicine Authors: Jeremy Fried Tags: Cardiology Clinical Research Education Emergency Medicine Pediatrics R&R in the FASTLANE critical care EBM literature recommendations research and reviews Source Type: blogs
Research and Reviews in the Fastlane 133
This study certainly suggests a benefit to using Dexmedetomidine in these patients.
Recommended by: Nudrat Rashid
The Best of the Rest
Emergency Medicine
Beadle KL et al. Isopropyl alcohol nasal inhalation for nausea in the Emergency Department: A randomized controlled trial. Ann Emerg Med. 2015. PMID: 26679977
This is a small double-blinded RCT comparing inhaled isopropyl alcohol to saline placebo for short-term relief of nausea in the ED. Although it is hard to believe patients (and possibly investigators) were truly blinded to the odor of isopropanol, this study found isopropanol superior to placebo for improvement...
Source: Life in the Fast Lane - May 4, 2016 Category: Emergency Medicine Authors: Nudrat Rashid Tags: Education Emergency Medicine Intensive Care Neurology Neurosurgery critical care examination R&R in the FASTLANE recommendations research and reviews Resuscitation Source Type: blogs
Research and Reviews in the Fastlane 131
This study only shows an association and not causality and will need further prospective studies to elucidate the truth. However, in the absence of better evidence, either agent appears reasonable as the first line but rocuronium has a number of advantages (absence of contraindications, longer paralysis).
Recommended by: Anand Swaminathan
Read More: Does Succinylcholine Increase Mortality in Severe TBI Patients? (UMEM Education Pearls), Rocuronium vs. Succinycholine (Core EM)
The R&R iconoclastic sneak peek icon key
The list of contributors
The R&R ARCHIVE
R&R Hall of famer You simply MUST READ th...
Source: Life in the Fast Lane - April 20, 2016 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Cardiology Education Emergency Medicine Gastroenterology Intensive Care LITFL Neurology Pre-hospital / Retrieval Resuscitation EBM literature R&R in the FASTLANE recommendations research and reviews Source Type: blogs
T-wave inversion in a young woman with hyperventilation and carpopedal spasm
This case is another good one contributed by Brooks Walsh, with an excellent review.A 24 year-old African-American female presented to the ED with nausea and vomiting for 1 day. She also complained of paresthesias and cramping in her hands and wrists, as well as perioral paresthesias. She had no significant personal or family medical history. Vitals signs and exam were remarkable only for hyperventilation with clear lungs, and bilateral carpopedal spasms.An ECG was obtained to assess the QTc prior to administering ondansetron:A bedside focused echocardiogram did not demonstrate overt septal or concentric hype...
Source: Dr. Smith's ECG Blog - January 13, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
