A teenager with chest pain, a troponin below the limit of detection, and " benign early repolarization "
Sent by anonymous, written by Pendell MeyersA male in his teens presented with complaints of chest discomfort and dyspnea beginning while exercising but without obvious injury. He immediately stopped exercising and symptoms started to improve. Later that evening he felt recurrent central chest discomfort, shortness of breath, and vomited. Symptoms have been constant since this second episode, and are still present on arrival, which seems to have been less than 1 to 2 hours from onset of symptoms. No similar symptoms in the past. No prior exertional complaints of chest pain, dizziness, lightheadedness, or undue shortness of...
Source: Dr. Smith's ECG Blog - January 9, 2023 Category: Cardiology Authors: Pendell Source Type: blogs

What does LBBB look like in severe hypothermia? Is there a long QT? Is the QT appropriate for the temperature?
This patient was found down in a Minneapolis winter.  He was very cold with frostbitten fingers and toes.  He was alert but encephalopathic and delirious and very agitated and could not be adequately calmed with olanzapine and lorazepam, so we intubated him.  The first reliable temperature could only be obtained with a Foley thermistor, and it was 26.5 degrees C (79.7 F).His BP was 76/60.  K was 2.8 mEq/L.Here was his first ECG:There is sinus bradycardia with left bundle branch block (LBBB), with proportional ST-T, and VERY long QT and a PVC.  I measure the QT at 800 ms. Notice that there are ...
Source: Dr. Smith's ECG Blog - January 6, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs

Ischemic ST depression maximal in V1-V4 (vs. V5-V6), even if less than 0.1 millivolt, is specific for Occlusion Myocardial Infarction (vs. subendocardial non-occlusive ischemia)
Conclusion: Among high-risk ACS patients, the specificity for OMI of suspected ischemic STDmaxV1-4 was 97%. STEMI criteria missed half of OMIs detected by STDmaxV1-4. These data support that any ischemic STD maximal in V1-V4 in ACS is due to OMI until proven otherwise. (Source: Dr. Smith's ECG Blog)
Source: Dr. Smith's ECG Blog - June 27, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs

The Art of Prescribing (Or Not)
By HANS DUVEFELT I have learned a few things about prescribing medications during my 42 years as a physician. Some are old lessons, and some are more recent. I thought I’d share some random examples. First: I don’t like to have to use medications, but when they seem necessary, I choose, present and prescribe them with great care. CHOOSING MEDICATIONS Medications are like people. They have personalities. With so many choices for any given diagnosis or symptom, I consider their mechanism of action, possible beneficial additional effects and their risk of unwanted side effects when selecting which one to presc...
Source: The Health Care Blog - February 1, 2021 Category: Consumer Health News Authors: Christina Liu Tags: Medical Practice Patients Physicians Primary Care Hans Duvefelt Source Type: blogs

Olanzapine FTW for Nausea Outside of CINV
by Drew Rosielle (@drosielle)A few months agoan interesting olanzapine study was published which I have been meaning to write a post about. It ' s important because while olanzapine has really established itself in the last decade as a highly effective antiemetic for chemotherapy induced nausea and vomiting, and is now in multiple CINV guidelines (eg Antiemetics: ASCO Guideline), etc, we don ' t have a lot of data for its efficacy for nausea outside of CINV, and so a well-done RCT is welcome.The study is amulti-center, US, adult, randomized, placebo-controlled, double-blind trial of olanzapine for nausea in advanced cancer...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 1, 2021 Category: Palliative Care Tags: anorexia cachexia nausea olanzapine rosielle Source Type: blogs

Top 25 Psychiatric Medications for 2018
Psychiatric medications are an important part of treatment for many people with mental disorders, such as depression, bipolar disorder, ADHD, schizophrenia, anxiety, and others. They play an important role in helping to alleviate the most serious symptoms, allowing people to better focus on their lives and on other treatment types, such as psychotherapy. Psychiatric medications are an important part of many people’s treatment plans for obtaining the most effective treatment for a mental health concern or mental illness. It’s good to know what drugs are being prescribed most often for mental disorders in the U.S...
Source: World of Psychology - December 15, 2019 Category: Psychiatry & Psychology Authors: John M. Grohol, Psy.D. Tags: General Medications Psychiatry psychiatric meds psychiatric prescriptions Source Type: blogs

The Curse of Delusional Parasitosis
​Delusional parasitosis is a rare condition, but it is more common where methamphetamine and cocaine abuse is high. It is a fascinating condition to witness; patients are convinced that their skin is infested with foreign organisms or materials despite incontrovertible evidence to the contrary.This condition is known by numerous names—Ekbom syndrome, delusory parasitosis, psychogenic parasitosis, delusional parasitosis, delusional ectoparasitosis, formication, chronic tactile hallucinosis, dermatophobia, parasitophobia, and cocaine bugs—but delusional parasitosis and more recently delusional infestation are considere...
Source: M2E Too! Mellick's Multimedia EduBlog - September 29, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

True Confessions On Why I Prescribe Things Without'Evidence '
by Drew RosielleWe have a ' required reading ' list for our fellowship, which includes a bunch of what I think are landmark or otherwise really important studies. One of them is thisvery well done RCT of continuous ketamine infusions for patients with cancer pain, which showed it to be ineffective (and toxic).We also recently have seen another high-quality study published with negative results for ketamine. This was a Scottish, multi-center, randomized, placebo-controlled, intention-to-treat, and double-blinded study oforal ketamine for neuropathic pain in cancer patients. The study involved 214 patients, 75% of whom were ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 6, 2018 Category: Palliative Care Tags: fatigue ketamine methylphenidate neuropathic pain research research issues rosielle The profession Source Type: blogs

True Confessions On Why I Prescribe Things Without'Evidence '
by Drew RosielleWe have a ' required reading ' list for our fellowship, which includes a bunch of what I think are landmark or otherwise really important studies. One of them is thisvery well done RCT of continuous ketamine infusions for patients with cancer pain, which showed it to be ineffective (and toxic).We also recently have seen another high-quality study published with negative results for ketamine. This was a Scottish, multi-center, randomized, placebo-controlled, intention-to-treat, and double-blinded study oforal ketamine for neuropathic pain in cancer patients. The study involved 214 patients, 75% of whom were ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - July 6, 2018 Category: Palliative Care Tags: fatigue ketamine methylphenidate neuropathic pain research research issues rosielle The profession Source Type: blogs

What Are the Rules for Ethical Medication of Migrant Kids?
Reports that migrant children held by the Office of Refugee Resettlement are being drugged require an immediate and unambiguous response by the Trump administration. According to court filings, the drugs that are alleged to be among those given to children without their parents’ consent include clonazepam, duloxetine, guanfacine, geodon, olanzapine, latuda and divalproex. Drugging children without… Read more The post What Are the Rules for Ethical Medication of Migrant Kids? appeared first on The Hastings Center. (Source: blog.bioethics.net)
Source: blog.bioethics.net - July 2, 2018 Category: Medical Ethics Authors: Susan Gilbert Tags: Health Care Children & Psychiatric Medications Children and Families Hastings Bioethics Forum Health and Health Care migrant children psychotropic drugs syndicated Undocumented Patients Source Type: blogs

Let's Stop Claiming That Palliative Care Improves Survival
by Drew RosielleHospice and palliative care community, I ' m calling for a moratorium on all blanket, unqualified claims that hospice and palliative care improve survival.Let ' s just stop doing this.There has never been any actual evidence that palliative care (PC) interventions improve survival in patients, but since thelandmark Temel NEJM 2010 RCT of early outpatient palliative care for lung cancer patients showed a clinically and statistically significant improvement in longevity in the PC arm, I have heard and all read all sorts of statements by palliative people and all sorts of others (hospital executives, poli...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 30, 2018 Category: Palliative Care Tags: lung cancer palliative palliative care quality of life rosielle temel The profession Source Type: blogs

Let's Stop Claiming That Palliative Care Improves Survival
by Drew RosielleHospice and palliative care community, I ' m calling for a moratorium on all blanket, unqualified claims that hospice and palliative care improve survival.Let ' s just stop doing this.There has never been any actual evidence that palliative care (PC) interventions improve survival in patients, but since thelandmark Temel NEJM 2010 RCT of early outpatient palliative care for lung cancer patients showed a clinically and statistically significant improvement in longevity in the PC arm, I have heard and all read all sorts of statements by palliative people and all sorts of others (hospital executives, poli...
Source: Pallimed: A Hospice and Palliative Medicine Blog - June 30, 2018 Category: Palliative Care Tags: lung cancer palliative palliative care quality of life rosielle temel The profession Source Type: blogs

The 1000th Thread!
Discussion Blog)
Source: Bioethics Discussion Blog - December 24, 2017 Category: Medical Ethics Source Type: blogs

The 1000th Thread!
This is the 1000th presentation to my bioethics blog since starting on Google Blogspot.com in 2004.There has been many topics covered. Though comments by the visitors has always been encouraged and, since as a "discussion blog", comments leading to discussions I have felt was the definitive function here. Virtually none of the thread topics have gone unread and most have had some commentary, some with mainly particularly strong and emphatic opinions http://bioethicsdiscussion.blogspot.com/2013/01/should-pathologists-be-physicians.html, some with extensive up to 12 years long continued discussion http://bioethicsdiscussion....
Source: blog.bioethics.net - December 24, 2017 Category: Medical Ethics Authors: Maurice Bernstein, M.D. Tags: Health Care syndicated Source Type: blogs

Worst Health Care Revolving Door Case So Far, Version 2.0? - From President of Lilly USA to US Secretary of Health and Human Services?
DiscussionLast week we noted that Mr Trump famously promised to " drain the swamp " in Washington.  Last week, despite his previous pledges to not appoint lobbyists to powerful positions, he appointed a lobbyist to be acting DHHS Secretary.  This week he is apparently strongly considering Mr Alex Azar, a pharmaceutical executive to be permanent DHHS Secretary, even though the FDA, part of DHHS, has direct regulatory authority over the pharmaceutical industry, and many other DHHS policies strongly affect the pharmaceutical industry.  (By the way, Mr Azar was also in charge of one lobbying effort.) So sho...
Source: Health Care Renewal - October 19, 2017 Category: Health Management Tags: crime deception DHHS Donald Trump Eli Lilly legal settlements marketing regulatory capture revolving doors Source Type: blogs