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A man in his 50s with acute chest pain and diffuse ST depression
Submitted by Alex Bracey, with edits by Meyers and SmithA man in his 50s with history of type B aortic dissection with prior TEVAR experienced acute onset chest pain at rest and presented to the Emergency Department. Here is his ECG on arrival:What do you think?Here is a prior ECG on file (presumed baseline):There is sinus rhythm with minimal STD in V5, V6, II, III, aVF. There is the tiniest amount of STE in aVL, but the T wave is not hyperacute (instead there is a terminal inversion). I would call this ECG consistent with subendocardial ischemia, but also the question of possible high lateral OMI (for which I am not ...
Source: Dr. Smith's ECG Blog - March 19, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
An operative field of dreams
I am in a select crowd. I have been fortunate enough to help some special people in their time of pain and heartache and bewilderment, facing operation or cancer or other ailments. I was fortunate to even get into medical school when I did; my grades weren ’t too good, and no doubt in my mind […]Find jobs at Careers by KevinMD.com. Search thousands of physician, PA, NP, and CRNA jobs now. Learn more.
Source: Kevin, M.D. - Medical Weblog - March 16, 2021 Category: General Medicine Authors: < span itemprop="author" > < a href="https://www.kevinmd.com/blog/post-author/arthur-williams" rel="tag" > Arthur Williams, MD < /a > < /span > Tags: Physician Surgery Source Type: blogs
80-something year old with acute chest pain. 3 visits. Fascinating Ultrasound progression
An 80-something year old man with history of metastatic cancer had acute onset of chest pain and called 911.Here is his prehospital ECG:What do you think?The computer read ***Anterior STEMI*** along with RBBB.Smith interpretation: There is Right Bundle Branch Block (RBBB). There is 1 mm of STE in inferior leads and also in lateral precordial leads. As a general rule, RBBB should not have ST Elevation (there are some infrequent patients with RBBB who have non-ischemic STE, usually discordant to the negative S-wave, as in this case). Moreover, the T-waves appear hyperacute.I would activate the cath lab base...
Source: Dr. Smith's ECG Blog - March 15, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
Peekaboo
Well, about two weeks ago we received the sad but expected news that Peekaboo has an inoperable and malignant nasal tumor located on the left side of her face, the side that has become deformed. The vets refer to it as a sarcoma.
Because of her age (she’s almost 14 years old) and other factors, the vets and Stefano and I are in agreement: we’ll do nothing, except monitor her and (try to) make sure she’s not in pain (although it’s very difficult to figure out if a cat is in pain or not)…
I’ve begun giving her curcumin, mixed in with her wet food, but it’s way too early (just a few d...
Source: Margaret's Corner - March 1, 2021 Category: Cancer & Oncology Authors: Margaret Tags: Blogroll feline nasal cancer feline sarcoma Source Type: blogs
Pain model – helping to target change
In my recent post on behavioural approaches to pain management, I had a number of commentators ask why do it, why not focus on pain intensity, and aren’t I invalidating a person’s experience if I target a person’s response to their experience. Today’s post will explore some of these points.
I suppose my first point needs to distinguish between pain as an experience, and pain behaviour – or what we do when we experience pain. I like to use a pretty old “model” or diagram to help untangle these concepts. It’s drawn from Loeser’s “Onion ring” model, and he w...
Source: HealthSkills Weblog - February 28, 2021 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Clinical reasoning Coping strategies Pain Pain conditions Therapeutic approaches models pain models Source Type: blogs
A North Carolina Pediatric Hospitalist Tells Her Pandemic Story to Senator Richard Burr: Thirteen Months (And Counting) In Medical Whistle-blower Hell - Courtesy Of Private Equity/For-Profit Healthcare And Cruelly-Indifferent/Morally-Bankrupt State & Federal Oversight
Author ' s Note: I cannot " sound-bite " the last year - and perhaps it ' s time to write the book. Scroll about half-way down to read the letter to Senator Burr. The bottom line is that for thethird time in 23 years, as a Pediatrician staffing a community hospital, I was fired " with-out cause " immediately after intervening in a neonatal ( " bad baby " ) case, rescuing the situation/ " saving " the baby, and reporting it INTERNALLY to Peer Review. NO discussion. NO recourse. NO review. A total cover-up. And EVERY SINGLE TIME I ' ve asked the state/Federal government to enfor...
Source: Dr.J's HouseCalls - February 28, 2021 Category: American Health Tags: ACA Apollo Global Management ApolloMD Ballad Heath Central Carolina Hospital CMS Duke Lifepoint ETSU Medicaid Medical Whistleblower NCDHHS Pandemic Quality Assruance Randolph Health Richard Burr Trump Source Type: blogs
The Paradigm Shift That Wasn ’ t: The ISCHEMIA Trial
By ANISH KOKA
A recent email that arrived in my in-box a few weeks ago from an academic hailed the latest “paradigm shift” in cardiology as it relates to the management of stable angina. (Stable angina refers to chronic,non-accelerating chest pain with a moderate level of exertion). The points made in the email were as follows (the order of the points made are preserved):
The financial burden of stress testing was significant ( 11 billion dollars per annum in the USA!)For stable CAD, medical treatment is critical. We now have better medical treatments than all prior trials including ischemia. th...
Source: The Health Care Blog - February 26, 2021 Category: Consumer Health News Authors: Christina Liu Tags: Medical Practice Physicians Anish Koka cardiology ISCHEMIA trial Source Type: blogs
Grown Children Should Not Attempt to Force Their Beliefs on Dying Parent
Photo credit Sven Mieke
Dear Carol: I dearly love my husband who is 81. This is a second marriage for both of us, but we’ve been married 23 happy years. Now, my beloved is dying from cancer. He has other health challenges, including emphysema, and he’s made his peace. All that he wants now is pain relief, so we’ve been working with hospice to provide what they can. His grown children, who’ve seen little of him, have become aggressive in pushing their religious view...
Continue reading on Inforum for insight into how adult children can make end-of-life harder for parents:
Purchase Minding Our Elders: Caregiver...
Source: Minding Our Elders - February 23, 2021 Category: Geriatrics Authors: Carol Bradley Bursack Source Type: blogs
Why We Need Good Primary Care Physicians
By HANS DUVEFELT
I have made the argument that being the first contact for patients with new symptoms requires skill and experience. That is not something everybody agrees on.
One commenter on my blog expressed the opinion that it is easy to recognize the abnormal or serious and then it is just a matter of making a specialist referral.
That is a terribly inefficient model for health care delivery. It also exposes patients to the risks of delays in treatment, increased cost and inconvenience and the sometimes irreversible and disastrous consequences of knowledge gaps in the frontline provider.
UNNECESSARY SPECIA...
Source: The Health Care Blog - February 15, 2021 Category: Consumer Health News Authors: Christina Liu Tags: Medical Practice Physicians Primary Care Hans Duvefelt primary care physicians Source Type: blogs
Flowers, chocolates, organ donation — are you in?
Chocolates and flowers are great gifts for Valentine’s Day. But what if the gifts we give this year could be truly life-changing? A gift that could save someone’s life, or free them from dialysis?
You can do this. For people in need of organ, tissue, or blood donation, a donor can give them a gift that exceeds the value of anything that you can buy. That’s why February 14th is not only Valentine’s Day — it’s also National Donor Day, a time when health organizations nationwide sponsor blood drives and sign-ups for organ and tissue donation. Read on if you’ve ever wondered what can be donated, had reservations ...
Source: Harvard Health Blog - February 11, 2021 Category: Consumer Health News Authors: Robert H. Shmerling, MD Tags: Health Heart Health Kidney and urinary tract Lung disease Source Type: blogs
COVID-19 vaccines: Safety, side effects –– and coincidence
As the pandemic rages on, it’s increasingly clear that widespread vaccination is essential to help contain it. Physical distancing, universal face coverings, and frequent handwashing are effective, but not foolproof. And of course, these measures don’t work if they are not followed.
So, the rapid development of mRNA vaccines and other vaccines to prevent COVID-19 is welcome — some say miraculous — news. But while many people are scrambling to get a vaccine, others are hesitating.
Start here: Are these vaccines safe and effective?
It’s natural to wonder if brand new vaccines against a novel coronavirus, developed ...
Source: Harvard Health Blog - February 8, 2021 Category: Consumer Health News Authors: Robert H. Shmerling, MD Tags: Health Vaccines Source Type: blogs
COVID-19 vaccines: Safety, side effects — and coincidence
As the pandemic rages on, it’s increasingly clear that widespread vaccination is essential to help contain it. Physical distancing, universal face coverings, and frequent handwashing are effective, but not foolproof. And of course, these measures don’t work if they are not followed.
So, the rapid development of mRNA vaccines and other vaccines to prevent COVID-19 is welcome — some say miraculous — news. But while many people are scrambling to get a vaccine, others are hesitating.
Start here: Are these vaccines safe and effective?
It’s natural to wonder if brand new vaccines against a novel coronavirus, developed ...
Source: Harvard Health Blog - February 8, 2021 Category: Consumer Health News Authors: Robert H. Shmerling, MD Tags: Health Vaccines Source Type: blogs
81 Adversity Quotes to Help You Overcome Tough Times
We all face tough times and setbacks from time to time. That's just a part of life. But how we handle it makes all the difference.
So in today's post I’d like to share the best quotes on adversity.
Timeless thoughts from the past 2000+ years about how to deal with and overcome adversity but also about what the benefits of adversity in life are.
I hope these thoughts and advice will be as helpful for you as they have been for me the past few years.
And if you want more motivation then have a look at this post about dealing with the Humpday slump and check out this one filled with quotes about inner peace.
Inspiring...
Source: Practical Happiness and Awesomeness Advice That Works | The Positivity Blog - February 8, 2021 Category: Consumer Health News Authors: Henrik Edberg Tags: Personal Development Source Type: blogs
The Art of Asking: What ’s Your Biggest Fear?
By HANS DUVEFELT
When a patient presents with a new symptom, we quickly and almost subconsciously create a hierarchy of diagnostic possibilities. I pride myself in my ability to effectively share my process of working through these types of clinical algorithms.
But sometimes I seem to get nonverbal clues of dissatisfaction or simply no reaction at all to my eloquent reasoning. And only then do I remember to ask the important questions, “do you have any thoughts on what’s causing this” and, most importantly, “what’s your biggest fear that this could be”.
It doesn’t matter how brilliant a diagnostician...
Source: The Health Care Blog - February 5, 2021 Category: Consumer Health News Authors: Christina Liu Tags: Medical Practice Physicians Primary Care Hans Duvefelt Source Type: blogs
Confronting Stigma From Opioid Use Diorder in Cancer Care
by Fitzgerald Jones, Ho, Sager, Rosielle and MerlinHave you ever been so distressed by a perspective piece that it kept you up at night? The type of rumination that fills you with so much angst that you have no choice but to act. This is exactly how we felt when we read theAAHPM Quarterly Winter 2020 Let ’s Think About It Again.1 (member paywall)The column, which is structured as a sort of written debate in which two authors argue a clinical question, describes a case of a 45-year-old man with severe substance use disorder (SUD) recently diagnosed with extensive-stage small-cell lung cancer. He was offered aggr...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 30, 2021 Category: Palliative Care Tags: ftigerald jones ho merlin rosielle sager Source Type: blogs
