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A completely healthy 30-something woman with acute chest pain -- this post is loaded with info !!!
p.p1 {margin: 0.1px 0.0px 0.1px 0.2px; font: 11.0px Helvetica}A previously healthy young woman presented to the ED with one hour of acute onset right sided chest pain and pressure, very severe, radiating down the right arm.  Here is her initial ED ECG (time 0):What do you think?My impression:without any other information, I looked at this ECG and 2 features stood out: 1) the T-wave in lead I is hyperacute.  It is far too large for that QRS.  2) The T-wave in V6 is far too large; it is almost as tall as the R-wave, which is distinctly abnormal.  3) there is slight downsloping ST depression in V2 whi...
Source: Dr. Smith's ECG Blog - September 15, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs

Most Doctors Are Ill-Equipped to Deal With the Opioid Epidemic. Few Medical Schools Teach Addiction. - The New York Times
To the medical students, the patient was a conundrum.According to his chart, he had residual pain from a leg injury sustained while working on a train track. Now he wanted an opioid stronger than the Percocet he'd been prescribed. So why did his urine test positive for two other drugs — cocaine and hydromorphone, a powerful opioid that doctors had not ordered?It was up to Clark Yin, 29, to figure out what was really going on with Chris McQ, 58 — as seven other third-year medical students and two instructors watched."How are you going to have a conversation around the patient's positive tox screen results?&...
Source: Psychology of Pain - September 14, 2018 Category: Anesthesiology Source Type: blogs

Changing the treatment plan when covering for another doctor
I was a little taken aback when Dr. C. changed my patient from warfarin to one of the novel anticoagulants. And one I seldom use, at that. I have only worked with her for about three years, and we seem to come from the same mold: seasoned family docs with a penchant for teaching and patient empowerment. I had not imagined she would step in and completely change my treatment plan when she was just covering for one day. As far as which is safer, warfarin with variable therapeutic effect and fluctuating INRs or novel anticoagulants, which have hardly been studied at all in patients on dialysis, you won’t see test results th...
Source: Kevin, M.D. - Medical Weblog - August 8, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/a-country-doctor" rel="tag" > A Country Doctor, MD < /a > Tags: Physician Cardiology Medications Source Type: blogs

The Best iPhone App for the Wheat Belly Lifestyle
The Wheat Belly lifestyle is powerful for not only losing weight but for healing many, many chronic health conditions. But it can sometimes be overwhelming to begin a new style of eating. Luckily, there is now an app that can help you on your journey with my Wheat Belly 10-Day Grain Detox called Suggestic. If you have struggled to adopt a grain-free lifestyle or are brand new to the Wheat Belly lifestyle, Suggestic can be a massive help in guiding you through the ups and downs of this new and healthy lifestyle. Let me explain what Suggestic is and the advantages of using it. Going Grain-Free I’ve seen many begin this ...
Source: Wheat Belly Blog - July 24, 2018 Category: Cardiology Authors: Dr. Davis Tags: News & Updates app Detox gluten-free grain-free grains menu recipes shopping list suggestic wheat belly Source Type: blogs

LITFL Review 341
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog Welcome to the 341st LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chunk of FOAM. Readers can subscribe to LITFL review RSS or LITFL review EMAIL subscription The Most Fair Dinkum Ripper Beauts of the Week PARAMEDIC-2 epi...
Source: Life in the Fast Lane - July 22, 2018 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: LITFL review LITFL R/V Source Type: blogs

A man in his 40s with chest pain
Case submitted and written by Alex Bracey, with edits by Pendell Meyers and Steve SmithThis ECG was tossed onto my desk on my first day of a new rotation at a community site. The technician was nowhere to be found by the time I turned to ask what the story is or where the patient is located.Initial ECG at 1350 - are you concerned? - There is 0.5 mm STE in aVL, no clear STE in lead I. - There is ST depression in II, III, and aVF. - Nicely demonstrated here, leads III and aVL are reciprocal: STD in III is reciprocal ST depression to STE in aVL.This is diagnostic of occlusion (OMI). - There is also some slight STD in V4-...
Source: Dr. Smith's ECG Blog - July 13, 2018 Category: Cardiology Authors: Pendell Source Type: blogs

Top Online ECG Courses
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog Difficult to master (and even harder to teach), the area of ECG interpretation has spawned an entire learning industry devoted to the topic. We take a Google deep dive to evaluate you 17 of the the best #FOAMed and paid ECG courses available online. ECG Course selection criteria Inclusion criteria: The ECG course had to be in the English language readily accessible online, without requiring a formal application process found within the first 50 organic Google search res...
Source: Life in the Fast Lane - July 3, 2018 Category: Emergency Medicine Authors: Michael Connelly Tags: ECG Education Review Website ECG Academy ECG Course ECG Course online EKG medmastery Medvarsity Top 10 Source Type: blogs

Watch what happens when " pericarditis " and morphine cloud your judgment
Submitted and written by Alex Bracey with edits by Pendell Meyers and Steve SmithCaseA 50ish year old man with a history of CAD w/ prior LAD MI s/p LAD stenting presented to the ED with chest pain “similar to his prior MI, but worse.” The pain initially started the daypriorto presentation. The pain roused him from sleep but subsided without intervention. Around 19 hours later, he experienced the same pain, which prompted his presentation to the ED. By this time, three hours had passed from the onset of the pain but it was no longer present. Here is his initial ECG:00:04What do you think? - Sinus rhythm at ~70 bpmSTE in...
Source: Dr. Smith's ECG Blog - July 3, 2018 Category: Cardiology Authors: Pendell Source Type: blogs

LITFL Review 338
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog Welcome to the 338th LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chunk of FOAM. Readers can subscribe to LITFL review RSS or LITFL review EMAIL subscription The Most Fair Dinkum Ripper Beauts of the Week Josh Farkas rev...
Source: Life in the Fast Lane - July 1, 2018 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: Education LITFL review Source Type: blogs

The Evidence Crisis: Causal Inference – Don ’ t be a chicken (Part 3)
By ANISH KOKA Part 1 Part 2 Physicians have been making up numbers longer than people have been guessing weights at carnivals.  How much does this statin lower the chances of a heart attack? How long do I have to live if I don’t get the aortic valve surgery? In clinics across the land confident answers emerge from doctors in white coats.  Most of the answers are guesses based on whatever evidence about the matter exists applied to the patient sitting in the room.  The trouble is that the evidence base used to be the provenance of experts and anecdotes that have in the past concluded leeches were good for pneumonia...
Source: The Health Care Blog - June 29, 2018 Category: Consumer Health News Authors: anish_koka Tags: Uncategorized Source Type: blogs

Meet Mr Miyagi of ECGs – Melbourne September 2018
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog For the 3rd year running and return of Professor Amal Mattu (Mr Miyagi of ECGs), Melbourne is hosting another jam packed Emergency Cardiology Update, on the 8th and 9th of September 2018. Who’s going to be there? A line up of cardiology heavy weights! First Professor Amal Mattu whose relentless teaching of cardiology has earnt him numerous awards including the national educator of the year award and in 2013 ACEP’s highest honour for teaching, the “o...
Source: Life in the Fast Lane - June 21, 2018 Category: Emergency Medicine Authors: Neil Long Tags: Conference Amal Mattu Emergency Cardiology melbourne Source Type: blogs

Understanding and Creating Calculators for Medical Diagnoses: Exclusive Interview with MDCalc
  MDCalc is a 13-year-old medical reference started by two practicing emergency medicine physicians, Dr. Joe Habboushe and Dr. Graham Walker. A recent survey by EB Medicine has shown that MDCalc’s 370+ tools are now used weekly by 65% of U.S. ...
Source: Medgadget - June 15, 2018 Category: Medical Devices Authors: Alice Ferng Tags: Cardiology Critical Care Emergency Medicine Exclusive Neurology Pediatrics Public Health Source Type: blogs

The Collaborative Nature of Psychotherapy
“I don’t believe in psychotherapy.”  “Therapy is for crazy people; you’re not crazy.” “Therapy is for narcissists who just like to hear themselves talk.” “Therapy is for weak wimps who can’t solve their own problems.” “Therapy is for whiners who complain about everything.” “Therapy is like talking to a friend; why pay someone when you can talk to me?” These beliefs are what stops many people from seeking out psychotherapy. Too bad. For when therapy is humming, the possibilities for growth are endless. Instead of honing in only on your shortcomings, you learn ways to develop your best self....
Source: World of Psychology - May 8, 2018 Category: Psychiatry & Psychology Authors: Linda Sapadin, Ph.D Tags: Psychology Psychotherapy Stigma Treatment Character Strengths Coping Skills Personal Growth Therapeutic Alliance Therapeutic Approach Source Type: blogs

Chest Pain, " Negative " Stress Tests, POCUS, & ECG Equations -- A Case from Salim Rezaie (R.E.B.E.L. EM)
This case is posted by Salim Rezaie (@srrezaie)Chest Pain, “Negative” Stress Tests, POCUS,& ECG EquationsIt has some peer review by me at the end, so we ' reco-posting!!Chest Pain, " Negative " Stress Tests, POCUS,& ECG Equationsby Salim RezaieI was working a busy shift in the ED, like many of us do, and the next patient I was going to see was a 57 year old male with no real medical problems complaining of chest pain.  I remember thinking as I walked into the room this guy looks ashen and diaphoretic ….he doesn’t look well.  He is a paramedic telling me how he has been having off and on chest pain...
Source: Dr. Smith's ECG Blog - April 30, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs