Ahead of Print: Demystifying the Pediatric ECG
Emergency physicians are able to quickly decode the ciphers of ECGs into meaningful clinical data, at least until they are faced with a pediatric ECG. It breaks their pattern recognition, and they are forced to use the slow part of their brain (recommended reading: Daniel Kahneman’s Thinking, Fast and Slow). Even though the pediatric ECG looks vaguely similar to all of the other ECGs seen during a shift, this one turns into a mystery and confidence drains. It doesn’t look normal based on an adult tracing, but they are unsure if it’s normal for the child. The best ECG readers can resort to folding the tracing unde...
Source: Spontaneous Circulation - August 3, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Ahead of Print: Demystifying the Pediatric ECG
Emergency physicians are able to quickly decode the ciphers of ECGs into meaningful clinical data, at least until they are faced with a pediatric ECG. It breaks their pattern recognition, and they are forced to use the slow part of their brain (recommended reading: Daniel Kahneman’s Thinking, Fast and Slow). Even though the pediatric ECG looks vaguely similar to all of the other ECGs seen during a shift, this one turns into a mystery and confidence drains. It doesn’t look normal based on an adult tracing, but they are unsure if it’s normal for the child. The best ECG readers can resort to folding the tracing under...
Source: Spontaneous Circulation - August 3, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Demystifying the Pediatric ECG
Emergency physicians are able to quickly decode the ciphers of ECGs into meaningful clinical data, at least until they are faced with a pediatric ECG. It breaks their pattern recognition, and they are forced to use the slow part of their brain (recommended reading: Daniel Kahneman’s Thinking, Fast and Slow). Even though the pediatric ECG looks vaguely similar to all of the other ECGs seen during a shift, this one turns into a mystery and confidence drains. It doesn’t look normal based on an adult tracing, but they are unsure if it’s normal for the child. The best ECG readers can resort to folding the tracing under...
Source: Spontaneous Circulation - August 3, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
A Patient's Lie Masks the Cause of Chest Pain
A man in his 30s comes to your emergency department at 3 a.m. profoundly diaphoretic and reporting severe 10/10 chest pain. He has been at a party all night, and the chest pain started about 30 minutes earlier. He had a previous heart attack, but cannot remember many of the details. He reports no medication or drug use. No doubt this is a concerning presentation, and you immediately order an ECG, blood work, and an aspirin.
While this is in process, you review the electronic medical information, which reveals that the previous “heart attack” was actually observation for chest pain rule-out. The ECG showed nonspeci...
Source: Spontaneous Circulation - July 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
A Patient's Lie Masks the Cause of Chest Pain
A man in his 30s comes to your emergency department at 3 a.m. profoundly diaphoretic and reporting severe 10/10 chest pain. He has been at a party all night, and the chest pain started about 30 minutes earlier. He had a previous heart attack, but cannot remember many of the details. He reports no medication or drug use. No doubt this is a concerning presentation, and you immediately order an ECG, blood work, and an aspirin.
While this is in process, you review the electronic medical information, which reveals that the previous “heart attack” was actually observation for chest pain rule-out. The ECG showed nonspecifi...
Source: Spontaneous Circulation - July 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
A Forty-Year Struggle for Openness
In 1977, while I was busy with Star Wars and action figures, Andreas Gruentzig was using his kitchen-made balloon catheter to dilate and open a highly stenotic LAD coronary artery. Fixing atherosclerotic disease of the coronary arteries had previously required open heart bypass surgery, a procedure only 10 years old at the time. He had taken coronary catheterization, which until then had only been used for diagnostics and surgical planning, and became the first to perform transluminal interventional therapy. Unfortunately, it turned out that the coronary artery would often close either immediately or over the following day...
Source: Spontaneous Circulation - June 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
A Forty-Year Struggle for Openness
In 1977, while I was busy with Star Wars and action figures, Andreas Gruentzig was using his kitchen-made balloon catheter to dilate and open a highly stenotic LAD coronary artery. Fixing atherosclerotic disease of the coronary arteries had previously required open heart bypass surgery, a procedure only 10 years old at the time. He had taken coronary catheterization, which until then had only been used for diagnostics and surgical planning, and became the first to perform transluminal interventional therapy. Unfortunately, it turned out that the coronary artery would often close either immediately or over the following day...
Source: Spontaneous Circulation - June 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
The Leading Cause of Failure
Pacemaker and implantable cardioverter defibrillator development has revolutionized the treatment of many kinds of cardiac diseases. The technology advancements have been tremendous, and once-large external batteries are now replaced by gumstick-sized modules as sophisticated as any computer. Unfortunately, the leads that provide sensing, pacing, and defibrillation represent a vulnerable part of the system, and have short- and long-term failure modes. Failure modes can cause a spectrum of issues from minor annoyances to catastrophic failure and death. Failure usually requires replacement of the generator, leads, or both, w...
Source: Spontaneous Circulation - May 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
The Leading Cause of Failure
Pacemaker and implantable cardioverter defibrillator development has revolutionized the treatment of many kinds of cardiac diseases. The technology advancements have been tremendous, and once-large external batteries are now replaced by gumstick-sized modules as sophisticated as any computer. Unfortunately, the leads that provide sensing, pacing, and defibrillation represent a vulnerable part of the system, and have short- and long-term failure modes. Failure modes can cause a spectrum of issues from minor annoyances to catastrophic failure and death. Failure usually requires replacement of the generator, leads, or both, w...
Source: Spontaneous Circulation - May 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
A History of General Refrigeration
Ancient societies figured out that hypothermia was useful for hemorrhage control, but it was Hippocrates who realized that body heat could be a diagnostic tool. He caked his patients in mud, deducing that warmer areas dried first.
Typhoid fever, the plague of Athens in 400 BC and the demise of the Jamestown Colony in the early 1600s, led Robert Boyle to attempt to cure it around 1650 by dunking patients in ice-cold brine. This is likely the first application of therapeutic hypothermia, but it failed to lower the 30 to 40 percent mortality rate. One hundred years later, James Currie tried to treat fevers by applying ho...
Source: Spontaneous Circulation - March 31, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
A History of General Refrigeration
Ancient societies figured out that hypothermia was useful for hemorrhage control, but it was Hippocrates who realized that body heat could be a diagnostic tool. He caked his patients in mud, deducing that warmer areas dried first.
Typhoid fever, the plague of Athens in 400 BC and the demise of the Jamestown Colony in the early 1600s, led Robert Boyle to attempt to cure it around 1650 by dunking patients in ice-cold brine. This is likely the first application of therapeutic hypothermia, but it failed to lower the 30 to 40 percent mortality rate. One hundred years later, James Currie tried to treat fevers by applying hot,...
Source: Spontaneous Circulation - March 31, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Curious Consequences of the Lessor Metals
The vagaries of any list or group are that invariably some members are far more popular than others. Hyperkalemia gets all of the attention when we talk about the cardiac effects of electrolyte abnormalities. It is certainly important (read: life-threatening), and we have multiple life-saving treatments that lend themselves well to testing.
We are well versed in hyperkalemia, though one of its treatments has become controversial (I am looking at you, kayexalate). But other electrolyte abnormalities beyond hyperkalemia also deserve attention.
Hypokalemia: The potassium level in the body is closely regulated, but h...
Source: Spontaneous Circulation - March 2, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Curious Consequences of the Lessor Metals
The vagaries of any list or group are that invariably some members are far more popular than others. Hyperkalemia gets all of the attention when we talk about the cardiac effects of electrolyte abnormalities. It is certainly important (read: life-threatening), and we have multiple life-saving treatments that lend themselves well to testing.
We are well versed in hyperkalemia, though one of its treatments has become controversial (I am looking at you, kayexalate). But other electrolyte abnormalities beyond hyperkalemia also deserve attention.
Hypokalemia: The potassium level in the body is closely regulated, but hypok...
Source: Spontaneous Circulation - March 2, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Maleficent Troponins
We physicians are obsessed with classifying, sorting, and differentiating in a quest for never-ending precision. We gather all manner of “facts” from our patients. Sights, smells, reactions to pushing or pulling. We divine sounds with antiquated stethoscopes or peer underneath the skin with ultrasound. We subject them to tests of blood, urine, and fluids from any place our needles can reach.
All of this is to arrive at an exact diagnosis that is often frustrated by the secondary nature of the data. Our disappointment has driven us mad, but the promise of exactness from biomarkers leaves us giddy. We have convi...
Source: Spontaneous Circulation - February 2, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Maleficent Troponins
We physicians are obsessed with classifying, sorting, and differentiating in a quest for never-ending precision. We gather all manner of “facts” from our patients. Sights, smells, reactions to pushing or pulling. We divine sounds with antiquated stethoscopes or peer underneath the skin with ultrasound. We subject them to tests of blood, urine, and fluids from any place our needles can reach.
All of this is to arrive at an exact diagnosis that is often frustrated by the secondary nature of the data. Our disappointment has driven us mad, but the promise of exactness from biomarkers leaves us giddy. We have convince...
Source: Spontaneous Circulation - January 30, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
