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Preserving Patient Dignity (Formerly Patient Modesty) Volume 127
A Worthy Posting today on Volume 126 to set off a discussion of " Preserving Patient Dignity " which should be more acknowledgment that there has been, within the past, some ignorance by the medical profession that the concept of the dignity of the patient exists and should not be attacked and injured. Here is the last posting of our contributor Reginald:Hello,As I pondered why dignity is such a hard concept for healthcare, I mused regarding what has changed – realizing that what happened in the past was not always something better.Thirty years ago I had a cardiologist as a GP. Yes, a cardiologist as a G...
Source: Bioethics Discussion Blog - July 28, 2023 Category: Medical Ethics Source Type: blogs
A man in his 70s with weakness and syncope
DiscussionBrugada Type 1 ECG changes are associated with sudden cardiac death (SCD) and the occurrence of ventricular dysrhythmias. Patients that develop a Type 1 pattern without any precipitating or provoking factors have a risk of SCD of 0.5-0.8% per year. In patients that only have this pattern induced by a sodium channel blocking agent have a lower rate of SCD (0 - 0.35% per year)[1]. Drugs that have been associated with Brugada ECG patterns include tricyclic antidepressants, anesthetics, cocaine, methadone, antihistamines, electrolyte derangements, and even tramadol. [2]. Our patient had a Brugada Type ...
Source: Dr. Smith's ECG Blog - July 22, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
High-Frequency Low-Tidal-Volume Ventilation During Atrial Fibrillation Ablation Improves Long Term Outcome
Catheter ablation for pulmonary vein isolation is an important modality of treatment for paroxysmal atrial fibrillation. It is also useful for persistent atrial fibrillation, though a little less. Importance of maintaining a stable contact force of the catheter during radiofrequency ablation cannot overstressed as it contributes to lesion size and achieving transmural lesion. Both these are important in reducing re-connection of pulmonary veins, an important cause for recurrent atrial fibrillation after catheter ablation. General anaesthesia during procedure reduces the rate of pulmonary vein reconnection and hence recurr...
Source: Cardiophile MD - June 24, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
The Current State of 521 FDA-Approved, AI-Based Medical Devices
The rise of Artificial Intelligence (AI) and Machine Learning (ML) in healthcare has reshaped the industry. And due to the recent march of ChatGPT, Midjourney and similar tools, various AI algorithms have entered the lives of the general population as well. These technologies will undoubtedly change the way medicine is practiced. Given that healthcare is an industry where decisions can literally be a matter of life and death, the importance of effective regulation can’t be overstated. Now this is one hell of a challenge even for the most seasoned professionals.
AI and ML present novel regulatory challenges. Unlike...
Source: The Medical Futurist - June 6, 2023 Category: Information Technology Authors: Andrea Koncz Tags: Artificial Intelligence in Medicine AI digital health fda Healthcare AI in healthcare AI in medicine AI-based medical devices Source Type: blogs
Myocardial Ischemia-Reperfusion Injury
Myocardial Ischemia-Reperfusion Injury is a paradoxical exacerbation of cellular dysfunction and cell death occurring after restoration of blood supply in previously ischemic tissues. Reperfusion of the myocardium after coronary occlusion in acute myocardial infarction can cause reperfusion arrhythmias like accelerated idioventricular rhythm. Myocardial ischemia-reperfusion injury can also occur after cardiac surgery and circulatory arrest [1]. Though reperfusion is essential for salvage of the myocardium it can sometimes cause paradoxical damage. Reperfusion injury can also affect distant organs occasionally leadin...
Source: Cardiophile MD - April 20, 2023 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
An anesthesiologist ’ s story: Going beyond the protocol to save a life
I was waiting for my son at the ice rink in one of Chicago’s northern suburbs. Hundreds of people had gathered to watch the Illinois State Championship games. A parent, who knew I was an anesthesiologist, grabbed me by the elbow and said, “Hey, Doc, someone in the lobby is not feeling well.” I went
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An anesthesiologist’s story: Going beyond the protocol to save a life originally appeared in KevinMD.com.
Source: Kevin, M.D. - Medical Weblog - April 15, 2023 Category: General Medicine Authors: Yuri Aronov, MD Tags: Physician Cardiology Surgery Source Type: blogs
Pre-operative cardiac fitness : No, it is not acceptable , you are not authorised to do this !
A 62-year-old man who is being scheduled for prostate surgery with no cardiac risk factors or comorbid status came for surgical clearance. I examined him and took an ECG, everything was fine and gave him clearance for surgery.
I was surprised to spot him the very next day, waiting in the lounge of my office. He said, his anesthetist was not happy with my pre-op-cardiac assessment report, suggested it was incomplete, and sent me back for echocardiography to know the LV ejection fraction.
I wanted to clarify with the patient, what exactly happened when he met his anesthesiologist.
“I am not sure doctor, the momen...
Source: Dr.S.Venkatesan MD - April 3, 2023 Category: Cardiology Authors: dr s venkatesan Tags: cardiac surgery Cardiac fitness for non cardiac surgery preoperative cardiac risk assesment surgical clearance and cardiac fitness Source Type: blogs
Life, death, and the balance in between: a cardiac anesthesiologist ’ s story PODCAST
Subscribe to The Podcast by KevinMD. Catch up on old episodes! David Alfery is a cardiac anesthesiologist who shares his experiences in the operating room and intensive care unit. In this discussion, he reflects on the lessons he learned about life, death, and the balance in between through his encounters with patients. He offers a
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Life, death, and the balance in between: a cardiac anesthesiologist’s story [PODCAST] originally appeared in KevinMD.com.
Source: Kevin, M.D. - Medical Weblog - January 27, 2023 Category: General Medicine Authors: The Podcast by KevinMD Tags: Podcast Cardiology Source Type: blogs
Intraoperative Imaging for Porcelain Aorta
Diffuse calcification of ascending aorta which may extend down is known as “Porcelain aorta”. Intraoperative epiaortic echocardiography along with manual palpation during surgery has been described as the most sensitive technique for detecting ascending aortic atheroma and calcification [1].
A prospective study evaluated this in hundred consecutive patients undergoing coronary bypass or valve surgery [2]. Ascending aorta was assessed by manual palpation by the operating surgeon, intraoperative transesophageal echocardiography and epiaortic ultrasound using linear and phased-array imaging. No difference was noted...
Source: Cardiophile MD - December 28, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Potential disadvantages of perioperative heparin bridging
Some of the potential disadvantages of perioperative heparin bridging are risk of thromboembolism due to subtherapeutic dose, more prolonged total hospital stay and cost as well as inconvenience of heparin therapy.
In addition to this, there can be excessive bleeding during re-initiation of warfarin with heparin overlap. Hence continuing warfarin through the procedure is becoming standard of care in certain special instances. This is more applicable to procedures with relatively low bleeding risk in those with high risk of thromboembolism. Cataract surgery under topical anesthesia is one such potential situation in which ...
Source: Cardiophile MD - December 4, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is the most common cause of acquired heart disease in children in developed countries?
Kawasaki disease is the most common cause of acquired heart disease in children in developed countries. In developing countries it will be rheumatic heart disease.
Timely treatment of Kawasaki disease with intravenous immunoglobulin can reduce the incidence of coronary aneurysms from 25% to around 4%. Children with coronary aneurysms due to Kawasaki disease needs lifelong cardiology follow up. The prognosis depends on the initial and current level of coronary involvement. Some children may develop coronary obstruction and thrombosis leading to myocardial infarction. Revascularization procedures may be needed in some of th...
Source: Cardiophile MD - November 17, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
Device Measures Hemoglobin More Accurately in Dark Skin
Researchers at the University of Texas at Arlington, in collaboration with Shani Biotechnologies, a local firm, have created a point-of-care device that can accurately measure hemoglobin levels and perform pulse oximetry in individuals with dark skin...
Source: Medgadget - November 11, 2022 Category: Medical Devices Authors: Conn Hastings Tags: Anesthesiology Cardiology Critical Care Emergency Medicine Military Medicine Pediatrics Surgery utarlington Source Type: blogs
Triggers for IABP
Intra-Aortic Balloon Pump inflates the balloon in diastole and deflates at the onset of systole.
This image of the IABP screen shows diastolic augmentation in the pressure tracing. Period during which the balloon remains inflated is shown as a horizontal bar below the ECG tracing at the top. Live visual indication of balloon inflation will also be there in the balloon inflation indicator at the bottom of the screen when the IABP is operational.
Any of the several types of triggers can be used for timing for inflation in diastole.
ECG trigger: Balloon will be inflated in the middle of the T wave and deflated at the peak o...
Source: Cardiophile MD - October 28, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What are ventricular ectopic beats (VPC)? Cardiology Basics
Ventricular ectopic beats are premature heart beats originating from the ventricles. Normal heart beats originate from the sinus node, situated in the upper part of right atrium. Sinus node is the natural pacemaker of the heart which gives out regular impulses to induce sequential contractions of atria and ventricles.
Ventricular ectopic beats (VEB) are also known by other names like ventricular premature beat (VPB), ventricular premature complex (VPC) and premature ventricular complex (PVC). Ventricular ectopic is the commonest form of cardiac arrhythmia.
In a ventricular ectopic beat, the sequence of activation is diffe...
Source: Cardiophile MD - October 25, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
What is an implantable cardioverter defibrillator (ICD)? Cardiology Basics
Implantable cardioverter defibrillator or ICD is a cardiac implantable electronic device or CIED. The device is implanted subcutaneously under local anaesthesia, usually below the left clavicle. The electrodes from the device are introduced into the right sided cardiac chambers through a subclavian vein puncture. The ICD senses and analyzes heart rhythm continuously. It can detect life threatening ventricular arrhythmias and treat them electrically.
If a ventricular tachycardia is detected, the ICD tries to overdrive it by fast pacing. If it does not suppress the ventricular tachycardia, the ICD delivers a shock through i...
Source: Cardiophile MD - October 23, 2022 Category: Cardiology Authors: Johnson Francis Tags: General Cardiology Source Type: blogs
