Rhythm Nation March 2015 – Answer! Congratulations to VTACHomas for being first! Excellent discussion from JFreedman and Eschnitz. This is a complicated ECG! Let’s first look at the option of ventricular bigeminy. Ventricular bigeminy has recurring premature ventricular contractions (PVCs) after every atrial sinus beat. There is then a Read more…
Thanks to Dr. Kincade for today’s Morning Report! Wellens Syndrome Pattern of inverted or biphasic T waves in precordial leads that are specific for critical LAD stenosis Critical stenosis LAD High risk of anterior MI w/o medical tx: 75% pt advance to ant MI in avg 8.5 days Read more…
A 33 year old man presents with chest pain and mild shortness of breath, progressively worsening over the last two days – sharp, sternal, worse on inspiration/lying flat, no radiation, better with sitting up. ROS + for URI 8 days ago. CXR: unremarkable ECG: T wave flattening and T wave Read more…
Here are the images again: There is a right middle third clavicle fracture and right scapula fracture! Scapula Fractures: Relatively uncommon Many associated injuries, which can be LIFE-THREATENING: hemothorax, pneumothorax, pulmonary contusion, humeral fractures, skull fractures, or splenic injury Treatment: REMEMBER to treat life-threatening injuries FIRST! Scapula Read more…
The Case: A 49 year old man without any past medical history presents with R hip pain for 2 months. The pain is nonradiating, worse with flexion of the R hip, walking, or bending forward. Over the past month, he reports occasional night sweats, increased fatigue, 10lbs of unintentional Read more…
An EMS note arrives – an obese 60 year old F with a history of the sugar, the pressure, and a “stomach problem…called digestive heart failure”. VS: HR 120s, RR 40s, O2sat 88% on NRB, BP SEE BELOW. PE diaphorectic, Crackles all the way up the back. Name the diagnosis Read more…
Here’s Dr. Alsup with today’s Morning Report! Hip Dislocations *Dislocations and fracture-dislocations are true orthopedic emergencies History: ABC’s: This injury is a red flag for multisystem injury Associated injury (95%) Assoc acetabular fracture 70% Knee fractures/ligamentous injury/ dislocation 30% Sciatic palsy 10% of patients (peroneal nerve branch) Read more…
Cardioactive Steroids The cardioactive steroid (CAS) that is most likely to be encountered is digoxin, which is still used clinically, but CAS are also present in animals such as the Bufo toad and in many plants, including foxglove, oleander, lily of the valley, and red squill. The effects of acute Read more…
35 year old male presents s/p trauma. Patient was riding a motorcycle when he was struck by another vehicle, which caused patient flip in the air and fall on his right shoulder. On exam you see visible deformity around his right clavicle. You decide to get a xray and see Read more…
Dr. Grock presents today’s Morning Report! Pulmonary Infections CAP If no abx in last 3 mo and healthy: A Macrolide (2nd line Doxy) If chronic heart, lung, liver, renal disease, DM, ETOH, Ca, Asplenia, Immunosuppressed, or abx use in last 3 months: Resp fluoroquinolone, B-lactam + Macrolide If Read more…