Thursday POTD AWESOMENESS

 ·   · 
TODAYS VERSION OF PEARLS OF THE DAY IS A REQUEST FROM DOCTOR BOWEN AND OUR ROYAL NORWEIGAN CHIEF ASTRID "CURED FISH" HAALAND
SGARBOSSA CRITERIA :
another [dumb] eponymous topic (see yesterday's email about Brugada)
BASICS
  • Allows you to diagnose cardiac ischemia in a LBBB EKG
  • He was probably some old white cardiologist
  • IMPORTANT: There are the original criteria and the modified. Today we will be discussing MODIFIED
EKG FINDING IN LBBB (NORMAL)
  • Widened QRS, QRS down in V1 and (possibly) up in V6
  • Appropriately discordant T-waves
    • The T waves will usually be REBELS and don't listen to their parents and go the OPPOSITE WAY of the EVIL QRS. That's what discordant is yo.
    • BUT they aren't that bad, they don't want to be like Dr. Bowen and be pure evil, they are usually <5mm (or< 25% of the S wave) in the opposite direction
  • NORMAL LBBB EKG
SGARBOSSA CRITERIA (MODIFIED) FOR IDENTIFYING LBBB WITH ISCHEMIA PUT IN TECHNICAL TERMS (SORRY)
  • ≥ 1 lead with ≥1 mm of concordant ST elevation
  • ≥ 1 lead of V1-V3 with ≥ 1 mm of concordant ST depression
  • ≥ 1 lead anywhere excessive discordant STE, (≥ 25% of the depth of the preceding S-wave).
    I KNOW, THIS CRAP MAKES NO SENSE
    SO LETS BREAK THIS DOWN INTO THINGS EVEN JB CAN UNDERSTAND
  • Any ST segment elevation that goes SAME DIRECTION as the QRS is BAD (middle picture above)
  • Any ST segment DEPRESSION is BAD (right picture above)
  • Any ST segment that goes SUPER OPPOSITE is bad
  • THANK YOU FOR READING ALL THESE THINGS THIS WEEK, LOOK FORWARD TO WEEK 2 OF PEARLS OF THE DAY COMING TO AN EMAIL INBOX NEAR YOU NEXT WEEK! ***CROWD GOES WILD WITH APPLAUSE***
 · 
Share

HEART STOPPING POTD WEDNESDAY!!!!!

 ·   · 
THANK YOU TO CAROLINE FOR A TRULY HEART WARMING M&M THIS MORNING ABOUT PROLONGED QT AND ALL THE DISASTERS THAT IT CAN CAUSE...
SO LETS TALK ABOUT SOME MORE CARDIOLOGY STUFF AND SYNCOPE, BECAUSE WE ALL LOVE IT RIGHT? AND THAT WE ALSO LOVE CAPS LOCKS!
BRUGADA SYNDROME
Also a heart stopping condition (....yeah I went there), causing syncope, not commonly seen in the ED, but when you see it you HAVE TO recognize it.
SO, when you get an EKG and see this...... you'll know what to do.
Image result for brugada syndrome
WHAT IS IT?????
  • GENETIC DISORDER, CAUSING CONDUCTION PROBLEMS IN THE HEART
HOW TO DIAGNOSE IT?
  • In the ED, the only way is by EKG. There are 3 types of Brugada so for every patient who syncopizes you need to make sure you check for all of them. There are genetic tests to confirm, but for our sakes, EKG EKG EKG
Image result for brugada syndrome
SO WHAT? THEY HAVE INTERESTING EKG AND THIS RARE DISEASE (OR MAYBE NOT SO RARE). DISCHARGE WITH NSAIDS AND PMD FOLLOWUP RIGHT?
  • It actually is thought to be THE most common cause of sudden unexplained death
  • These people are at EXTREMELY high risk of ventricular arrhythmias (VF, VT), and the first presentation is usually SYNCOPE

 

THESE PEOPLE NEED AICD's and PRONTO. LIKLEY CARDS ADMISSION VS ACUTE CARDS F/U WITH ED CONSULTATION
  • No medication has shown to really effectively prevent the arrhythmias.
  • STILL, average age of death of these peeps is 41.

 

Lesson of the Day??? With Syncope, BE AFRAID, BE VERRRRRY AFRAID
 · 
Share

 ·   · 

Thats really the question we are all asking ourselves…. At least in terms of Chest Tubes!!!

 

FOR THIS VERSION OF TRAUMA TUESDAYS WITH JOSH, WE’RE GOING TO HAVE A SHORT DISCUSSION ABOUT CHEST TUBE SELECTION! (Hold your excitement please).

 

First, What WE KNOW

 

  • Simple PTX get pigtails
  • Crashing traumatic patients get b/l large bore chest tubes (for now)

 

 

SO you’re probably asking yourself what’s the big deal, that covers it right?

Well NO. There are a few things in contention and a few new studies showing us that WE KNOW NOTHING JON SNOW (for those who don’t get the reference you can just stop reading and catch up 7 seasons of GoT, right now, go!)

 

 

  • Traumatic Isolated PTX: These used to get large bore Chest Tubes. This was really the first thing that changed over to 14F pigtail catheters. If you don’t believe me, this was a great study showing that they were equally as effective, and caused way less pain to the patient. https://www.ncbi.nlm.nih.gov/pubmed/24375295
  • Traumatic Hemo/Pneumothorax: These use to get the BIG MAMA 36/38/40 Fr Chest tubes because bigger is better right? Well maybe not. This study (https://www.ncbi.nlm.nih.gov/pubmed/22327984) showed that a 28Fr chest tube is equally as effective, HOWEVER with similar pain scores as the big ones.

 

 

BUT CAN WE DO BETTER? THIS IS FREAKING 2017 FOR CRYING OUT LOUD. THERE ARE ZOMBIE DRAGONS ROAMING THE WESTEROS!

 

YES WE CAN! (AT LEAST WE THINK WE CAN)

 

AT EAST TRAUMA 2017, there was a paper presented showing 7 years of data from University of Arizona, which showed:

  • Nearly 500 patients were treated with a tube for HTX or HPTX during the 7 year study period, 2/3 with a chest tube and 1/3 with a pigtail
  • Pigtails had more fluid drain initially (430cc vs 300cc, significant), and 1 less treatment day (4 vs 5, also significant)
  • Failure rate and insertion-related complications were the same (about 22% and 6%, respectively)
  • The group found that their use of pigtails steadily and significantly increased over the years

http://thetraumapro.com/2017/01/05/east-2017-7-pigtail-vs-chest-tube-does-size-matter/

SO FINAL WORD: HAVE A DISCUSSION WITH YOUR ATTENDINGS/SURGEONS ABOUT USING A MORE HUMANE TUBE, YOU CAN ALWAYS GO BIGGER!

 · 
Share