Brugada Syndrome: An ECG Pattern You Need to Know
Brugada Syndrome is an abnormal ECG (Right Bundle Branch Block Pattern with coved ST elevation over the right precordial leads of V1-V3), which leads to ventricular fibrillation (VF) and sudden cardiac death (SCD) in patients with structurally normal hearts. It has been recognized as a clinical entity since 1992. Why should all ED physicians know about this entity? Although a rare syndrome, it is often mistaken as a STEMI and more importantly the clinical spectrum can be asymptomatic to SCD. [+]
Trick of the Trade: Got a shoulder dislocation? Park it
Myriad techniques exist to reduce shoulder dislocations, which includes scapular rotation, Hennepin, Snowbird, Cunningham, and Legg maneuvers. They are nicely reviewed at ShoulderDoc.co.uk. You can also supplement any technique with ultrasound-guided intraarticular lidocaine for improved pain control. Recently, Dr. Jay Park (Beth Israel Medical Center in New York) contacted me about his novel approach to shoulder reduction which anatomically makes sense. If his animation video doesn’t convince you, check out the video of an actual reduction. [+]
Anterior Shoulder Dislocation: Are Prereduction Films Needed?
A patient comes into your department with an obvious shoulder dislocation. You know you can easily reduce the shoulder and have the patient discharged before the orthopedic consultant calls back. But what if there is a fracture? Do you need to get that plain film before popping it back into place? [+]
Patwari Academy video: Torsades de Pointes
Torsades de pointes is a polymorphic form of ventricular tachycardia. Why does this occur? What does it characteristically look like? Why is this an important form of ventricular tachycardia to differentiate from the more classic monomorphic ventricular tachycardia? View this short 9 minute video on QT intervals and Torsades de Pointes. [+]
Reflections on CMS Simulation Instructor Course
I just completed the 4 day intensive Center for Medical Simulation Institute for Medical Simulation Instructor Course. The title of the course is a mouthful and just as intense and high yield as the actual course was itself. The chief purpose of the course is to develop debriefing skills as a medical instructor. The structure and nature of the course seemed so effortless and fluid, and yet at the end of the 4 days, I knew that the debriefing skills I had learned were ingrained into my brain. I highly recommend this course to any medical educator with simulation interest. [+]
Navigating the waters of medical education and social media
SUNY Downstate Department of Emergency Medicine held a lecture series May 22, 2013 as a primer for the EM residents on how to use social media to enhance medical education. This session was designed to be an introduction for the novice on how to get the most out of FOAM (Free Open Access Meducation), Twitter, and Blogging with a section on professionalism. Invited speakers included Drs. David Marcus, Jeremy Faust, Jordana Haber, and myself Nikita Joshi. The slides from the session are presented below. Enjoy! [+]
Pitfalls to avoid in collecting patient related teaching materials
Educators are eager to gather valuable learning tools such as EKGs and x-rays to be used in teaching for our learners, whether from our home institutions or internationally through the internet. However, this may not always be seen as altruistic; history and even modern day medicine is full of examples of misguided attempts to further medicine at the expense of patients such as the Tuskegee Syphilis Experiment from 1932-1972. The focus of this post is how to go about collecting patient data for teaching purposes and avoiding confidentiality and consent violations while always remaining respectful of the patient and their [+]
Lead aVR: The Forgotten 12th Lead
Augmented leads (aVR, aVF, and aVL) were developed to derive more localized information looking at the right, lower, and left part of the heart respectively. Specifically, lead aVR obtains information from the right upper side of the heart. It also gives reciprocal information on the left lateral side of the heart, which is already covered by leads aVL, I, II, V5, and V6. This is the main reason lead aVR has become forgotten. [+]
Should physicians be trained as “knowledge workers”?
According to Wikipedia a Knowledge Worker is someone whose main job is to employ creative, divergent, convergent thinking to solve problems with the help of searching new information. In the 21st century these Knowledge Workers may use Internet tools, such as social media, to form a collaborative network of expertise. These networks might be open or not. There are plenty of companies using knowledge management in order to optimize their performance. [+]
Wellens’ Syndrome: Is it on your radar?
Wellen’s Syndrome was first described in 1982 in which 75% of patients with t wave inversions in V2-V4 went on to have an acute myocardial infarction (MI). This was again repeated in 1989, and showed that all patients with this morphology had >50% LAD stenosis. The incidence in the United States is about 10-15%. [+]