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STEMI with Tombstones and Shark Fins

Here’s a deadly ECG with Tombstones AND Shark Fins. When you
this you must act ... SharkFins #ecg #ekg #electrocardiogram
Hypercortisolism (Cushing syndrome) - Simplified Differential Diagnosis Algorithm
Exogenous (ACTH-independent)
Endogenous
 • ACTH-dependent:
    - ACTH-secreting
Algorithm Exogenous (ACTH-independent ... Endogenous • ACTH-dependent ... : - ACTH-secreting ... Disease) - ACTH-secreting ... in the body • ACTH-independent
Diagnosis Adrenal Insufficiency - Algorithm

Step 1) Screening Test: 6-8AM Cortisol Level
 - Early morning cortisol levels
Cosyntropin is an ACTH ... to a bolus of ACTH ... - Check ACTH ... looking at the ACTH ... - Low ACTH is
Adrenal Insufficiency Differential Diagnosis Algorithm
Clinical suspicion: Weakness, fatigue, nausea, musculoskeletal pain, dizziness, volume depletion, abdominal pain,
Adrenocorticotropic hormone (ACTH ... Baseline plasma ACTH ... High baseline ACTH ... normal baseline ACTH
ECG of a 32-year-old lady with chest pain. 

Cath showed 100% proximal LAD Occlusion.
Cath showed 100% ... Clinical #ECG #EKG #Electrocardiogram
Fibrinolysis. 
Fibrinolysis occurs when plasminogen is activated to plasmin under the influence of factors such as
Plasmin then acts ... and urokinase act ... -antiplasmin), act
Primary Adrenal Insufficiency:
 • ACTH stimulation test - Synthetic ACTH does not stimulate cortisol secretion because
Insufficiency: • ACTH ... test - Synthetic ACTH ... by endogenous ACTH ... Low • Plasma ACTH ... stimulation by ACTH
Adrenal Insufficiency Diagnosis Algorithm - Evaluation of HPA Axis Response to ACTH

Early am cortisol < 3
Axis Response to ACTH ... secondary AI Measure ACTH ... Diagnosis #Algorithm #ACTH
Gout Management in CKD
 • Colchicine
 • NSAID
 • Glucocorticoid
 • ACTH
 • Interleukin-1 Inhibitors

#Gout #Management
Glucocorticoid • ACTH
Primary Adrenal Insufficiency
Addison's Disease - Damage of the adrenal glands with lack of cortisol, androgens and
AM cortisol and ACTH ... AI present - ACTH ... Administer 250 mcg ACTH ... AI present - ACTH ... DEXAMETHASONE - ACTH