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Double Apical Impulse (S4) Visualization on Physical Exam - Hi-Res Video Version: https://www.grepmed.com/images/7802/physicalexam-cardiology-impulse-double-gallop-apical-signs

On palpation, the PMI
Double Apical Impulse ... (S4) Visualization ... A prominent S4 sound ... The S4 sound is ... #Impulse #S4 #Gallop
Double Apical Impulse (S4) Visualization on Physical Exam - A small stick taped to the chest
Double Apical Impulse ... (S4) Visualization ... had a prominent S4 ... #Double #Apical ... #Impulse #S4 #Gallop
Cardiac Auscultation Practice - S4 Gallop

S4: add this extra heart sounds by tapping first finger twice

Setup:
Auscultation Practice - S4 ... Gallop S4: add
Apical Impulse Waveforms on Physical Examination
- Normal
- Sustained Palpable S4
- "Triple Ripple"
- Palpable S3

#Apical #Impulse #Waveforms
Sustained Palpable S4
Simplified Vasopressors and Inotropes Comparison Chart
MAP = CO x SVR
Dobutamine - Norepinephrine - Epinephrine - Phenylephrine
and Inotropes Comparison ... Vasopressin When in doubt ... Vasopressors #Inotropes #comparison
Double Counting on Cardiac Monitoring
The “double counting” heart rate phenomenon. T waves are so prominent the
Double Counting ... Monitoring The “double ... @EM_RESUS #Double
Myocarditis
Diagnosis 
• Endomyocardial biopsy (gold standard, rarely performed) 
• Clinical presentation 
• Cardiovascular MRI 
Clinical 
•
tachycardia • S3, S4
Kidney Biopsy - Diagnosis Algorithms
1) Normal Glomerulus by LM
2) Glomerular Crescents
3) Double Contours of GBM
4) Endocapillary
Crescents 3) Double
Thrombotic Microangiopathy - TTP VS HUS

Big picture points : Often hard to differentiate the two entities,
When in doubt, start ... thrombocytopenia #Comparison
Common Fungal Pathology 
 • Candida - Small yeast intermingled with pseudohyphae
 • Aspergillosis - Septate
Blastomycosis - Round, double ... table #atlas #key #comparison