Approach to ECGs
Check
- Age, gender, name
- 25mm/s; 10mm/mV
- 1mm = 40ms; 0.1 mV
Rate
- 300 / big squares - RR only
- #QRS in 10s
- 2 dots = 3s; #QRS in 6s x 10
Rhythm
(1) Pfor every QRS and vv
(2) P+ve in l, II
(3) 60-100 bpm
- Axis - QRS +ve in I, II
- LAD: Inf Ml, WPW, LVH, LBBB, LAFB
- RAD: AntLat MI, WPW, RVH, RBBB, dextrocardia, normal LPFB, dextrocardia, normal
Intervals
- PR = 120-200ms (3-5 small boxes)
- HiPR: AV block
- LoPR: WPW, ectopic atrial pacemaker
- QRS = < 100-120ms (<2.5-3 small boxes)
- WideQRS: RBBB (V1/V2 rsr', lat leads slurred S), LBBB (V5/V6 rs, qs; lat leads rsr'), V-pacemaker, ↑K, ICD/pacer
- QTc < 1/2 RR or M<420ms, F<440ms, no safe #, but >500 DANGER
- Short QT <300-360 ms: ↑ca
- Long QT: "antis and hypos"-ABx, antipsychotics, antidepressants, TCA, antihistamines, antiarhythmics, hypo K, hypo Mg, congenital, MI, high ICP
Hypertrophy
- Dr. Michael Wong @mchlwng
#Approach #ECG #EKG #diagnosis #electrocardiogram #cardiology #interpretation
Azithromycin - since there has been a lot of noise around chloroquine/hydroxychloroquine, thought we can take a quick review of azithromycin since it is being used in combination with hydroxychloroquine as one of the investigational treatments for COVID-19…
-
Note azithromycin has a long half-life of about 68 hrs (or more) and is an inhibitor of P-glycoprotein/ABCB1 so watch for potential DIs with colchicine, dabigatran, edoxaban, ranolazine, etc. Also, don't forget about increased QT prolongation risk when used in combo with chloroquine or hydroxychloroquine‼️
For Educational Purposes Only
#Azithromycin #COVID19 #Pandemic #Treatment #Coronavirus #InfectionDiseases
Arthrocentesis - Joint Fluid Analysis
Effusion Characteristics (Color, Clarity, WCC, PMN, Crystals, Bacteria) by Disease Process:
OA, Traumatic arthritis SLE, , RF , Pseudogout (positively birefringent crystals), Gout (negatively birefringent crystals), TB arthritis, Septic arthritis
#Diagnosis #Differential #Arthrocentesis #Joint #Syonvial #Fluid #Effusion #Analysis #Table #Aspiration #Pseudogout #Septic #Infective #Arthritis #Interpretation
Bisphosphonates for Osteoporosis Treatment or Prevention
Bisphosphonates are common medications used in the treatment and prevention of osteoporosis. There are 4 drugs in this class with approved osteoporosis indications. There are a variety of dosing frequencies, from daily, weekly, monthly, to yearly. Bisphosophonates inhibit osteoclasts, which in turn increase bone mineral density. Important counseling points is to take the oral versions with water but on an empty stomach, ensure to keep an empty stomach for at least 30 minutes after and remain upright for that entire time. Ibandronate is the same points except 60 minutes instead of 30 min.
Jarred Prudencio, PharmD - https://www.instagram.com/ambcarerx
#Bisphosphonates #Dosing #Schedule #Frequency #Pharmacology #Endocrinology #Osteoporosis #Management
Guide to Acute Kidney Injury (AKI)
What to ask/look for:
- HPI, PMH, full ROS
- Nephrotoxins (NSAlDs, contrast, OTCs, herbals, abx, illicits, chemo, immunosuppression)
- Hx of AKI/CKD
- Recent hypo/hypertension?
- TTE/liver fxn?
- BMP, cap, CBC w/ diff
- Urinalysis/microscopy/UOP/weights
- Urine Na/K/Cl/urea/protein/Cr
- Renal/bladder US w/ PVR
- CPK, uric acid (rhabdo/TLS)
Causes of Inpatient AKI (Liano 1996)
- ATN - 45%
- Pre-renal disease — 21%
- AKI on CKD— 13% (mostly ATN and pre-renal)
- Urinary tract obstruction — 10% (most often prostate related)
- Glomerulonephritis or vasculitis — 4%
- Atheroemboli — 1%
#AcuteKidneyInjury #AKI #Nephrology #Diagnosis #Algorithm #Causes #Differential
Drugs associated with hypokalemia and hypomagnesemia
Hypokalemia
- Shift from extracellular fluid to intracellular fluid compartment
- b2-receptor agonists
- Insulin (high dose) with glucose
- Xanthines (theophylline, caffeine)
- Verapamil (in overdose)
- Sodium bicarbonate
- Extrarenal Laxatives
- Renal
- Antimicrobials Nafcillin, ampicillin, penicillin, aminoglycosides, amphotericin B, foscarnet
- Diuretics
- Acetazolamide
- Furosemide and other loop diuretics
- Thiazides
- Mannitol
- Mineralocorticoids Fludrocortisone
- Antiepileptic Topiramate
Hypomagnesemia
- Extrarenal Proton pump inhibitor
- Renal
- Antimicrobials Drug-induced renal Fanconi syndrome: Aminoglycosides (gentamycin, streptomycin, tobramycin), pentamidine, amphotericin B, foscarnet, antiretroviral therapy
- Diuretics
- Furosemide
- Thiazide
- Antitumoral
- Cisplatin
- Tyrosine kinase inhibitors
- Immunosuppressants
- Calcineurin inhibitors (cyclosporine, tacrolimus)
- Mycophenolate
- Anti-EGF receptors (cetuximab, panitumumab)
#Drugs #hypokalemia #hypomagnesemia #Medications #differential #diagnosis #nephrology #Causes #hypomg
