The JT Interval and Pro-Arrhythmic Risk Measured from the J-point to the end of the T-wave, the JT interval represents the time for ventricular repolarization in the setting of ventricular conduction abnormalities. JTc=QTc-QRS When do you use the JT Interval? - Right Bundle Branch Block - Left Bundle Branch Block - Ventricular Pacing Prolonged JT interval was a stronger risk factor for mortality than prolonged QT interval in patients with QRS ≥120 ms Rachel Klosko, PharmD @rachel_klosko #JT #Interval #JTInterval #QTc #electrocardiogram #pathophysiology #ekg #ecg #cardiology

Diastolic Dysfunction Grading - Echocardiography Grade 0 (Normal): • E/A >0.8, e’ > 8 cm/s, E/e’ < 8 Grade 1 (Impaired Relaxation): • E/A <0.8, e’ < 8 cm/s, E/e’ < 8 • Impaired Relaxation & Decreased LV Compliance • Mild Decrease in LV Muscle Relaxation Speed Grade 2 (Pseudonormal): • E/A >0.8, e’ < 8 cm/s, E/e’ 8 - 15 • Increase in LAP causing more “Push” from LA during Early Filling • Moderate Decrease in LV Muscle Relaxation Speed Grade 3 (Restrictive): • E/A >2, e’ << 8 cm/s, E/e’ > 15 • Severe increase in LAP causing more “Push” from LA during Early Filling. Also LA enlargement • Severe Decrease in LV Muscle Relaxation Speed - POCUS 101 @Pocus101 #diastology #Diastolic #Dysfunction #Grading #Echocardiography #echocardiogram #grades #diagnosis #cardiology #POCUS

LVH by voltage criteria - (Sokolow-Lyon Index) #Diagnosis #Cardiology #MedStudent #EKG #LVH #Hypertrophy #Criteria #Sokolow #Lyon #Voltage #Criteria #ECGEducator

The H2FPEF score and point allocations for each clinical characteristic (top), with associated probability of having heart failure with preserved ejection fraction (HFpEF) based on the total score as estimated from the model (bottom). #H2FPEF #HFPEF #Score #CHF #Diastolic #Diastology #Cardiology #Diagnosis

Fig. 8. Surface marking to guide needle insertion. In the paramedian sagittal (PS) oblique view, each interspace (L3–L4 in this case) is centered in turn on the ultrasound screen (A ). A corresponding skin mark is made at the midpoint of the probe's long edge (B ). The probe is then turned 90 degrees to obtain the transverse interlaminar view (C ). The midline is centered on the ultrasound screen, and skin marks are made at the midpoint of the probe's long and short edges (D ). The intersection of these two marks provides an appropriate needle insertion point for a midline approach to the epidural or intrathecal space at that level. #PainManagement #POCUS #Spinal #Epidural #Anesthesia #Anatomy #Probe #Orientation #Marking #Parasagittal #Transverse

True Hyponatremia Differential Algorithm Instead (or in addition) of volume status examination, check urine sodium and serum uric acid: - Urine sodium low, uric acid high in hypovolemic and hypervolemic hyponatremia - Urine sodium high and uric acid low in euvolemic hyponatremia - Joel Topf, MD FACP @kidney_boy #True #Hyponatremia #Differential #Algorithm #Diagnosis #Nephrology

ANTIBIOTIC SUSCEPTIBILITIES IN INTENSIVE CARE Antibiotic spectra made simple(r). Version 2, now updated with new bugs & drugs. - Dr. Alex Psirides @psirides (Wellington Intensive Care Unit) PDF Source: https://drug.wellingtonicu.com/PDF/Wellington%20ICU%20Antibiotic%20Summary.pdf #Antibiogram #Antibiotics #Classes #Bacterial #Spectra #Spectrum #Coverage #Susceptibility #Susceptibilities #ICU #CriticalCare #Overview #Pharmacology #Microbiology #sensitivities ** GrepMed Recommended Text: Comprehensive Review of Infectious Diseases - https://amzn.to/2WTEUXA

Antibiotics - Spectrum and Coverage Antibiogram #Antibiogram #Antibiotics #Classes #Bacterial #Spectrum #Coverage #Susceptibility #Susceptibilities #InfectiousDiseases #Pharmacology

For my UME micro course, I made a figure that captures this terminology and lets learners compare/contrast spectra of activity visually. Let’s start with a horizontal bar that represents the spectrum of clinically important bacteria. We will represent antibiotics above that spectrum with another horizontal bar. If you shined a light from above the antibiotic, it would cast a shadow on that part of the spectrum – you might say it ‘covers’ that part of the spectrum. Narrow spectrum antibiotics cover only a sliver of the spectrum. We ‘expand’ or ‘broaden’ this coverage by selecting a ‘broad spectrum’ antibiotic. I’ve drawn the broad spectrum abx above the narrow spectrum abx to illustrate the concept of “escalation” and “de-escalation”. Let’s add names to the spectrum. On the left is Gram pos and on the right is Gram neg. I’ve also dropped 2 vertical lines – Abx A covers ONLY Gram pos, Abx C covers ONLY Gram neg, and Abx B covers a bit of both. Ideally, we could arrange all the clinically important organisms in a way that allowed us to depict every abx as a continuous horizontal bar – alas, this is not possible, and thus most abx have “holes” in their coverage! Let’s take it a step further and put actual organism names on the spectrum – this lets us compare/contrast important drug classes with granularity. For example, here’s the Gram pos part of the spectrum filled in with the penicillins and cephalosporins. Here’s the Gram neg end of the spectrum comparing some common beta lactam drugs. We can combine these two ends into 1 continuous spectrum. I also add anaerobes as the bridge between the two, and place intracellular organisms (like Legionella and Mycoplasma) on one end. In the next tweet will be the composite figure with all the commonly encountered abx! In this final figure, abx are divided by beta lactam and non beta lactam. Since we know that in vitro activity does not equal clinical use, I’ve color coded the abx bars – green means active and preferred, dark blue means active, and light blue means unreliably active. Dr. Varun Phadke @VarunPhadke2 #antibiotics #coverage #antibiogram #pharmacology #management #spectrum #table #sensitivities

Intern Pocket Cards - Antibiogram and Susceptibilities VRE - MRSA - GRAM POSITIVES - GRAM NEGATIVES - PSEUDOMONAS - ANAEROBES - ATYPICALS - ANAEROBES - ATYPICALS - penicillin, amoxicillin/ampicillin, amox-clav/amp-sulbactam, methicillin/oxacillin, piperacilin-tazobactam/ticarcillin-clavulanate - 1st gen cephalosporins, 2nd gen cephalosporins (cefoxitin,cefotetan), 3rd gen cephalosporins, 4th gen cephalosporins (cefepime), (ceftazidime), 5th gen cephalosporins (ceftaroline) - carbapenems, aztreonam - ceftaz-avi, ceftolozane-tazo, mero-vabor / imi-relee, cefiderocol - TMP-SMX - clindamycin - vancomycin / oritavancin / dalbavancin - daptomycin, linezolid / tedizolid - tetracyclines (doxycycline) - tigecycline / eravacycline / omadacycline - lefamulin - macrolides - quinolones (delafloxacin, moxifloxacin) - aminoglycosides - fosfomycin - colistin / polymyxin B - metronidazole Antimicrobial Stewardship: → What syndrome? (e.g., UTI, bacteremia, etc.) What bug? (Use culture data. If none, what is most likely?) → What drug? (IV or PO?) Check local antibiogram. Initial duration of therapy? → Can I de-escalate? If on IV, can I switch to PO? Can I stop? (Use clinical data like vitals, WBC count and cultures to tailor therapy) → Discharge patient - Confirm type of IV access (if indicated) and if frequency of medication and lab is feasible at discharge destination by Jennifer Fulcher, MD, PhD @FulchJen Full Inpatient Pocket Cards Collection: https://bit.ly/pocketcardset #Antibiogram #Susceptibilities #antibiotics #management #pharmacology