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An Appropriately-Inappropriate Cardiac “Shock”

He was 60-year-old man who underwent surgery for an implantable cardiac defibrillator (ICD) approximately 3 years prior who was returning to the clinic for routine followup. He felt well and had no other complaints.

He was connected to the EKG and the programmer’s wand was placed over the device. I interrogated his device and when the initial screen appeared, there it was — a single shock from his device, received two weeks ago.

“Mr. Smith, are you aware that you had an ICD shock about two weeks ago?”

“Yeah.”

“Why didn’t you call us?”

“I don’t know.”

“Did it bother you?”

“Not really.”

“Why not?”

There was a pause. I looked up from the programmer and took a quick look at him. He was looking away. Instantly, I realized the answer. Read more »

*This blog post was originally published at Dr. Wes*

Coffee And The Heart – Researchers Are Getting Paid Way Too Much To Rehash Old Data

This week, coffee seems to be good for the heart:

“People who are moderate coffee drinkers can be reassured that they are not doing harm because of their coffee drinking,” said Arthur Klatsky, the study’s lead investigator and a cardiologist at Kaiser’s Division of Research.

These “surprising” data are to be presented at the AHA meeting March 5th. (You’ll have to wait until then to get the REAL scoop, it seems.)

But a quick Google search on Dr. Klatsky’s earlier studies using the same questionaire database shows the problems with using questionaire data to make such sweeping conclusions. Take, for instance, these findings from 1973: Read more »

*This blog post was originally published at Dr. Wes*

Why I Sent A Guy With A Normal EKG To The Cath Lab

I sent a guy with a normal EKG to the cath lab.  Let me tell you my side of the story.

Dude was minding his own business when he started having crushing, substernal chest pain.  I see dude by EMS about 45 minutes into his chest pain.  He’s had the usual: aspirin, 3 SL NTG’s an IV, a touch of MS (I can abbreviate here, as it’s not a medical record) and is continuing to have pain.

He describes it like you’d expect (elephants have a bad rep in the ED), and looks ill.  Frankly, he looks like a guy having an MI.  Sweaty, pale, uncomfortable, restless but not that ‘I’ve torn my aorta’ look.  The having an MI look.

Every EM doc knows the look.  I didn’t ask about risk factors.

On to the proof: the EKG.  EMS EKG: normal.  ?What?  Yeah, maybe there’s some anterior J-point elevation, but not much else.  Our EKG: Normal. Read more »

*This blog post was originally published at GruntDoc*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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