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Loss Of Consciousness From Vigorous Laughter: A Case Series

Laughter is the best medicine, and now, here’s the best medicine to treat laughter. Fainting from laughter happens, albeit rarely, and is probably a vasovagal response, reports a case series in the medical literature.

Dubbed “Sitcom Syncope,” the series of three patients and a literature review of other cases evaluated patients who reported loss of consciousness during vigorous laughter. The series was reported by Prashan H. Thiagarajah, MD, an ACP Associate Member at the Allegheny General Hospital in Pittsburgh, Pa., and colleagues in Postgraduate Medicine.

The three patients reported seven fainting spells induced by vigorous laughter that were witnessed friends or family.

All patients were hospitalized and underwent a complete history and physical, 12-lead echocardiogram, chest radiograph, routine blood analysis, transthoracic echocardiography, Holter monitoring, carotid duplex study, stress testing, polysomnography, and head-up tilt table testing. In each cases, structural heart disease and cerebrovascular disease were ruled out. Read more »

*This blog post was originally published at ACP Internist*

When A Routine Case In The EP Lab Goes Awry

Easy case.

Seen it a hundred times.

Old guy (or gal).

Comes into ER.

Found “down.”

“Hey doc, looks like his hearts goin’ slow. I think he (or she) needs a pacer.”

“On any meds that might do this?”

“Nah.”

“How’s his (her) potassium?”

“4.3, normal.”

And like lots of times, you head in. Glad you can help. Call-team’s on their way, thanks to you. Called the device rep to make sure they can be there just in case, too. Cool as a cucumber. Nothin’ to it. Been here, done this.

You arrive to a guy (or gal) that looks pretty good. Maybe has one or two medical problems. Heart rate’s better thanks to the atropine and the fluids they gave him (her) on arrival. The intraosseus line in the tibia is impressive, too. (“At least he (she) wasn’t awake when that happened,” you think.)

So you review, examine, plan your approach. EKG on presentation? Ouch, heart rate agonal. Wide complex rhythm of right bundle branch rhythm. Look at the monitor: “lots more right bundle branch rhythm there, thank goodness, P waves, too.” you secretely notice.

Seems he (or she) is willing (how many times does he (or she) want to pass out at home?), understands what lies ahead, that the crew’s on their way. “We’ll be taking you over in just a few minutes. Any other questions?” There are none.

Perfect.

And after a while the crew arrives, assembles the poor guy (or gal) on the table and ships him (or her) over to the cath lab area. Chest is prepped, equipment assembled, antibiotics given, monitors connected…

… damn we’re good. Smooth operators.

So the local anesthetic is injected and the incisions made. Dissection to the pre-pectoralis fascia just above the breast muscle accomplished, even the wires passed easily into the vein using ultrasound guidance. Even having a nice chat with the guy (or gal).

Poetry in motion.

Sheaths placed in the vein over the guidewire, pacing leads placed through the sheath. Until, from the control room… Read more »

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

iPhone App Can Substitute For Expensive Pulse Oximeter

The Electrical and Computer Engineering in Medicine (ECEM) research group in collaboration with the Pediatric Anesthesia Research Team (PART) at the University of British Columbia have developed a mobile solution to measuring key vital signs — called the “Phone Oximeter”.

The Phone Oximeter uses a traditional FDA approved pulse oximetry sensor, but researchers have modified it to interface with a phone, in this case, your iPhone. Currently the setup is being interfaced with an iPhone for trial studies, but is compatible with Android, and other mobile operating systems.

What makes the Phone Oximeter special is its ability to capture SpO2 (blood oxygen saturation), heart rate, and respiratory rate — then dynamically comprehend the variables using the decision support software, giving medical staff or even laymen individuals key help in making decisions on medical care.

So how would a device like this be useful in the medical setting? Read more »

*This blog post was originally published at iMedicalApps*

Don’t Treat The Number, Treat The Patient

In medicine we’re often reminded not to base our therapy solely on lab test results. Although it’s tempting to reduce patient care to a checklist of “normal” bloodwork targets, we all know that this is only a fraction of the total health picture. Today I made a mistake that brought this truism home: “Don’t treat the number, treat the patient.”

I’m turning 40 this year and decided to make an ambitious fitness goal for myself — to be in better shape at 40 than I was at 30. No small feat for a person who used to be in good form a decade ago (not so much now, ahem). So, I joined a gym owned by an affable triathlete and invited her to make me her project. Let’s just say that Meredith believes that one piece of sprouted grain bread is the breakfast of champions — and with that she has me doing many hours of cardio sprints and strength training every week. I’m still alive. Barely.

Today in my endurance spinning class (an unusual form of torture where you get yelled at — I mean encouraged — on a stationary bicycle for an hour and a half in a dark room filled with high-decibel rock music and sweaty co-sufferers), I was somewhat alarmed by my heart rate. I was taught in medical school that one’s maximum heart rate is 220 minus your age. So mine should be about 180. I assumed that anything higher than that was incompatible with life.

So when I saw my heart rate monitor rise to 185 on a steep climb at maximum speed, I wondered if I might be about to die. I certainly felt physically challenged, but not quite at death’s door, so I looked around sheepishly at my nearest peer’s monitor to see if she was handling the strain any better. Nope, she was also at 185. “Gee, what a coincidence,” I thought. “We must be exactly the same fitness level.” Read more »

What Women’s Tears Do To Men

Humans are the only living things that cry when they are overcome with emotion. Why do we do this?

A study by Noam Sobel and colleagues at the Weizmann Institute provide part of the answer, at least as it relates to women. The scientists showed that when men get a whiff of women’s tears, they experience a temporary, generalized loss of libido and a dip in testosterone. Really. (And you thought that red, runny nose was the turn off, didn’t you?)

Scientists have known for decades that the chemical composition of “emotional tears” differs from tears shed due to simple irritation. But now, it appears that some of the chemicals contained in the former are actually pheromones; biological substances that create behavioral changes in others who are exposed to them. Such chemicals were known to exist in urine in anogenital gland secretions (dont ask), but not in tears.

Sobel’s team began its study by posting ads on Israeli college campus bulletin boards in which they sought volunteers who cried easily. Seventy-one people responded. All but one were women. From that group, the scientists identified six who were profuse criers and who could return to their labs every other day.

The scientists then asked each one to select a movie that was guaranteed to make them break down, to watch it in private, and to collect their tears in a vial. For the controls, Sobel’s group trickled a saline solution down the same women’s cheeks and collected that. Sobel’s group subsequently asked male volunteers to sniff the contents of the two vials and ran a battery of psychological and physiological tests to measure their responses. Read more »

*This blog post was originally published at Pizaazz*

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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