November 19th, 2011 by DrWes in Research
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Before reaching for tests like EKGs to screen teen athletes, we should first ask ourselves if we’ve taken a careful history:
The new study consisted of Madsen and his fellow researchers sending out surveys to every pediatrician and family practice doctor in Washington State. They received a good response–surveys were returned by 72 percent of pediatricians and 56 percent of family practitioners.
The results were disheartening:
- 28 percent of doctors surveyed failed to always ask if a teen experienced chest pain during exercise.
- 22 percent of doctors surveyed failed to Read more »
*This blog post was originally published at Dr. Wes*
August 27th, 2011 by Paul Auerbach, M.D. in Health Tips, Opinion
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Increasing numbers of young people participate in outdoor activities, including strenuous competitive athletics. In so doing, they subject their bodies to stresses that are more intense and prolonged than those presented by a largely sedentary life. Every story of a sudden death in a young person is a tragedy, and usually accompanied by commentary pondering the role and utility of pre-activity screening. Could the death have been prevented? What was the physiological condition of the deceased? Could the collapse, often attributed to a heart problem, have been predicted? Was there an examination or evaluation that might have indicated that the deceased was at greater risk, or should have been held out of the activity? These are all important questions, with no simple answers.
Sudden collapse and cardiac arrest in a young person seems wrong. It shouldn’t happen. It is a parent’s worst nightmare. Similar horrors occur on the freeway when a teenage driver is killed, or at the beach when a surfer is tossed in a monster wave and drowned. We know a great deal about injury prevention; much of our teaching and experience points to errors in judgment. But the situation is different when the seemingly healthy slumps to the ground without a pulse. That person has been taken by surprise in a cruel act of fate.
Sometimes we learn that the victim had Read more »
This post, The Importance Of Physicals For Young Athletes, was originally published on
Healthine.com by Paul Auerbach, M.D..
June 20th, 2011 by DrWes in True Stories
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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*
June 14th, 2011 by admin in News
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SHL Telemedicine has announced the release of SmartHeart, a lightweight and portable device that they claim can take “hospital-grade” ECGs by “anyone, anywhere, anytime.” The device connects wirelessly to smartphones and can transmit the ECG to a physician for a preliminary diagnosis. The possibilities for a device like this are endless – but so are the questions it raises.
The device greatly streamlines the process of obtaining an ECG as it avoids the need to actually come in to a clinic and can be used to monitor high risk patients from their own homes. The smartphone can then transmit the ECG to an office or a hospital where health care professionals can examine them instantly. As cardiovascular disease is the leading cause of death in the US, a low-cost and easily used cardiovascular diagnostic device could have a huge impact on a sizeable part of the population. SmartHeart is set to cost $500, which is less than an iPhone itself.
However, a portable ECG device that anyone can supposedly use raises some major concerns. The first question is its practical application. For a patient to just have this at home implies that they are at high risk for cardiovascular events. Arrhythmias typically require continuous cardiac monitoring rather than a 10-second ECG, which this device does not appear to provide. So, is this device intended to Read more »
*This blog post was originally published at iMedicalApps*
July 16th, 2010 by DrWes in Better Health Network, Health Policy, Humor
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From a discussion thread on Medscape (registration required) posted in response to comments on my earlier post entitled “If Lawyers Billed Like Doctors:”
Mr. Clark, it appears quite likely you are having a heart attack and will require my services. I will need a retainer of $1,500 via either cash or cashier’s check. This does not cover any treatment, but merely retains me as your physician.
Then you will need to deposit $5,000 into an escrow account. I will bill this account for services rendered. My charges are $400 an hour and I bill in 15-minute increments. Which means if it takes me 5 minutes to review your EKG, I still bill for 15 minutes.
When the escrow account reaches $1,000 you will need to deposit an additional $4,000 into the account or I will cease to be your physician and you forfeit the money in the escrow as well as the retainer, and if you continue to require my care you will need to retain me again.
Would you like me to treat your heart attack?
Ouch.
-WesMusings of a cardiologist and cardiac electrophysiologist.
*This blog post was originally published at Dr. Wes*
