Podcasts about qrs

Contributor: Meghan Hurley, MD Educational Pearls: What is hyperkalemia? Hyperkalemia is when the measured blood level of potassium reaches above 5.2 - 5.5 mEq/L (normal 3.5 - 5.2 mEq/L).  What are common causes of hyperkalemia?  Chronic or acute kidney disease. Medications that impact the Renin-Angiotensin-Aldosterone-System (RAAS).  Hypoaldosteronism and primary adrenal insufficiency (Addison's Disease). What are concerns of hyperkalemia? The biggest concern with hyperkalemia is the impact on the cardiac conduction system. At differing levels of hyperkalemia, the patient may initially have peaked T waves, that then progress into a widening of the QRS complex which may eventually lead to a sine wave pattern.  This increases risk for cardiac arrest with ventricular fibrillation, PEA, and asystole. What is the treatment algorithm for hyperkalemia? Works through a three-tier approach. First tier treatment is with a calcium agent (calcium gluconate or chloride).  Thought for the longest time to "stabilize the cardiac membrane/action potential". Recent research shows the true mechanism of action is likely through acting on calcium dependent channels.  Does not fix underlying hyperkalemia, but buys time for the heart.  Second tier treatment is inducing intracellular potassium shift. Can be achieved through agents such as insulin (which may need to be bolused with glucose to prevent hypoglycemia), albuterol, or sodium bicarbonate.  Third tier is potassium elimination If the patient is producing urine, loop or thiazide diuretics can be considered.  Hemodialysis may also be considered based on patient condition.  Long term (and slowest method of elimination) through fecal excretion. Unlikely to see benefits in emergency management.  Key Takeaways?  Hyperkalemia is a condition that can be brought on by primarily renal conditions and medication side effects. Careful attention must be paid to the patient's cardiac status, and urgent cardiac stabilization (though now we may know that calcium doesn't truly "stabilize" the cardiac membrane) must be performed to prevent deadly arrhythmias. Definitive management involves addressing the offending agent, offloading potassium, and stabilizing the patient long term.   References: Geldermann N, Dzimiera J, Fischer H, Christ M. Acute hyperkalaemia in emergency care: evidence-based approaches. Emerg Med J. 2026;43(5):305-311. doi:10.1136/emermed-2025-215469 Piktel JS, Wan X, Kouk S, Laurita KR, Wilson LD. Beneficial Effect of Calcium Treatment for Hyperkalemia is Not Due to "Membrane Stabilization." Crit Care Med. 2024;52(10):1499-1508. doi:10.1097/CCM.0000000000006376 Hunter RW, Bailey MA. Hyperkalemia: pathophysiology, risk factors and consequences. Nephrol Dial Transplant. 2019;34(Suppl 3):iii2-iii11. doi:10.1093/ndt/gfz206   Summarized by Dan Orbidan, OMS3 | Edited by Dan Orbidan & Ahmed Abdel-Hafiz, NREMT-P   Donate: https://emergencymedicalminute.org/donate/   Join our mailing list: http://eepurl.com/c9ouHf

Picture this. You're standing over a patient whose monitor is showing one of the most frightening rhythms in cardiology. Someone says, "It's complete heart block," and suddenly everyone's focused on the ECG. But here's the question that separates a technician from a clinician: Do you actually understand why it's happening? In this episode of Ten Minute Medic, we're going beyond memorizing P waves, QRS complexes, and AV dissociation. Instead, we're going to pull back the curtain on the heart's electrical system and discover why third-degree heart block is actually one of the most logical rhythms in medicine. Once you understand the physiology, you'll never have to memorize this rhythm again—you'll be able to predict it, explain it, and, most importantly, recognize what it means for your patient. So, if you're ready to stop chasing rhythm strips and start understanding the story they're telling, let's jump in. Third Degree Heart Block Study Guide

CardioNerds (Drs. Apoorva Gangavelli, Jenna Skowronski, and Hannah Every) discuss the continuum of prevention and heart failure with Drs. Anu Lala and Martha Gulati. Grounded in a clinical case of a 55-year-old woman with uncontrolled hypertension, type 2 diabetes, and obesity who is on the trajectory toward heart failure, this episode unpacks a paradigm-shifting framework from a joint HFSA/ASPC Scientific Statement. The discussion explores how prevention should not be siloed from heart failure management but rather integrated across a patient’s lifespan—from primary prevention in at-risk individuals, to secondary prevention in those with established heart failure, to tertiary prevention in patients with advanced therapies such as LVADs and heart transplantation. The experts highlight the importance of aggressive risk factor management, biomarker-guided screening, the AHA’s Life’s Essential 8, and the need for multidisciplinary collaboration and systems-level change to shift heart failure care from reactive to proactive. Audio editing for this episode was performed by CardioNerds Intern, Dr. Julia Marques Fernandes. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Prevention PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls Systemic inflammatory diseases are associated with an elevated CVD risk that has significant implications for early detection, risk Heart failure prevention is a continuum, not a checkpoint. Prevention applies at every stage—from at-risk (Stage A) through advanced/post-transplant care—and every clinical encounter is an opportunity to intervene. The AHA’s Life’s Essential 8 (diet, physical activity, nicotine exposure, sleep, BMI, blood lipids, blood glucose, blood pressure) forms the foundation at every stage. Hypertension carries the highest population-attributable risk for heart failure of any modifiable risk factor. In the Framingham Heart Study, 91% of patients with newly diagnosed HF had pre-existing hypertension. The SPRINT trial demonstrated a 38% reduction in HF incidence with intensive blood pressure targets (30 ng/L or NT-proBNP >125 ng/L) identify individuals at heightened risk for progression to symptomatic HF. The ACC/AHA/HFSA guidelines give a Class IIa recommendation for natriuretic peptide screening in at-risk patients. Urine albumin-to-creatinine ratio (UACR) is an underutilized screening tool that provides additional insight into CKM risk. The heart failure label does not close the prevention window—it accentuates it. Secondary prevention through GDMT optimization (quadruple therapy in HFrEF) and continued risk factor management remains critical. Tertiary prevention extends to post-LVAD and post-transplant patients, where hypertension, diabetes, obesity, and CKD management remain essential to long-term outcomes. Show notes For a comprehensive review, please review the full HFSA/ASPC Joint Scientific Statement: Lala A, Beavers C, Blumer V, et al. The Continuum of Prevention and Heart Failure in Cardiovascular Medicine. J Card Fail. 2026;32:75-105. doi:10.1016/j.cardfail.2025.06.013 1. What is the “continuum of prevention” framework, and how does it differ from traditional approaches to heart failure prevention? Historically, prevention and heart failure management have been treated as separate disciplines—primary prevention handled by preventive cardiologists and treatment managed by heart failure specialists. This joint HFSA/ASPC Scientific Statement reframes prevention as a dynamic, continuous process that spans a patient’s entire lifespan, regardless of HF stage or ejection fraction. The framework maps onto the ACC/AHA HF staging system: Primary prevention targets Stage A (“at risk”) and Stage B (“pre-HF”) patients to reduce the burden of incident HF. Secondary prevention targets Stage C (symptomatic) and Stage D (advanced) patients to reduce the impact of established HF through GDMT optimization and ongoing risk factor management. Tertiary prevention encompasses risk factor management in patients with LVADs or heart transplants—populations where hypertension, diabetes, and obesity still drive outcomes. The Central Figure of the statement illustrates that Life’s Essential 8 (blood pressure and lipid control, diabetes management, exercise, sleep, smoking cessation, weight management, and diet/nutrition counseling) forms the foundation at every stage, with pharmacologic and device-based therapies layered on top as disease progresses (Figure) 2. How do traditional risk factors drive heart failure, and what should clinicians prioritize? Hypertension carries the greatest population-attributable risk for HF. In the Framingham Heart Study (N=5,143), HTN was associated with a 2- to 3-fold increased risk of HF, with a population-attributable risk of 39% in men and 59% in women. The SPRINT trial showed a 38% reduction in HF incidence and 25% reduction in the primary composite outcome with intensive BP targets (30 ng/L or NT-proBNP >125 ng/L) are associated with heightened risk for progression to symptomatic HF. In the ARIC study, incorporating NT-proBNP reclassified 20% of older adults without HF into Stage B. Factors that affect interpretation include age, sex, obesity (lower values), and CKD (higher values). High-sensitivity cardiac troponin (hs-cTn): Concentrations above the 99th percentile are now included in the definition of Stage B HF. Troponin testing may complement natriuretic peptides, particularly when BNP/NT-proBNP values are ambiguous. Risk scores: The PCP-HF equation predicts 10-year HF risk using traditional risk factors plus QRS duration. The AHA PREVENT score incorporates HF risk calculation and includes markers of kidney function (albuminuria, eGFR), though it may underestimate risk in men and Black adults. The CKM syndrome staging framework (Stages 0–4) provides a holistic approach to assessing systemic cardiovascular-kidney-metabolic risk. 4. What are the key nontraditional risk factors and cross-cutting themes in heart failure prevention? Genetics: Pathogenic cardiomyopathy variants exist in ~1 in 200 individuals in the general population. The HFSA and ACMG recommend cascade testing to identify at-risk family members. Polygenic risk scores for dilated cardiomyopathy show a 3.8-fold risk for DCM in the top 10th percentile compared with the median. Sex-specific considerations: Women have 2.8 times the odds of developing HFpEF, while men have similarly increased odds of HFrEF. A complete obstetric/gynecologic history is essential—preeclampsia is associated with a 4-fold increased risk of HF. Peripartum cardiomyopathy requires intentional screening in high-risk populations. Cardiotoxic exposures: Clinicians should be aware of medications that cause direct myocardial toxicity (e.g., anthracyclines, trastuzumab, tyrosine kinase inhibitors). A team-based approach with pharmacists can help optimize medication selection and risk factor modification. Social determinants of health: Environmental exposures (air pollution, arsenic, lead, cadmium), food insecurity, financial instability, and limited healthcare access contribute to HF risk and progression. Equity-focused, risk-based prevention strategies are needed. Psychological health: Depression is common in HF and independently associated with worse outcomes. Screening with brief questionnaires (e.g., PHQ-2) is recommended. Meditation, spirituality, and holistic wellness approaches remain underutilized. 5. What systems-level and policy changes are needed to move the needle on heart failure prevention? Multidisciplinary HF prevention clinics that bring together preventive cardiologists, HF specialists, endocrinologists, nephrologists, dietitians, pharmacists, exercise physiologists, and genetic counselors are advocated by the statement. EHR-embedded risk stratification could proactively flag patients on a trajectory toward HF—analogous to sepsis alerts or fall risk flags—enabling earlier intervention, particularly for patients who may not reach a cardiologist. Cardiac rehabilitation remains underutilized, particularly in HFrEF (Class 2b recommendation) and HFpEF (not yet covered by Medicare). The HF-ACTION trial showed quality-of-life benefits, and the REHAB-HF trial showed particular benefit in older patients with HFpEF. Policy priorities include expanding insurance coverage for preventive screening and novel therapies (SGLT2i, GLP-1 RAs, nsMRAs), reducing clinical inertia through team-based care models with closer follow-up intervals, and ensuring equitable access to evidence-based therapies across diverse populations. Digital health and AI hold promise for personalized risk prediction, remote monitoring (e.g., wearable devices, implantable PA pressure monitors), and virtual cardiac rehabilitation to overcome access barriers. Figure  Lala A, Beavers C, Blumer V, et al. The continuum of prevention and heart failure in cardiovascular medicine: a joint scientific statement from the Heart Failure Society of America and the American Society for Preventive Cardiology. J Card Fail. 2026;32(1):75-105. doi:10.1016/j.cardfail.2025.06.013) References Key references are bolded. Lala A, Beavers C, Blumer V, et al. The continuum of prevention and heart failure in cardiovascular medicine: a joint scientific statement from the Heart Failure Society of America and the American Society for Preventive Cardiology. J Card Fail. 2026;32(1):75-105. doi:10.1016/j.cardfail.2025.06.013 Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(18):e895-e1032. doi:10.1161/CIR.0000000000001063 Lloyd-Jones DM, Allen NB, Anderson CAM, et al. Life’s Essential 8: updating and enhancing the American Heart Association’s construct of cardiovascular health: a presidential advisory from the American Heart Association. Circulation. 2022;146(5):e18-e43. doi:10.1161/CIR.0000000000001078 SPRINT Research Group, Wright JT Jr, Williamson JD, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373(22):2103-2116. doi:10.1056/NEJMoa1511939 Levy D, Larson MG, Vasan RS, Kannel WB, Ho KK. The progression from hypertension to congestive heart failure. JAMA. 1996;275(20):1557-1562. doi:10.1001/jama.1996.03530440037034 Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002;288(23):2981-2997. doi:10.1001/jama.288.23.2981 Yusuf S, Sleight P, Pogue J, et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med. 2000;342(3):145-153. doi:10.1056/NEJM200001203420301 Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373(22):2117-2128. doi:10.1056/NEJMoa1504720 Anker SD, Butler J, Filippatos G, et al. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med. 2021;385(16):1451-1461. doi:10.1056/NEJMoa2107038 Solomon SD, McMurray JJV, Claggett B, et al. Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2022;387(12):1089-1098. doi:10.1056/NEJMoa2206286 Filippatos G, Anker SD, Agarwal R, et al. Finerenone reduces risk of incident heart failure in patients with chronic kidney disease and type 2 diabetes: analyses from the FIGARO-DKD trial. Circulation. 2022;145(6):437-447. doi:10.1161/CIRCULATIONAHA.121.057983 Solomon SD, McMurray JJV, Vaduganathan M, et al. Finerenone in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2024;391(16):1475-1485. doi:10.1056/NEJMoa2407107 Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med. 2023;389(24):2221-2232. doi:10.1056/NEJMoa2307563 Deanfield J, Verma S, Scirica BM, et al. Semaglutide and cardiovascular outcomes in patients with obesity and prevalent heart failure: a prespecified analysis of the SELECT trial. Lancet. 2024;404(10454):773-786. doi:10.1016/S0140-6736(24)01498-3  Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al. Semaglutide in patients with heart failure with preserved ejection fraction and obesity. N Engl J Med. 2023;389(12):1069-1084. doi:10.1056/NEJMoa2306963 Ndumele CE, Neeland IJ, Tuttle KR, et al. A synopsis of the evidence for the science and clinical management of cardiovascular-kidney-metabolic (CKM) syndrome: a scientific statement from the American Heart Association. Circulation. 2023;148(20):1636-1664. doi:10.1161/CIR.0000000000001175 Khan SS, Matsushita K, Sang Y, et al. Development and validation of the American Heart Association’s PREVENT equations. Circulation. 2024;149(6):430-449. doi:10.1161/CIRCULATIONAHA.123.067626 Khan SS, Ning H, Shah SJ, et al. 10-year risk equations for incident heart failure in the general population. J Am Coll Cardiol. 2019;73(19):2388-2397. doi:10.1016/j.jacc.2019.02.057 Bozkurt B, Fonarow GC, Goldberg LR, et al. Cardiac rehabilitation for patients with heart failure: JACC expert panel. J Am Coll Cardiol. 2021;77(11):1454-1469. doi:10.1016/j.jacc.2021.01.030 Packer M. Leptin-aldosterone-neprilysin axis: identification of its distinctive role in the pathogenesis of the three phenotypes of heart failure in people with obesity. Circulation. 2018;137(15):1614-1631. doi:10.1161/CIRCULATIONAHA.117.032474 Lala A, Tayal U, Hamo CE, et al. Sex differences in heart failure. J Card Fail. 2022;28(3):477-498. doi:10.1016/j.cardfail.2021.10.006 Bozkurt B, Coats AJS, Tsutsui H, et al. Universal definition and classification of heart failure. Eur J Heart Fail. 2021;23(3):352-380. doi:10.1002/ejhf.2115 Hershberger RE, Givertz MM, Ho CY, et al. Genetic evaluation of cardiomyopathy—a Heart Failure Society of America practice guideline. J Card Fail. 2018;24(5):281-302. doi:10.1016/j.cardfail.2018.03.004 Levine GN, Cohen BE, Commodore-Mensah Y, et al. Psychological health, well-being, and the mind-heart-body connection: a scientific statement from the American Heart Association. Circulation. 2021;143(10):e763-e783. doi:10.1161/CIR.0000000000000947 Ezekowitz JA, Colin-Ramirez E, Ross H, et al. Reduction of dietary sodium to less than 100 mmol in heart failure (SODIUM-HF): an international, open-label, randomised, controlled trial. Lancet. 2022;399(10333):1391-1400. doi:10.1016/S0140-6736(22)00369-5

Join CardioNerds EP Council Chair Dr. Naima Maqsood and Episode Lead Dr. Sukriti Banthiya as they discuss the results of the International Collaborative LBBAP Study (I-CLAS) with expert faculty Dr. Theofanie Mela and Dr. Pugazhendhi Vijayraman. Audio editing by CardioNerds academy intern, Grace Qiu. The International Collaborative LBBAP Study (I-CLAS) evaluated clinical outcomes between biventricular pacing (BVP) and left bundle branch area pacing (LBBAP) in patients with left ventricular ejection fraction (LVEF) ≤50% undergoing cardiac resynchronization therapy. Between January 2018 and June 2023, 2,579 patients were enrolled across 18 centers. The primary composite outcome was defined as all-cause mortality or heart failure hospitalization. LBBAP demonstrated a shorter paced QRS duration and was associated with a lower risk of primary composite outcome and heart failure hospitalization. No significant difference was observed in all-cause mortality. Additionally, procedural complications were lower with LBBAP. This episode was planned in collaboration with  Heart Rhythm TV with mentorship from Dr. Daniel Alyesh and Dr. Mehak Dhande.  Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Journal Club PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron!

We discuss this ominous complication of providing local anesthesia. Hosts: Elaine Jonas, MD Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/LAST.mp3 Download Leave a Comment Tags: Critical Care, Toxicology Show Notes I. Pathophysiology & Mechanisms Definition: Systemic toxicity secondary to local anesthetic (LA) via accidental intravascular injection or excessive systemic absorption. Threshold: Occurs when plasma concentration exceeds the safety threshold for cardiac and neural tissue. Agent Profile: Bupivacaine (High Risk) Highly lipophilic with high protein binding. “Fast-on, Slow-off” Kinetics: Strong Na+ channel binding with extremely slow dissociation during diastole. Myocardial Depression: Direct inhibition of Ca2+ release from the sarcoplasmic reticulum, impairing contractility. Low CC:CNS Ratio: The dose required for cardiac collapse is very close to the dose that triggers seizures (narrow safety margin). Contributing Factors: Acidosis/Hypercapnia: Increases the fraction of free drug and promotes ion trapping in the brain/heart; shifts the LA-binding curve toward higher toxicity. Hypoxemia: Exacerbates myocardial depression and lowers seizure threshold. II. Risk Assessment & Prevention Patient-Specific Risk Factors Extremes of Age: Neonates (low α-1-acid glycoprotein) and elderly (reduced clearance). Body Composition: Low muscle mass/frailty (decreased volume of distribution). Organ Dysfunction: Hepatic: Reduced metabolism of amide LAs. Renal: Accumulation of metabolites; risk of metabolic acidosis lowering seizure threshold. Cardiac: Reduced cardiac output slows hepatic delivery/clearance; heart failure patients are more sensitive to Na+ channel blockade. Pregnancy: Increased sensitivity to cardiotoxicity. Procedural Risk Factors Vascularity of Site (Highest to Lowest Risk): Intercostal blocks (highest absorption rate). Caudal/Epidural. Interfascial plane blocks (e.g., TAP block). Psoas compartment/Sciatic. Brachial plexus. Technique: Large volume infiltration, lack of ultrasound, lack of incremental injection. Prevention Mandates Weight-Based Dosing: Lidocaine (Plain): Max 4.5 mg/kg. Lidocaine (with Epi): Max 7 mg/kg. Bupivacaine: Max 2.5–3 mg/kg. Incremental Injection: 3–5 mL aliquots with frequent aspiration. Intravascular Marker: Use Epinephrine (1:200,000) to detect accidental IV placement (HR increase >10 bpmor SBP increase >15 mmHg). III. Clinical Presentation Neurologic Phase (Early to Late) Subjective: Metallic taste, tinnitus, circumoral numbness/tingling. Objective: Visual disturbances, agitation, confusion, tremors. Critical: Generalized tonic-clonic seizures, rapid progression to CNS depression, coma, and apnea. Note: Early phases are often masked in patients receiving midazolam or propofol. Cardiovascular Phase Initial: Hypertension and tachycardia (if epi used) or transient stimulatory phase. Conduction Defects: PR prolongation, QRS widening (classic sign), bundle branch blocks. Dysrhythmias: Bradycardia (most common), VT/VF, PEA, asystole. Contractility: Profound, refractory hypotension and cardiogenic shock. IV. Immediate Management Algorithm Goal: Prevent hypoxia/acidosis and sequester the toxin. 1. Initial Actions Stop Injection: Immediately halt all LA administration. Call for Help: Specify “LAST Protocol” and “Intralipid Kit.” Airway Management: 100% O2​. Hyperventilate slightly if needed to counter respiratory acidosis. Low threshold for intubation (hypoxia/acidosis rapidly worsen LAST). 2. Seizure Control First-line: Benzodiazepines (e.g., Midazolam). Avoid: Propofol if hemodynamically unstable (exacerbates cardiac depression). Neuromuscular Blockers: May be needed for ventilation, but remember they do not stop CNS seizure activity. 3. Lipid Emulsion Therapy 20% Indications: Start at first sign of serious toxicity (airway compromise, seizures, or CV instability). Bolus: 1.5 mL/kg IV over 1 minute. Infusion: 0.25 mL/kg/min immediately following bolus. If Instability Persists: Repeat bolus (up to 2 times). Increase infusion to 0.5 mL/kg/min. Upper Limit: ≈12 mL/kg total dose. 4. Modified ACLS Epinephrine: Use low doses (

Äntligen kommer avsnittet vi alla väntat på - intox-HLR med Johanna Nordmark Grass från Giftinformation. Vi diskuterar vad som är viktigt att tänka på som är annorlunda vid ett hjärtstopp orsakat av substanser. Hur noga ska vi tolka QRS och hur läser man ett QT-nomogram? Vi pratar om vanliga läkemedel som i överdoser kan ge kardiovaskulär och cerebral toxicitet, Arin hatar på laktat och det visar sig att Johanna har en lite PhD i bakfickan!

En aquest episodi parlem d’un fenomen que hi ha darrere d’alguns casos de mort sobtada. L’Albert n’ha fet una entrada al seu blog i ens comparteix les imatges que il·lustren millor aquesta condició. R sobre T Aquest episodi també l’hem gravat en versió vídeo que podeu trobar a can YouTube Menys és més Benzodiazepines en episodis de delírium en gent gran Per aquest Menys és Més us portem una recomanació de l’Essencial que ens diu que en les persones grans, el delírium no s’hauria de prevenir ni tractar de manera rutinària amb benzodiazepines, excepte en els casos en què sigui causat per la privació d’alcohol o de sedants. UrgemMot L’Albert ens recorda que la paraula extrasístole és femenina, però extrasistòlia sí que és masculina. També presentem en recull de mots relacionats amb el tema d’aquest episodi: Aleteig auricular: recomana anomenar així l'atrial flutter; evita l'anglicisme flutter. Ritme d'escapament: ritme que apareix quan falla el marcapassos normal; la forma correcta és ritme d'escapament (no ritme d'escape). Fibril·lació auricular paroxismal: forma paroxística de fibril·lació auricular; el diccionari prefereix fibril·lació auricular paroxismal. Blocatge i hemiblocatge cardíac: trastorns de conducció del cor; cal dir blocatge o hemiblocatge i no bloqueig. Blocadors β‑adrenèrgics / blocadors dels canals del calci: termes recomanats per a fàrmacs com labetalol, bisoprolol, verapamil o diltiazem; evita els castellanismes bloquejant o blocker. Marcapassos: dispositiu per generar impulsos que estimulen el cor; la forma correcta és marcapassos, no marcapàs. Tamponament cardíac: situació en què el cor és comprimit per líquid o sang; cal dir tamponament (no taponament). Onda: denominació correcta de les onades de l'electrocardiograma (onda P, QRS i T); evita l'ús d'ona. Elèctrode toràcic: adhesiu que es col·loca al tòrax per captar l'activitat elèctrica; porta accent obert en la segona e. Monitoratge / monitorar: termes recomanats per al procés de vigilància del ritme i les constants vitals; s'eviten monitorització i monitoritzar. Carretó d'aturada / carretó de cures: carretó utilitzat per portar material d'emergència i per a la reanimació; s'ha d'evitar dir-ne carro. Respirador manual: dispositiu utilitzat per ventilar manualment un pacient durant la RCP; en català és respirador manual, no baló ressuscitador. Recomanacions L’Albert ens recomana una de les webs pioneres del moviment #FOAMED: first10em.com. En aquest lloc, del Dr. Justin Morgensten hi trobem últimament moltes entrades on fa lectura crítica d’articles científics rellevants per a la nostra pràctica. I en Xavi ens presenta un recurs molt visual, l’Atles d’ingressos potencialment evitables. Ens mostra les taxes d’ingressos d’algunes malalties que s’haguessin pogut evitar si el sistema sanitari hagués atès correctament aquests pacients. Ens mostra els resultats per regions de salut, cosa que ens facilita saber com es comporta el sistema en el nostre territori. Transcripció de l'àudio Tall d'àudio inicial: Es caulets, de Trèvol Programari: Debian, OBS, vdo.ninja, Audacity, Ardour, Nvidia Broadcast

CRT—now framed as cardiac physiologic pacing—remains a cornerstone for HFrEF patients with LVEF ≤50% and either high ventricular pacing burden or a wide QRS, with the biggest gains in LBBB and QRS ≥150 ms. ⚡

Carel van Wyk is the founder and CEO of MoneyBadger. MoneyBadger enables easy bitcoin payments at 650 thousand stores in South Africa. MoneyBadger on Nostr: https://primal.net/p/nprofile1qqsz85k206vm3vqdmlvcy9l4kyfqchlnf4hnctasxufa3ph0ck9decgpk49rf MoneyBadger on X: https://x.com/MoneyBadgerPayWesbite: https://www.moneybadger.co.za/EPISODE: 189BLOCK: 933542PRICE: 1112 sats per dollar(00:03:26) What is Money Badger? Mission and merchant focus(00:05:13) Paying anywhere in South Africa(00:05:27) 650,000 locations(00:07:04) Leveraging existing QR payment rails and the Pick n Pay breakthrough(00:10:01) How the flow works: bridging proprietary QR to Lightning(00:11:18) MoneyBadger app as translator vs. using any Lightning wallet(00:13:04) Fiat settlement, volatility handling, and business model(00:17:07) Why no Money Badger wallet? Integrations with Blink, Zeus, Aqua(00:20:20) A clever LNURL/Lightning Address pattern to decode merchant QRs(00:23:39) Pragmatic, a bit hacky, and works across wallets(00:28:04) Replicability beyond SA: Kenya's M‑Pesa, Ghana, Latin America(00:32:10) Creating demand: Bitcoin Ekasi as proof-of-use for Pick n Pay(00:35:15) Real usage: growth to ~5k tx/month and $200k volume(00:39:40) Who spends Bitcoin? From cash users to OGs and ideologues(00:42:34) Incentives and the challenge of moving the middle(00:43:42) Tax context in South Africa: capital gains thresholds(00:46:59) UX talk: tap-to-pay vs. QR, hardware realities and patience(00:49:12) Beyond POS: treasury, suppliers, and stablecoin pull(00:51:03) Bitcoin vs. stablecoins in SA usage; Luno/Binance integrations(00:55:07) Wild flexibility: paying with almost any token via partners(00:57:46) Urgency to prove Bitcoin as money before it's siloed(00:58:00) Hypothetical: Square/Cash App design vs. bridge approach(01:03:41) Consumer friction at checkout and signaling acceptance(01:07:38) Tipping, bridges to Venmo/Cash App, and cash realities(01:09:19) Call to action: spend Bitcoin to create demand(01:11:08) Wrap-up: plans to visit SA, links, and farewellmore info on the show: https://citadeldispatch.comlearn more about me: https://odell.xyz

Luis is an AWS Community Builder, CTO, and game developer! In this session, you'll learn how to build a live FAST (Free Ad-Supported TV) channel using AWS Elemental MediaLive. We'll walk through the end-to-end process: from ingest and transcoding, to dynamic ad insertion with MediaTailor and VOD integration via MediaConvert. This talk is perfect for engineers, architects, or media professionals looking to deliver scalable, serverless streaming solutions on AWS. 00:00 - Intro 04:50 - Building FAST Channels 06:20 - Key Concepts 18:10 - Architecture of the demo 21:00 - QRs for repo and player demo 22:25 - Building the demo live! 46:51 - Alternate Architectures 2 & 3 How to find Luis: https://www.linkedin.com/in/luis-valdivia-humareda/ Luis' links: https://github.com/lvaldivia/vbrownbag2025

Wil sits down in-person with Tim McLaughlin, technologist-turned-operator who founded GoTab after opening two Caboose breweries and confronting real service-model pain (giant spaces, staffing constraints). Years before COVID, Tim taped QRs to tables and proved guests will change behavior to avoid pain (lines), which pushed GoTab to build not just ordering but a deep KDS and, later, a POS when closed ecosystems (e.g., API roadblocks) blocked integrations. Today GoTab focuses on operations over payments, hybrid service (QR + handheld + kiosk), open integrations, and white-glove 24/7 support, while running lean and profitable (not “growth at any cost”). With Opsie for inventory/costing, expansion in higher-labor markets like Australia, and an operator-first pricing philosophy (inspired by Costco's cap idea), Tim argues tech should feel invisible, amplify hospitality, and never replace it.10 Takeaways Pain drives adoption: guests embraced QR ordering in 2018 at Caboose Commons to skip long lines—two years before COVID. Operations > payments: GoTab's edge is the KDS/factory-mindset—batching, throttling, inventory links—not just taking money. Hybrid service wins: seamlessly mix QR tabs, handheld orders, kiosks, and traditional POS—flip zones on/off in real time. Open…for real: GoTab publishes APIs and keeps integrations (even with competitors to Opsie) because operators need choice. Closed ecosystems cost you: API fees/blocks pushed GoTab to build its own POS so operators aren't held hostage. Service is strategy: 24/7 phone/text/chat, humans + AI, fast responses—because hospitality vendors must model hospitality. Lean and profitable: modest capital, disciplined hardware R&D, profitable growth > headline valuations. Inventory is the sleeper win: most independents skip it; Opsie aims for “no-effort” inventory & COGS visibility inside GoTab. Follow labor costs: higher-labor markets (e.g., Australia with double-time on holidays) adopt efficiency tech faster. Pricing with trust: exploring a Costco-style profit cap; focus on transparent value, not nickel-and-diming via fees.

LISTENER DISCRETION IS ADVISED. References: Buxton. Sustained Monomorphic VT: Clinical Manifestations, Diagnosis, and Evaluation. Up-to-Date. Farré J, Rubio JM, Sternick EB. Confounding factors leading to misdiagnosing ventricular tachycardia as supraventricular in the emergency room. Indian Pacing Electrophysiol J. 2023;23(1):1-13. doi:10.1016/j.ipej.2022.11.002 Kashou AH, Evenson CM, Noseworthy PA, et al. Differentiating wide complex tachycardias: A historical perspective. Indian Heart J. 2021;73(1):7-13. doi:10.1016/j.ihj.2020.09.006 Salim Rezaie, "SVT With Aberrancy Versus VT", REBEL EM blog, November 22, 2013. Available at: https://rebelem.com/svt-aberrancy-versus-vt/. 
Steinman RT, Herrera C, Schuger CD, Lehmann MH. Wide QRS tachycardia in the conscious adult. Ventricular tachycardia is the most frequent cause. JAMA. 1989 Feb 17;261(7):1013-6. PMID: 2915409. Vereckei A. Current algorithms for the diagnosis of wide QRS complex tachycardias. Curr Cardiol Rev. 2014 Aug;10(3):262-76. doi: 10.2174/1573403x10666140514103309. PMID: 24827795; PMCID: PMC4040878.

To pass the written ACLS exam and mega code, students need to be able to identify basic ECG dysrhythmias, including the two types of second-degree heart block.One method of ECG rhythm identification is to ask a series of questions such as:What's the rate (150);Is the rhythm regular or irregular;What's the shape, width, and frequency of P waves and QRS complexes; andWhat's the P-R interval and is it constant?ECG characteristics of a second-degree Mobitz type I (Wenckebach).Identification of unstable bradycardia and its treatment with Atropine.ECG characteristics of a second-degree Mobitz type II.Possible effect of using Atropine on patients with a second-degree type II AV block.Treatment of unstable bradycardic patients refractory to Atropine using TCP, Dopamine, or Epinephrine drip.Starting dose and titration of Dopamine and Epinephrine drips.Good luck with your ACLS class!Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/savePass ACLS Web Site - Other ACLS-related resources: https://passacls.com@Pass-ACLS-Podcast on LinkedIn The Curious Clinicians: History of Doctor Wenckebach & Mobitzhttps://curiousclinicians.com/2022/07/06/episode-52-way-back-wenckebach/Practice ECGs with rationale at Dialed Medics:https://dialedmedics.com/

To pass ACLS, you will need to be able to identify common rhythms on a monitor during your mega code and ECG strips on your written exam.If you don't normally monitor patients as part of your job, I suggest two things:1. Find a system for ECG interpretation that works well for you; and2. Practice reading ECGs every day for a few weeks before your class.Review of normal ECG morphology of P wave, QRS complex, and T wave in lead II.Characteristics of first degree heart block.Characteristics of third degree (complete) AV block.Treatment of unstable patients in third degree block following the ACLS Bradycardia algorithm. Special considerations for use of Atropine when patients are in a third degree heart block.The use of TCP, Dopamine, & Epinephrine drip for unstable bradycardic patients refractory to Atropine.Good luck with your ACLS class!Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/Free Prescription Discount Card - Download your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vipPass ACLS Web Site - Episode archives & other ACLS-related podcasts: https://passacls.com@Pass-ACLS-Podcast on LinkedIn

En el video en vivo que realice el pasado domingo 15 de junio, hable de ciberseguridad y como protegernos de los códigos QRs que nos envían a sitios webs falsos o a phishing en general. Espero sus comentarios...

To pass the written ACLS exam and mega code, students need to be able to identify basic ECG dysrhythmias, including the two types of second-degree heart block.One method of ECG rhythm identification is to ask a series of questions such as:What's the rate (150);Is the rhythm regular or irregular;What's the shape, width, and frequency of P waves and QRS complexes; andWhat's the P-R interval and is it constant?ECG characteristics of a second-degree Mobitz type I (Wenckebach).Identification of unstable bradycardia and its treatment with Atropine.ECG characteristics of a second-degree Mobitz type II.Possible effect of using Atropine on patients with a second-degree type II AV block.Treatment of unstable bradycardic patients refractory to Atropine using TCP, Dopamine, or Epinephrine drip.Starting dose and titration of Dopamine and Epinephrine drips.Good luck with your ACLS class!Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/Free Prescription Discount Card - Download your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vipPass ACLS Web Site - Episode archives & other ACLS-related podcasts: https://passacls.com@Pass-ACLS-Podcast on LinkedIn The Curious Clinicians: History of Doctor Wenckebach & Mobitzhttps://curiousclinicians.com/2022/07/06/episode-52-way-back-wenckebach/

Welcome to the RIDINOUTALLDAY podcast, hosted by M. Davis and featuring special guest S. Dot, one of the top rap artists in Las Vegas. In this intense and humorous episode, they dive into a wild debate: can 100 men take down a single gorilla? The conversation takes unexpected turns as they analyze the odds, strategies, and chaos that would ensue in such a scenario.Beyond the outrageous debate, the hosts also touch on societal issues, discussing a controversial new bill regarding school discipline. They explore personal stories of school experiences and share their thoughts on effective discipline measures in modern education.Join them for an entertaining mix of thought-provoking discussion and laughter, brought to you by two of the COLDEST NIGGAS in the city. And im still not editing SHIT!!RIDINOUTALLDAY INSTAGRAM https://www.instagram.com/mdavis?igsh=MWc0YjByejR4YXlreQ%3D%3D&utm_source=qrS.E.T. NEW SINGLE https://music.apple.com/us/album/off-the-roof/1809873477?i=1809873478S.E.T. INSTAGRAM https://www.instagram.com/set_sdot?igsh=MWd4bGN6MDVmdGU1bA==

To pass ACLS, you will need to be able to identify common rhythms on a monitor during your mega code and ECG strips on your written exam.If you don't normally monitor patients as part of your job, I suggest two things:1. Find a system for ECG interpretation that works well for you; and2. Practice reading ECGs every day for a few weeks before your class.Review of normal ECG morphology of P wave, QRS complex, and T wave in lead II.Characteristics of first degree heart block.Characteristics of third degree (complete) AV block.Treatment of unstable patients in third degree block following the ACLS Bradycardia algorithm. Special considerations for use of Atropine when patients are in a third degree heart block.The use of TCP, Dopamine, & Epinephrine drip for unstable bradycardic patients refractory to Atropine.Good luck with your ACLS class!Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/Free Prescription Discount Card - Download your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/savePass ACLS Web Site - Episode archives & other ACLS-related podcasts: https://passacls.com@Pass-ACLS-Podcast on LinkedIn

To pass the written ACLS exam and mega code, students need to be able to identify basic ECG dysrhythmias, including the two types of second-degree heart block. One method of ECG rhythm identification is to ask a series of questions such as: What's the rate (150);Is the rhythm regular or irregular;What's the shape, width, and frequency of P waves and QRS complexes; and What's the P-R interval and is it constant?ECG characteristics of a second-degree Mobitz type I (Wenckebach). Identification of unstable bradycardia and its treatment with Atropine. ECG characteristics of a second-degree Mobitz type II. Possible effect of using Atropine on patients with a second-degree type II AV block. Treatment of unstable bradycardic patients refractory to Atropine using TCP, Dopamine, or Epinephrine drip. Starting dose and titration of Dopamine and Epinephrine drips.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInOther Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/Save money on prescription medications for you and your pets: https://nationaldrugcard.com/ndc3506*Commissions may be earned from the above links.Good luck with your ACLS class!The Curious Clinicians: History of Doctor Wenckebach & Mobitz at https://curiousclinicians.com/2022/07/06/episode-52-way-back-wenckebach/

In this episode, we explore lamotrigine's cardiac side effects, focusing on QTc prolongation and QRS widening. How concerned should psychiatrists be about the FDA warning regarding lamotrigine's cardiac effects? We examine the evidence behind these concerns and discuss practical implications for clinical practice. Faculty: Scott Beach, M.D. Host: Richard Seeber, M.D. Learn more about our memberships here Earn 0.5 CME: Lamotrigine: From Current Indications to Cardiac Side Effects Lamotrigine Effect on QTc Prolongation and QRS Widening

To pass ACLS, you will need to be able to identify common rhythms on a monitor during your mega code and ECG strips on your written exam. If you don't normally monitor patients as part of your job, I suggest two things: 1. Find a system for ECG interpretation that works well for you; and2. Practice reading ECGs every day for a few weeks before your class.Review of normal ECG morphology of P wave, QRS complex, and T wave in lead II.Characteristics of first degree heart block. Characteristics of third degree (complete) AV block. Treatment of unstable patients in third degree block following the ACLS Bradycardia algorithm. Special considerations for use of Atropine when patients are in a third degree heart block. The use of TCP, Dopamine, & Epinephrine drip for unstable bradycardic patients refractory to Atropine.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting. Donations at Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated and will help ensure others can benefit from these tips as well.Good luck with your ACLS class!Helpful Listener Links:Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/*FREE to anyone in the U.S. Save $$ on prescription medications for you and your pets with National Drug Card - https://nationaldrugcard.com/ndc3506 *Indicates affiliate links. I may get paid a small commission if you purchase products or memberships using my link. It doesn't affect the price you pay.Practice ECGs at Dialed Medics: https://dialedmedics.com/

If you've tried everything to heal chronic Lyme, fatigue, or stubborn health issues but still feel stuck, the problem isn't you. It's that conventional medicine often misses the invisible root causes: trapped emotions, EMF toxicity, and energy blockages.  Dr. Michael Rankin Sr., a naturopathic doctor and bioenergetics pioneer, shares why nothing should last more than six months if you're asking the right questions. With over 40 years in holistic health, Dr. Rankin reveals how bioenergetic scans, PEMF therapy, and emotional detox can reverse conditions mainstream doctors call “incurable.” From dissolving bone spurs to healing insomnia, his clinic uses modern tech like BioResonance and ZYTO to map the body's energy field—no invasive tests needed.   “If you have a condition for more than six months, someone's not asking the right questions. Nothing lasts more than six months.” ~ Dr. Michael Rankin Sr.   In This Episode: - Dr. Rankin's journey into bioenergetics - Bioenergetic scans vs. blood tests: Which reveals more? - How bioenergetic testing works - Biopsies, and other hidden health bombs - Detoxing the liver and regenerating Tissues - Why root canals and scars may be blocking your healing - How radionics and bioresonance can improve sleep - PEMF devices and grounding - The Infinity Bed: deep sleep and beyond - The magic of PEMF and QRS devices - Castor oil: the detox protocol you're missing - QRS PEMF mats and how they work - The power of positive affirmations For more information, visit https://www.myersdetox.com    Ready to detox heavy metals? Take the quiz: http://www.heavymetalsquiz.com    Resources Mentioned in This Episode: - QRS PEMF Mat: Get a discount at https://testingcancer.com. - Puori PW1 Whey Protein: Get 20% off today! Visit https://puori.com/Wendy and enter code WENDY at checkout. - Chef's Foundry P600 Cookware: Get an exclusive discount today! Visit https://bit.ly/MyersDetox to claim your special offer. Dr. Jockers Functional Nutrition Podcast: Search "Dr. Jockers" on your favorite podcast platform: https://podcasts.apple.com/us/podcast/dr-jockers-functional-nutrition/id1497791107    About Dr. Michael Rankin Sr. Dr. Michael Rankin Sr. is a naturopathic doctor and director of the Kelly Metabolic Center. With decades of experience in bioenergetic medicine, he specializes in resolving emotional trauma, cancer, and chronic pain using non-invasive technologies like BioResonance, ZYTO, and PEMF therapy. A former conventional medic turned holistic pioneer, Dr. Rankin's work bridges ancient wisdom and modern science—proving that energy, not drugs, holds the key to lasting healing. His clinic offers remote bioenergetic scans and personalized protocols to detox scars, reverse calcification, and restore vitality. Learn more about Dr. Rankin at https://testingcancer.com/    Disclaimer The Myers Detox Podcast was created and hosted by Dr. Wendy Myers. This podcast is for information purposes only. Statements and views expressed on this podcast are not medical advice. This podcast, including Wendy Myers and the producers, disclaims responsibility for any possible adverse effects from using the information contained herein. The opinions of guests are their own, and this podcast does not endorse or accept responsibility for statements made by guests. This podcast does not make any representations or warranties about guests' qualifications or credibility. Individuals on this podcast may have a direct or indirect financial interest in products or services referred to herein. If you think you have a medical problem, consult a licensed physician.

To pass the written ACLS exam and mega code, students need to be able to identify basic ECG dysrhythmias, including the two types of second-degree heart block. One method of ECG rhythm identification is to ask a series of questions such as:What's the rate (150);Is the rhythm regular or irregular;What's the shape, width, and frequency of P waves and QRS complexes; andWhat's the P-R interval and is it constant?ECG characteristics of a second-degree Mobitz type I (Wenckebach). Identification of unstable bradycardia and its treatment with Atropine.ECG characteristics of a second-degree Mobitz type II.Possible effect of using Atropine on patients with a second-degree type II AV block. Treatment of unstable bradycardic patients refractory to Atropine using TCP, Dopamine, or Epinephrine drip.Starting dose and titration of Dopamine and Epinephrine drips.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Good luck with your ACLS class!The Curious Clinicians Podcast: History of Doctor Wenckebach & Mobitz at https://curiousclinicians.com/2022/07/06/episode-52-way-back-wenckebach/Practice ECGs with rationale at Dialed Medics at https://dialedmedics.com/

Jamie is a 68 year old male with a history of hypertension presents with dizziness, palpitations, and shortness of breath. An ECG reveals a regular rhythm at 110 bpm with narrow QRS complexes and absent P waves. What is the MOST likely diagnosis? A) Atrial fibrillation B) Paroxysmal supraventricular tachycardia (PSVT) C) Ventricular tachycardia D) Sinus tachycardia TEXT OUR TEAM: (727) 732-4573

Modeling Disease Pathways Through Ventricular Depolarization   Guest: Peter van Dam, PhD  Host: Anthony H. Kashou, MD   Detection of disease progression is hampered due to the large variation in normal QRS morphologies, even for the ECG expert. Cardiac modeling techniques can improve the interpretation and diagnostic value of the ECG by visualizing relevant QRS deviations. Comparing the QRS waveforms and electrical pathway in genetical patients to normal controls shows that even small changes in the QRS can be detected in patients with a genetical disease, like Brugada or ACM.    Topics Discussed: What is the PathECG?  How do you compare PathECG to normal ECG waveform?  What can the PathECG add to the ECG? Could PathECG improve the quality of the ECG diagnosis? Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. LinkedIn: Mayo Clinic Cardiovascular Services Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.

In this special holiday bonus episode, Ryan takes a look back at some of the most captivating episodes of The Poison Lab from 2022. Get ready for an ultimate test of your toxicology differential diagnosis skills as we compile all the "Stump the Toxicologist" segments into one streamlined, binge-worthy episode. Explore eight unique poisoning cases, be sure to check the show notes for a description of each case. time stamp of where it begins, and links to the original episodes, where you can dive deeper into the discussions and unravel the mysteries behind these intriguing cases! Case Teasers and Time StampsEpisode 13, March 2nd, 2022: Dr. Howard Greller0:06:19 Case 1: A 19-year-old male collapses at home and presents to the ED unresponsive, tachycardic, and hypotensive, with a wide QRS complex on EKG and a serum lactate of 20. 0:22:58 Case 2: A 16-year-old female presents to the ED 9 hours after ingesting 100 tablets of an unknown medication in a suicide attempt. She presents with vomiting, lethargy, bloody diarrhea, and a metabolic acidosis. An abdominal x-ray shows numerous radiopaque tablets in her GI tract. She is treated with a redacted antidote and whole bowel irrigation, but her condition worsens and she develops liver failure. She is transferred to a tertiary care center for a liver transplant, but recovers. On day 12, she develops a lower GI bleed and bowel perforation and dies. 0:34:42 Case 3: A seven-month-old child presents with crying, cough, vomiting, and respiratory distress. 0:37:42 Case 4: A 32-year-old male with a history of alcohol use and depression presents to the ED seven hours after ingesting two handfuls of an unknown medication and alcohol in a suicide attempt. He is initially anxious and tremulous, but has normal vital signs and labs, aside from an elevated ethanol level. He has a seizure nine hours after ingestion. His EKG shows a widened QRS, and he becomes hypotensive. He is intubated, placed on vasopressors, and undergoes extracorporeal membrane oxygenation (ECMO) and targeted temperature management (TTM), but dies three days later. Episode 15, July 6th, 2022: Dr. Josh Trebach0:46:11 Case 1: Two British medical students present to the ED after developing nausea, vomiting, paresthesias, myalgias, pruritus, and cold allodynia 12 hours after sharing a meal. Their neurological symptoms persisted for 4 weeks and the cold allodynia for 10 weeks.0:54:18 - 1:05:23 Case 2: A 16-year-old female presents to the ED unresponsive and cyanotic after intentionally ingesting a substance purchased online. Her oxygen saturation is in the 70s and a methemoglobin level is greater than 30%. 1:05:25 - 1:10:18 Case 3: A 48-year-old female, and co-author of the published case report, presents to the ED 10 minutes after eating a “peppery” tuna steak. She is tachycardic, hypotensive, flushed, and has conjunctival erythema. She also experiences abdominal pain, nausea, vomiting, diarrhea, headache, and chest pain. Her EKG shows tachycardia with ST depression. She requires phenylephrine to maintain her blood pressure. She is treated with famotidine and discharged from the hospital 43 hours later. 1:10:20 – 1:13:16 Case 4: A 63-year-old female presents to the ED 12 hours after ingesting five capsules of a weight loss product. She is bradycardic and has nausea, vomiting, and hyperkalemia.Episode 17, November 9th, 2022: Dr. Emily Kieran1:16:35 Case 1: A 34-year-old female presents to a clinic in West Bengal, India, with a three-year history of skin changes. She has hypo-pigmented macules on a background of hyperpigmentation, creating a “raindrop” like appearance on her...

Contributor: Travis Barlock MD Educational Pearls: What is the ST segment? The ST segment on an ECG represents the interval between the end of ventricular depolarization (QRS) and the beginning of ventricular repolarization (T-wave).  It should appear isoelectric (flat) in a normal ECG. What if the ST segment is elevated? This is evidence that there is an injury that goes all the way through the muscular wall of the heart (transmural) This is very concerning for a heart attack (STEMI) but can be occasionally caused by other pathology, such as pericarditis What if the ST segment is depressed? This is evidence that only the innermost part of the muscular wall of the heart is becoming ischemic This has a much broader differential and includes a partial occlusion of a coronary artery but also any other stress on the body that could cause a supply-and-demand mismatch between the oxygen the coronaries can deliver and the oxygen the heart needs This is called subendocardial ischemia What else should you look for in the ECG to identify subendocardial ischemia? The ST-depressions should be at least 1 mm The ST depressions should be present in leads I, II, V4-6 and a variable number of additional leads. There is often reciprocal ST elevation in aVR > 1 mm The most important thing to remember when you see subendocardial ischemia is…history Still, keep all cardiac causes on your differential, such as unstable angina, stable angina, Prinzmetal angina, etc. Also consider a wide array of non-cardiac causes such as severe anemia, severe hypertension, pulmonary embolism, COPD, severe pneumonia, sepsis, shock, thyrotoxicosis, stimulant use, DKA, or any other state that lead to reduced oxygen supply to the subendocardium and/or increased myocardial oxygen demand. References Birnbaum, Y., Wilson, J. M., Fiol, M., de Luna, A. B., Eskola, M., & Nikus, K. (2014). ECG diagnosis and classification of acute coronary syndromes. Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc, 19(1), 4–14. https://doi.org/10.1111/anec.12130 Buttà, C., Zappia, L., Laterra, G., & Roberto, M. (2020). Diagnostic and prognostic role of electrocardiogram in acute myocarditis: A comprehensive review. Annals of noninvasive electrocardiology : the official journal of the International Society for Holter and Noninvasive Electrocardiology, Inc, 25(3), e12726. https://doi.org/10.1111/anec.12726 Cadogan, E. B. a. M. (2024, October 8). Myocardial Ischaemia. Life in the Fast Lane • LITFL. Retrieved December 7, 2024, from https://litfl.com/myocardial-ischaemia-ecg-library/#:~:text=ST%20depression%20due%20to%20subendocardial,left%20main%20coronary%20artery%20occlusion. Summarized by Jeffrey Olson, MS3 | Edited by Meg Joyce & Jorge Chalit, OMS3 Donate: https://emergencymedicalminute.org/donate/  

To pass ACLS, you will need to be able to identify common rhythms on a monitor during your mega code and ECG strips on your written exam. If you don't normally monitor patients as part of your job, I suggest two things:Find a system for ECG interpretation that works well for you; andPractice reading ECGs every day for a few weeks before your class.Review of normal ECG morphology of P wave, QRS complex, and T wave in lead II.Characteristics of first degree heart block. Characteristics of third degree (complete) AV block.Treatment of unstable patients in third degree block following the ACLS Bradycardia algorithm. Special considerations for use of Atropine when patients are in a third degree heart block. The use of TCP, Dopamine, & Epinephrine drip for unstable bradycardic patients refractory to Atropine.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Good luck with your ACLS class!Practice ECGs at Dialed Medics: https://dialedmedics.com/

The following question refers to Sections 7.4 and 7.5 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure.The question is asked by the Director of the CardioNerds Internship Dr. Akiva Rosenzveig, answered first by Vanderbilt AHFT cardiology fellow Dr. Jenna Skowronski, and then by expert faculty Dr. Randall Starling.Dr. Starling is Professor of Medicine and an advanced heart failure and transplant cardiologist at the Cleveland Clinic where he was formerly the Section Head of Heart Failure, Vice Chairman of Cardiovascular Medicine, and member of the Cleveland Clinic Board of Governors. Dr. Starling is also Past President of the Heart Failure Society of America in 2018-2019. Dr. Staring was among the earliest CardioNerds faculty guests and has since been a valuable source of mentorship and inspiration. Dr. Starling's sponsorship and support was instrumental in the origins of the CardioNerds Clinical Trials Program.The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance.Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. American Heart Association's Scientific Sessions 2024As heard in this episode, the American Heart Association's Scientific Sessions 2024 is coming up November 16-18 in Chicago, Illinois at McCormick Place Convention Center. Come a day early for Pre-Sessions Symposia, Early Career content, QCOR programming and the International Symposium on November 15. It's a special year you won't want to miss for the premier event for advancements in cardiovascular science and medicine as AHA celebrates its 100th birthday. Registration is now open, secure your spot here!When registering, use code NERDS and if you're among the first 20 to sign up, you'll receive a free 1-year AHA Professional Membership! Question #38 Mrs. M is a 65-year-old woman with non-ischemic dilated cardiomyopathy (LVEF 40%) and moderate to severe mitral regurgitation (MR) presenting for outpatient follow-up. Despite improvement overall, she continues to experience dyspnea on exertion with two flights of stairs and occasional PND. She reports adherence with her medication regimen of sacubitril-valsartan 97-103mg twice daily, metoprolol succinate 200mg daily, spironolactone 25mg daily, empagliflozin 10mg daily, and furosemide 80mg daily. A transthoracic echocardiogram today shows an LVEF of 35%, an LVESD of 60 mm, severe MR with a regurgitant fraction of 60%, and an estimated right ventricular systolic pressure of 40 mmHg. Her EKG shows normal sinus rhythm at 65 bpm and a QRS complex width of 100 ms. What is the most appropriate recommendation for management of her heart failure?AContinue maximally tolerated GDMT; no other changesBRefer for cardiac resynchronization therapy (CRT)CRefer for transcatheter mitral valve intervention Answer #38 ExplanationChoice C is correct. The 2020 ACC/AHA Guidelines for the management of patients with valvular heart disease outline specific recommendations.In patients with chronic severe secondary MR related to LV systolic dysfunction (LVEF

The following question refers to Section 7.4 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure.The question is asked by the Director of the CardioNerds Internship Dr. Akiva Rosenzveig, answered first by Vanderbilt AHFT cardiology fellow Dr. Jenna Skowronski, and then by expert faculty Dr. Clyde Yancy.Dr. Yancy is Professor of Medicine and Medical Social Sciences, Chief of Cardiology, and Vice Dean for Diversity and Inclusion at Northwestern University, and a member of the ACC/AHA Joint Committee on Clinical Practice Guidelines.The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance.Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. American Heart Association's Scientific Sessions 2024As heard in this episode, the American Heart Association's Scientific Sessions 2024 is coming up November 16-18 in Chicago, Illinois at McCormick Place Convention Center. Come a day early for Pre-Sessions Symposia, Early Career content, QCOR programming and the International Symposium on November 15. It's a special year you won't want to miss for the premier event for advancements in cardiovascular science and medicine as AHA celebrates its 100th birthday. Registration is now open, secure your spot here!When registering, use code NERDS and if you're among the first 20 to sign up, you'll receive a free 1-year AHA Professional Membership! Question #37 Mr. S is an 80-year-old man with a history of hypertension, type II diabetes mellitus, and hypothyroidism who had an anterior myocardial infarction (MI) treated with a drug-eluting stent to the left anterior descending artery (LAD) 45 days ago. His course was complicated by a new LVEF reduction to 30%, and left bundle branch block (LBBB) with QRS duration of 152 ms in normal sinus rhythm. He reports he is feeling well and is able to enjoy gardening without symptoms, though he experiences dyspnea while walking to his bedroom on the second floor of his house. Repeat TTE shows persistent LVEF of 30% despite initiation of goal-directed medical therapy (GDMT). What is the best next step in his management?AMonitor for LVEF improvement for a total of 60 days prior to further interventionBImplantation of a dual-chamber ICDCImplantation of a CRT-DDContinue current management as device implantation is contraindicated given his advanced age Answer #37 Explanation Choice C is correct. Implantation of a CRT-D is the best next step. In patients with nonischemic DCM or ischemic heart disease at least 40 days post-MI with LVEF ≤35% and NYHA class II or III symptoms on chronic GDMT, who have reasonable expectation of meaningful survival for >1 year,ICD therapy is recommended for primary prevention of SCD to reduce total mortality (Class 1, LOE A). A transvenous ICD provides high economic value in this setting, particularly when a patient's risk of death from ventricular arrhythmia is deemed high and the risk of nonarrhythmic death is deemed low. In addition, for patients who have LVEF ≤35%, sinus rhythm, left bundle branch block (LBBB) with a QRS duration ≥150 ms, and NYHA class II, III, orambulatory IV symptoms on GDMT, cardiac resynchronization therapy (CRT) is indicated to reduce total mortality, reduce hospitalizations, and improve symptoms and QOL. Cardiac resynchronization provides high economic value in this setting. Mr.

To pass the written ACLS exam and mega code, students need to be able to identify basic ECG dysrhythmias, including the two types of second-degree heart block. One method of ECG rhythm identification is to ask a series of questions such as: What's the rate (150); Is the rhythm regular or irregular;What's the shape, width, and frequency of P waves and QRS complexes; andWhat's the P-R interval and is it constant?ECG characteristics of a second-degree Mobitz type I (Wenckebach). Identification of unstable bradycardia and its treatment with Atropine. ECG characteristics of a second-degree Mobitz type II. Possible effect of using Atropine on patients with a second-degree type II AV block. Treatment of unstable bradycardic patients refractory to Atropine using TCP, Dopamine, or Epinephrine drip. Starting dose and titration of Dopamine and Epinephrine drips.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.Good luck with your ACLS class!The Curious Clinicians: History of Doctor Wenckebach & Mobitzhttps://curiousclinicians.com/2022/07/06/episode-52-way-back-wenckebach/Practice ECGs with rationale at Dialed Medics:https://dialedmedics.com/

Pectra Devnet is Prague-Electra Network Upgrade Resources: ----------------- Presentation: https://docs.google.com/presentation/d/1zGLXgYWbV1LQ-8rTDmaiSd534Lz2EOaT/edit?usp=sharing&ouid=110450674004865651218&rtpof=true&sd=true EEST Specs: https://github.com/ethereum/execution-spec-tests/ Earlier talks on PEEPanEIP related to Pectra EIPs: ----------------- EIP-2537: https://youtu.be/Kr0WRewb_AA EIP-2935: https://youtu.be/QH5yuNd3B6o EIP-6110: https://youtu.be/tRTBgCN9VgY EIP-7002: https://youtu.be/MxvX1gNh-_4 EIP-7251: https://youtu.be/3cVhNXDTjgg EIP-7685: https://youtu.be/3g71BGZFASE EIP-7251: https://youtu.be/3cVhNXDTjgg ----------------- Other Resources: https://youtu.be/GriLSj37RdI https://youtu.be/SfDC_qUZaos https://youtu.be/CcL9RJBljUs https://youtu.be/-xY1EEzcp0s https://youtu.be/KdhHJa2SEwY Check out upcoming EIPs in Peep an EIP series at https://github.com/ethereum-cat-herders/PM/projects/2 PEEPanEIP - https://www.youtube.com/playlist?list=PL4cwHXAawZxqu0PKKyMzG_3BJV_xZTi1F Follow at Twitter: -------------------------- Parithosh - https://twitter.com/parithosh_j Mario Vega - https://twitter.com/elbuenmayini Pooja Ranjan - https://twitter.com/poojaranjan19 Topics covered: ------------------------- 00:12 - Starting Words 00:29 - Intro 01:27 - Parithosh Self Introduction 02:01 - Mario Vega Introduction 03:02 - Presentation Start 03:20 - Disclaimers related to the presentation by Parithosh 04:50 - Presentation by Mario 05:40 - EVM Prague Updates 09:26 - EVM Tests - EIP-2537: BLS Precompiles 11:11 - EVM Tests - EIP-2935: Historical Block Hashes from State 13:23 - EVM Tests - EIP-6110, EIP-7002, EIP-7251, EIP-7685: Execution Layer Requests 18:01 - EVM Tests - EIP-7702: Authorization Lists 21:13 - Want to Test EIP-7702? (Slide contain useful links and QRs) 22:07 - EVM Tests - EIP-7692: EOF Version 1 24:56 - Presentation by Parithosh 25:00 - CL Prague Updates 27:46 - Assertor - EIP-7251: MaxEB 31:07 - Hermes/Xatu- EIP-7594: PeerDAS 35:36 - Kurtosis 35:50 - What is Kurtosis? and why do we care? 38:08 - What is Assertor 41:31 - What's going to happen next? 44:44 - Need of Idea for next public testnet! 45:07 - Presentation End 46:21 - Q&A 46:27 - How many active Devnet/Testnet, as on date? 47:40 - Do we see more versions of Devnet? and how many? 51:10 - Do you think, we could have kept PeerDAS separate and deploy async in each client? 53:09 - What are the specific risk and challenge to include EIPs? 58:07 - How would we evaluate a success of Pectra Devnet Testing? 01:00:27 - How long would it take, to get Pectra on the mainnet? 01:03:08 - Shout out by Mario 01:04:35 - Closing Words ------------------------- #Pectra #ethereum #crypto #PectraDevnet

To pass ACLS, you will need to be able to identify common rhythms on a monitor during your mega code and ECG strips on your written exam. If you don't normally monitor patients as part of your job, I suggest two things: 1. Find a system for ECG interpretation that works well for you; and 2. Practice reading ECGs every day for a few weeks before your class.Review of normal ECG morphology of P wave, QRS complex, and T wave in lead II. Characteristics of first degree heart block. Characteristics of third degree (complete) AV block. Treatment of unstable patients in third degree block following the ACLS Bradycardia algorithm. Special considerations for use of Atropine when patients are in a third degree heart block.The use of TCP, Dopamine, & Epinephrine drip for unstable bradycardic patients refractory to Atropine.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.Good luck with your ACLS class!Practice ECGs at Dialed Medics: https://dialedmedics.com/

Contributor: Travis Barlock, MD Educational Pearls: SVT: supraventricular tachycardia Pharmacotherapy for SVT includes drugs that block the AV node, such as adenosine EKG criteria before adenosine administration in SVT Regular rhythm Monomorphic: ​​all QRS complexes are identical If the EKG is polymorphic, with QRS complexes displaying changing morphologies, it is unsafe to administer adenosine  Adenosine can worsen polymorphic VTach and lead to VFib References Ganz, Leonard I., and Peter L. Friedman. “Supraventricular Tachycardia.” New England Journal of Medicine, vol. 332, no. 3, 19 Jan. 1995, pp. 162–173, https://doi.org/10.1056/nejm199501193320307. Smith JR, Goldberger JJ, Kadish AH. Adenosine induced polymorphic ventricular tachycardia in adults without structural heart disease. Pacing Clin Electrophysiol. 1997;20(3 Pt 1):743-745. doi:10.1111/j.1540-8159.1997.tb03897.x Viskin, Sami, et al. “Polymorphic Ventricular Tachycardia: Terminology, Mechanism, Diagnosis, and Emergency Therapy.” Circulation, vol. 144, no. 10, 7 Sept. 2021, pp. 823–839, https://doi.org/10.1161/circulationaha.121.055783. Summarized by Meg Joyce, MS1 | Edited by Meg Joyce & Jorge Chalit, OMS3  

A patient's electrocardiogram exhibits signs of consecutive p-waves at a rate of 250 per minute with QRS complexes appearing at rate of 80 per minute.  The baseline waves are identical and have a sawtooth appearance.  Which of the following abnormal rhythms is MOST likely present? Find it all out in the podcast!  Be prepared for the NPTE so that you can pass with flying colors! Check out www.ptfinalexam.com/podcast for more information and to stay up-to-date with our latest courses and projects.  #Npte #PT /#ptboards #crushtheNPTE #study #studygram #spt #ptstudent #ptlife #sptprobs #physicaltherapystudent #physicaltherapy #physio #physiotherapist #ptlife #ptstudentstudy #ptstudents #physicaltherapist #ptfinalexam #pt #dpt #ptfinalexam #Nptae #crushtheNPTAE

To pass the written ACLS exam and mega code, students need to be able to identify basic ECG dysrhythmias, including the two types of second-degree heart block. One method of ECG rhythm identification is to ask a series of questions such as: What's the rate (150);Is the rhythm regular or irregular;What's the shape, width, and frequency of P waves and QRS complexes; andWhat's the P-R interval and is it constant?ECG characteristics of a second-degree Mobitz type I (Wenckebach).Identification of unstable bradycardia and its treatment with Atropine.ECG characteristics of a second-degree Mobitz type II. Possible effect of using Atropine on patients with a second-degree type II AV block.Treatment of unstable bradycardic patients refractory to Atropine using TCP, Dopamine, or Epinephrine drip. Starting dose and titration of Dopamine and Epinephrine drips.Connect with me:Website: https://passacls.com@PassACLS on X (formally known as Twitter)@Pass-ACLS-Podcast on LinkedInGive back & help others. Your support will help cover the monthly cost of software and podcast & website hosting. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Good luck with your ACLS class!The Curious Clinicians: History of Doctor Wenckebach & Mobitz: https://curiousclinicians.com/2022/07/06/episode-52-way-back-wenckebach/Practice ECGs with rationale at Dialed Medics: https://dialedmedics.com/

CardioNerds (Drs. Teodora Donisan, Jenna Skowronski, and Johnny Hourmozdi) discuss Cardiomyopathies with Dr. Steve Ommen. Through a case-based discussion, we review the diagnostic evaluation of suspected restrictive cardiomyopathy, and Dr. Ommen shares his expertise in the nuances of caring for patients with hypertrophic cardiomyopathy, from counseling to pharmacologic, device, and septal reduction therapies. We cover the foundations of diagnosis and management that will be helpful to CardioNerds preparing to encounter hypertrophic cardiomyopathy on the boards or on the wards. Dr. Johnny Hourmozdi drafted notes. The audio was engineered by Dr. Atefeh Ghorbanzadeh. The CardioNerds Beyond the Boards Series was inspired by the Mayo Clinic Cardiovascular Board Review Course and designed in collaboration with the course directors Dr. Amy Pollak, Dr. Jeffrey Geske, and Dr. Michael Cullen. CardioNerds Beyond the Boards SeriesCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls and Quotes - Cardiomyopathies The presence of an S4 and a rapid y-descent in the jugular venous pulsation on exam should clue you to the presence of a restrictive filling pattern. Restrictive filling doesn't necessarily mean restrictive cardiomyopathy and is more commonly due to dilated or ischemic cardiomyopathy. The five main topics of counseling that every hypertrophic cardiomyopathy (HCM) patient should understand: (1) Prognosis, (2) Family Screening, (3) Risk of Sudden Death, (4) Treatments, and (5) Physical Activity. Remember 1/3: In clinical trials of cardiac myosin inhibitors for HCM (mavacamten), about a third of patients had a tremendous improvement in symptoms, another third had some improvement, and the final third had no improvement or had to discontinue the drug due to negative inotropy. When counseling patients about septal reduction therapy, consider the patient's age. For younger patients, surgical myectomy at an experienced center offers a higher success rate and greater durability with lower rates of pacemaker placement when compared to alcohol septal ablation. Historically, the conclusion that it was higher risk to be an athlete with HCM was unfortunately generalized to mean that it was high risk to exercise for patients with HCM. “And we turned a generation of HCM patients into HCM cardiometabolic syndrome patients, which is actually a worse combination.” Notes - Cardiomyopathies What is the initial approach to evaluating a patient with new or suspected cardiomyopathy, including hypertrophic cardiomyopathy (HCM)? A history and physical exam, including a thorough past medical and family history, is always the first step and helps determine the patient's risk for potential underlying etiologies, including genetic cardiomyopathies, hypertrophic cardiomyopathy, or those related to treatments of previous cancer. In terms of ECG findings, pay attention to QRS voltage (high or low) and the presence of any arrhythmias. TTE should be obtained in all patients and is often sufficient to diagnose many underlying cardiomyopathies, including HCM. Cardiac MRI (CMR) is helpful as an adjunct when TTE alone is inconclusive or imaging quality is poor. CMR can help provide a better idea of chamber sizes and wall thickness, and late gadolinium contrast enhancement (LGE) can also be helpful if present in a specific pattern, though often HCM patients may have non-specific patterns of LGE. Invasive hemodynamics assessment is reserved for patients with discordance between non-invasive testing and the clinical impression. It can also be useful to guide the management of heart failure, especially in advanced disease. How do you treat patients with hypertrophic obstructive cardiomyopathy (HOCM)? In patients with HCM and LVOT obstruction (defined a...

The following question refers to Sections 6.1 and 7.4 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure.The question is asked by University of Colorado internal medicine resident Dr. Hirsh Elhence, answered first by University of Chicago advanced heart failure cardiologist and Co-Chair for the CardioNerds Critical Care Cardiology Series Dr. Mark Belkin, and then by expert faculty Dr. Mark Drazner.Dr. Drazner is an advanced heart failure and transplant cardiologist, Professor of Medicine, and Clinical Chief of Cardiology at UT Southwestern. He is the President of the Heart Failure Society of America.The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance.Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. /*! elementor - v3.23.0 - 25-07-2024 */ .elementor-toggle{text-align:start}.elementor-toggle .elementor-tab-title{font-weight:700;line-height:1;margin:0;padding:15px;border-bottom:1px solid #d5d8dc;cursor:pointer;outline:none}.elementor-toggle .elementor-tab-title .elementor-toggle-icon{display:inline-block;width:1em}.elementor-toggle .elementor-tab-title .elementor-toggle-icon svg{margin-inline-start:-5px;width:1em;height:1em}.elementor-toggle .elementor-tab-title .elementor-toggle-icon.elementor-toggle-icon-right{float:right;text-align:right}.elementor-toggle .elementor-tab-title .elementor-toggle-icon.elementor-toggle-icon-left{float:left;text-align:left}.elementor-toggle .elementor-tab-title .elementor-toggle-icon .elementor-toggle-icon-closed{display:block}.elementor-toggle .elementor-tab-title .elementor-toggle-icon .elementor-toggle-icon-opened{display:none}.elementor-toggle .elementor-tab-title.elementor-active{border-bottom:none}.elementor-toggle .elementor-tab-title.elementor-active .elementor-toggle-icon-closed{display:none}.elementor-toggle .elementor-tab-title.elementor-active .elementor-toggle-icon-opened{display:block}.elementor-toggle .elementor-tab-content{padding:15px;border-bottom:1px solid #d5d8dc;display:none}@media (max-width:767px){.elementor-toggle .elementor-tab-title{padding:12px}.elementor-toggle .elementor-tab-content{padding:12px 10px}}.e-con-inner>.elementor-widget-toggle,.e-con>.elementor-widget-toggle{width:var(--container-widget-width);--flex-grow:var(--container-widget-flex-grow)} Question #34 Question StemA 72-year-old woman with a history of hypertension, type 2 diabetes mellitus, and a recent myocardial infarction is seen in your clinic. Two months previously, she was hospitalized with a myocardial infarction and underwent successful revascularization of the left anterior descending artery with a drug-eluting stent. Following her myocardial infarction, an echocardiogram revealed an ejection fraction of 17%, and she was discharged on metoprolol succinate, lisinopril, spironolactone, and dapagliflozin with escalation to maximal tolerated doses over subsequent visits. A repeat echocardiogram performed today in your clinic reveals an ejection fraction of 26%. An electrocardiogram reveals normal sinus rhythm with a narrow QRS at a heart rate of 65 beats per minute. She is grateful for her cardiac rehabilitation program and reports no ongoing symptoms. Which of the following devices is indicated for placement at this time?Answer choicesAImplantable loop recorderBICDCCRT-DDCRT-P Answer #34 Explanation The correct answer is B.

Episodio 277 Seamos innovativos: Soccer Americano ¡En Honduras! Con tu esposa que también es una anormal. Destrozó a los ingleses y yo sonreí un poquito… A lo mejor es un problema de inteligencia o tal vez es que locos hay en todos lados. Estábamos mejor con Palpatine. ✅ Follow Up • Jaime fue a Metallica (y ✋

Understanding ECG Waveforms: Normal vs. Abnormal Guest: Dr. Peter van Dam Host: Anthony H. Kashou, M.D.    The ECG interpretation is majorly driven by event detection, i.e. QRS onset and end, QT time, P wave etc. From these we can determine the normal heart rhythm, and some performance measures, like heart rate etc. The ECG waveforms, however, are much less understood. This is a pity, as ECG waveforms, provide instantaneous information on the electrophysiological and structural function of the heart. In this respect it is interesting to know if there is something like a normal ECG waveform or normal PathECG (CineECG). This latter technique is a vector-based method to estimate the electrical position of a moving vector within the heart. Similar normal distributions can be created to compare to the normal ECGs.   Topics Discussed How can we define a normal ECG waveform? (ECGs from healthy normal people for different age groups, I used about 6000 normal ECGs, correction for heart rate by resampling to standard QT time (400 ms for instance, these ECGs can be used to create a distribution of amplitudes and derived signals (CineECG) to compare an ECG too) What is needed for an accurate waveform comparison? (Good baseline correction, not filtering, but baseline correction) What is the onset and end of the P-wave, QRS and T wave?) Are normal ECGs waveforms different from abnormal ECG waveforms? (Of course they overlap, describe left bundle branch block, or ischemia, with long QRS or deviating ST segment ) Did you use this method to classify ECGs as normal or abnormal? (results from our study (manuscript in preparation) that any QRST sequence in an ECG can be classified as abnormal with an accuracy (AUC) of more than 81%. In our study population 15% of the patients had only atrial related abnormal ECGS) Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. LinkedIn: Mayo Clinic Cardiovascular Services Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.

Contributor: Taylor Lynch MD Educational Pearls: Anticholinergics are found in many medications, including over-the-counter remedies Medications include: Diphenhydramine Tricyclic antidepressants like amitriptyline Atropine Antipsychotics like olanzapine Antispasmodics - dicyclomine Jimsonweed Muscaria mushrooms Mechanism of action involves competitive antagonism of the muscarinic receptor Symptomatic presentation is easily remembered via the mnemonic: Dry as a bone - anhidrosis due to cholinergic antagonism at sweat glands Red as a beet - cutaneous vasodilation leads to skin flushing Hot as a hare - anhidrotic hyperthermia Blind as a bat - pupillary dilation and ineffective accommodation Mad as a hatter - anxiety, agitation, dysarthria, hallucinations, and others Clinical management ABCs Benzodiazepines for supportive care, agitation, and seizures Sodium bicarbonate for TCA toxicity due to widened QRS Activated charcoal if patient present < 1 hour after ingestion Temperature monitoring Contact poison control with questions Physostigmine controversy Acetylcholinesterase inhibitor Black box warning for asystole and seizure Contraindicated in TCA overdoses Crosses blood-brain barrier, so useful for TCA overdoses Indicated only in certain anticholinergic overdose with delirium Disposition Admission criteria include: symptoms >6 hours, CNS findings, QRS prolongation, hyperthermia, and rhabdomyolysis ICU admission criteria include: delirium, dysrhythmias, seizures, coma, or requirement for physostigmine drip References 1. Arens AM, Shah K, Al-Abri S, Olson KR, Kearney T. Safety and effectiveness of physostigmine: a 10-year retrospective review. Clin Toxicol (Phila). 2018;56(2):101-107. doi:10.1080/15563650.2017.1342828 2. Nguyen TT, Armengol C, Wilhoite G, Cumpston KL, Wills BK. Adverse events from physostigmine: An observational study. Am J Emerg Med. 2018;36(1):141-142. doi:10.1016/j.ajem.2017.07.006 3. Scharman E, Erdman A, Wax P, et al. Diphenhydramine and dimenhydrinate poisoning: An evidence-based consensus guideline for out-of-hospital management. Clin Toxicol. 2006;44(3):205-223. doi:10.1080/15563650600585920 4. Shervette RE 3rd, Schydlower M, Lampe RM, Fearnow RG. Jimson "loco" weed abuse in adolescents. Pediatrics. 1979;63(4):520-523. 5. Woolf AD, Erdman AR, Nelson LS, et al. Tricyclic antidepressant poisoning: An evidence-based consensus guideline for out-of-hospital management. Clin Toxicol. 2007;45(3):203-233. doi:10.1080/15563650701226192 Summarized by Jorge Chalit, OMSIII | Edited by Jorge Chalit  

Take Home Points Always obtain an EKG in patients with ESRD upon presentation Always obtain an EKG in patients with hyperkalemia as pseudohyperkalemia is the number one cause If the patient with hyperkalemia is unstable or has significant EKG changes (wide QRS, sine wave) rapidly administer calcium salts In patients who are anuric, early mobilization ... Read more The post REBEL Core Cast 125.0 – Hyperkalemia appeared first on REBEL EM - Emergency Medicine Blog.

To pass ACLS, you will need to be able to identify common rhythms on a monitor during your mega code and ECG strips on your written exam. If you don't normally monitor patients as part of your job, I suggest two things: 1. Find a system for ECG interpretation that works well for you; and 2. Practice reading ECGs every day for a few weeks before your class. Review of normal ECG morphology of P wave, QRS complex, and T wave in lead II. Characteristics of first degree heart block. Characteristics of third degree (complete) AV block. Treatment of unstable patients in third degree block following the ACLS Bradycardia algorithm. Special considerations for use of Atropine when patients are in a third degree heart block. The use of TCP, Dopamine, & Epinephrine drip for unstable bradycardic patients refractory to Atropine.Connect with me:Website: https://passacls.com@PassACLS on X (formally known as Twitter)@Pass-ACLS-Podcast on LinkedInGive back & help others. Your support will help cover the monthly cost of software and podcast & website hosting. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Good luck with your ACLS class!Visit Dialed medics for online practice ECGs at: https://dialedmedics.com/

Management approach for electrical storm!For a deep dive into EKGs in wide complex tachycardias, take a look at this awesome lecture by Amal Mattu.References to articles mentioned in the podcast:Cheskes et al. Defibrillation Strategies for Refractory Ventricular Fibrillation. N Engl J Med. 2022 Nov 24;387(21):1947-1956Ortiz et al. Randomized comparison of intravenous procainamide vs. intravenous amiodarone for the acute treatment of tolerated wide QRS tachycardia: the PROCAMIO study. Eur Heart J 2017;38(17):1329-1335Song et al. Association of Dexmedetomidine With New-Onset Atrial Fibrillation in Patients With Critical Illness. JAMA Netw Open 2023;6(4):e239955Wang etc. Effect of Dexmedetomidine on Tachyarrhythmias After Cardiac Surgery: A Systematic Review and Meta-Analysis. J Cardiovasc Pharmacol 2022;79(3):315-324Zhong et al. Dexmedetomidine Reduces Incidences of Ventricular Arrhythmias in Adult Patients: A Meta-Analysis. Cardiol Res Pract 2022;5158362Do et al. Thoracic Epidural Anesthesia Can Be Effective for the Short-Term Management of Ventricular Tachycardia Storm. J Am Heart Assoc. 2017 Oct 27;6(11):e007080Tian et al. Effective Use of Percutaneous Stellate Ganglion Blockade in Patients With Electrical Storm. Circ Arrhythm Electrophysiol. 2019;12(9):e007118Batnyam et al. Safety and Efficacy of Ultrasound-Guided Sympathetic Blockade by Proximal Intercostal Block in Electrical Storm Patients. JACC Clin Electrophysiol 2024;10(4):734-746

Deepthy Varghese, MSN, ACNP, FNP, Northside Hospital is joined by James O'Hara, PhD, PA, Virginia Heart, and Shunmuga Sundaram Ponnusamy, MBBS, MD, CEPS-A, Velammal Medical College Hospital, and Research Institute to discuss a study that evaluated the impact of QRS morphology on the risk of life-threatening ventricular arrhythmias in heart failure patients treated with cardiac resynchronization therapy with a defibrillator (CRT-D). The analysis included 2,862 patients from five major ICD trials, focusing on those with a QRS duration of ≥130 ms. Patients were categorized into those receiving ICD-only or CRT-D. Key findings: Among patients with left bundle branch block (LBBB), those with CRT-D showed a significant 44% reduction in the risk of fast ventricular tachycardia (VT)/ventricular fibrillation (VF) compared to ICD-only patients. They also had a lower fast VT/VF burden and fewer appropriate shocks. In patients with non-left bundle branch block (NLBBB), CRT-D did not reduce the risk of fast VT/VF and was associated with a significant increase in the burden of fast VT/VF events compared to ICD-only patients. The study concludes that CRT-D effectively reduces life-threatening ventricular arrhythmias in LBBB patients but may increase the risk in NLBBB patients.    https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jacep.2023.09.018?s=03 Host Disclosure(s): D. Varghese: Nothing to disclose.    Contributor Disclosure(s): J. O'Hara: Honoraria, Speaking, and Consulting: Medtronic Inc., Boston Scientific  S. Ponnusamy: Honoraria, Speaking, and Consulting: Medtronic Inc.

Contributor: Travis Barlock MD Educational Pearls: Wide-complex tachycardia is defined as a heart rate > 100 BPM with a QRS width > 120 milliseconds Wide-complex tachycardia of supraventricular origin is known as SVT with aberrancy Aberrancy is due to bundle branch blocks Mostly benign Treated with adenosine or diltiazem Wide-complex tachycardia of ventricular origin is also known as VTach Originates from ventricular myocytes, which are poor inherent pacemakers Dangerous rhythm that can lead to death Treated with amiodarone or lidocaine 80% of wide-complex tachycardias are VTach 90% likelihood for patients with a history of coronary artery disease In assessing a wide-complex tachycardia, it is best to treat it as a presumed ventricular tachycardia Treating SVT with amiodarone or lidocaine does no harm  However, treating VTach with adenosine or diltiazem may worsen the condition References 1. Littmann L, Olson EG, Gibbs MA. Initial evaluation and management of wide-complex tachycardia: A simplified and practical approach. Am J Emerg Med. 2019;37(7):1340-1345. doi:https://doi.org/10.1016/j.ajem.2019.04.027 2. Viskin S, Chorin E, Viskin D, Hochstadt A, Schwartz AL, Rosso R. Polymorphic Ventricular Tachycardia: Terminology, Mechanism, Diagnosis, and Emergency Therapy. Circulation. 2021;144(10):823-839. doi:10.1161/CIRCULATIONAHA.121.055783 3. Williams SE, O'Neill M, Kotadia ID. Supraventricular tachycardia: An overview of diagnosis and management. Clin Med J R Coll Physicians London. 2020;20(1):43-47. doi:10.7861/clinmed.cme.20.1.3 Summarized by Jorge Chalit, OMSIII | Edited by Meg Joyce & Jorge Chalit

To pass the written ACLS exam and mega code, students need to be able to identify basic ECG dysrhythmias, including the two types of second-degree heart block. One method of ECG rhythm identification is to ask a series of questions such as:What's the rate (150); Is the rhythm regular or irregular;What's the shape, width, and frequency of P waves and QRS complexes; andWhat's the P-R interval and is it constant?ECG characteristics of a second-degree Mobitz type I (Wenckebach).Identification of unstable bradycardia and its treatment with Atropine.ECG characteristics of a second-degree Mobitz type II.Possible effect of using Atropine on patients with a second-degree type II AV block. Treatment of unstable bradycardic patients refractory to Atropine using TCP, Dopamine, or Epinephrine drip. Starting dose and titration of Dopamine and Epinephrine drips.Connect with me:Website: https://passacls.com@PassACLS on X (formally known as Twitter)@Pass-ACLS-Podcast on LinkedInGive back - buy Paul a bubble tea hereGood luck with your ACLS class!The Curious Clinicians: History of Doctor Wenckebach & MobitzPractice ECGs with rationale at Dialed Medics

BRASH es un acrónimo relativamente nuevo que describe un síndrome de bradicardias con hipotensión severa en el contexto de fallo renal e hiperkalemia. Usted está atendiendo a un masculino de 62 años de edad con debilidad general y desorientación progresivamente peor desde hace varias horas. Mantiene su propia vía aérea y respira espontáneamente, pero no tiene pulsos periféricos palpables. Los signos vitales son 28, 20, 86%, 82/38. Usted coloca al paciente en el monitor cardiaco y observa un bloqueo AV de 3er grado sin ondas P y con un complejo de escape ventricular. De inmediato le coloca oxígeno al paciente mediante mascarilla de no-reinhalación, obtiene dos accesos vasculares, administra 1 mg de atropina y se prepara para realizar intervenciones de segunda línea para aumentar la frecuencia cardiaca, entre ellas, la administración de una infusión de adrenalina y la colocación de un marcapasos externo. Los algoritmos están hechos para evitar desastres. No necesariamente representan el mejor cuidado posible. En este caso, el algoritmo de bradicardia nos dice qué acciones debemos hacer de inicio para mantener al paciente vivo. Sin embargo, no está funcionando. ¿Por qué? Debido a la hiperkalemia. Los medicamentos que causan bloqueo de la conducción a través del nodo atrioventricular (AV) pueden provocar episodios de hipotensión severa y refractaria en el contexto de fallo renal agudo. Bloqueo AV + fallo renal agudo El fallo renal puede ocurrir por cualquier causa no relacionada. El fallo renal pre-renal puede ocurrir, por ejemplo, por deshidratación severa o cualquier otra causa de pobre perfusión sistémica. El fallo renal produce hiperkalemia. La hiperkalemia y el bloqueo del nodo AV por los bloqueadores beta y/o por los bloqueadores de canales de calcio produce la hipotensión. BRASH: un acrónimo a recordar cuando se trata bradicardias sintomáticas Bradicardia Fallo Renal Bloqueo AV Shock Hiperkalemia Cada una de estas condiciones presenta un problema por sí mismo. Cuando se combinan, tienen un efecto sinergístico. Es decir, tiene un efecto más potente que la suma de sus partes individuales. BRASH no es un diagnóstico por separado, sino una descripción de los signos y síntomas asociados al ciclo vicioso de bradicardia, shock, fallo renal e hiperkalemia. Ciclo vicioso de bradicadia, shock, fallo renal e hiperkalemia La bradicardia puede venir por los medicamentos y/o por la hiperkalemia. En el paciente que ya toma estos medicamentos de forma continua, es posible que un deterioro súbito en la función renal de paso a la hiperkalemia. La causa del deterioro súbito de la función renal puede ser por cualquier causa pre-renal, renal o pos-renal. Una causa común de fallo renal pre-renal es cualquier causa de shock que provoque un episodio sostenido de pobre perfusión renal. El resultado es un aumento en los niveles de potasio debido a la pobre eliminación renal. La hiperkalemia produce bloqueo AV y bradicardia, lo que puede agravar aún más la bradicardia y agravar aún más la pobre perfusión renal, lo que provoca a su vez una peor hiperkalemia. SAMPLE El historial clínico del paciente es fundamental para entender el problema. Signos y síntomas Alergias Medicamentos Padecimientos Última ingesta ("last meal") Evento que precedió la emergencia Pistas importantes del historial El historial puede dar a relucir el hecho de que el paciente esté tomando medicamentos que bloquean el nodo AV. Quizás un cambio reciente en la dosis, o la introducción de otro medicamento que tenga un efecto en los niveles de potasio puede ser el detonante reciente. El historial puede dar a relucir el hecho de que el paciente ya padezca de una condición renal previa. El historial puede dar a relucir algún evento reciente que haya provocado el deterioro agudo en la función renal. Trate la bradicardia, la hiperkalemia y la causa de la pobre perfusión El manejo de la bradicardia puede no ser suficiente para lograr estabilizar hemodinámicamente al paciente con BRASH. Es importante reconocer rápidamente y tratar de inmediato de la hiperkalemia. Aunque las ondas T picudas e hiperagudas son signos clásicos de la hiperkalemia, son signos demasiado tempranos. La evolución natural de la condición va a producir bloqueo AV y prolongamiento del complejo QRS. Es decir, es la propia bradicardia y bloqueo AV el mejor signo de que el paciente puede tener una hiperkalemia. Simultáneo al manejo de la bradicardia y de la hiperkalemia, es esencial tratar la causa que está provocando la pobre perfusión renal (por ejemplo, fallo pre-renal por pobre perfusión). Si esto no se corrige, el escenario va a volver a repetirse. Pequeños estímulos con grandes efectos Como mencionado anteriormente, el efecto de esta combinación es sinergístico. Es decir, el efecto combinado es más grande que la suma de sus efectos individuales. No tiene que haber ocurrido un cambio en la dosis que el paciente está tomando del medicamento que bloquea el nodo AV, ni tiene que ser una dosis especialmente alta. Puede ser la misma dosis que ha tomado por largo tiempo sin efectos adversos. Un episodio reciente de deshidratación no tiene que llevar a fallo renal pre-renal. Sin embargo, en presencia del efecto del medicamento que bloquea el nodo AV, tiene un efecto dramático en el riñón. La hiperkalemia no tiene que ser de inicio muy alta. Es decir, no hay una correlación entre niveles específicos de potasio en sangre y los efectos observados. Peor aún, los cambios en el EKG no necesariamente van a progresar de la misma manera que siempre se habla de la hiperkalemia (primero ondas T hiperagudas). Como mencioné anteriormente, la bradicardia quizás es el único indicio. Entonces, cada uno de los estímulos no tiene que ser muy significativo: una dosis normal del medicamento que siempre ha tomado, un episodio relativamente benigno de deshidratación (por ejemplo), un nivel de potasio levemente elevado... pero la combinación produce una bradicardia severa, con fallo renal, bloqueo AV, shock e hiperkalemia... mejor conocido como BRASH. Referencias Arif AW, Khan MS, Masri A, Mba B, Talha Ayub M, Doukky R. BRASH Syndrome with Hyperkalemia: An Under-Recognized Clinical Condition. Methodist Debakey Cardiovasc J. 2020 Jul-Sep;16(3):241-244. doi: 10.14797/mdcj-16-3-241. PMID: 33133361; PMCID: PMC7587309. Farkas JD, Long B, Koyfman A, Menson K. BRASH Syndrome: Bradycardia, Renal Failure, AV Blockade, Shock, and Hyperkalemia. J Emerg Med. 2020 Aug;59(2):216-223. doi: 10.1016/j.jemermed.2020.05.001. Epub 2020 Jun 18. PMID: 32565167. Lizyness K, Dewald O. BRASH Syndrome. [Updated 2023 Mar 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK570643/ https://emcrit.org/ibcc/brash/ https://litfl.com/brash-syndrome/