An excellent high yield cardiology board review lecture I give the fourth year medical students, residents, and interns in preparation for Step 2 and Step 3 board exams. Download the slides and the audio lecture that goes with them!

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This is a lecture I give to all the medical students at the end of their third year clinical rotations to help them prepare for Step 2 boards. I also give this lecture in small parts throughout the year to the various internal medicine residents that rotate with us. It's a great introduction and intermediate course in EKG interpretation. After a brief introduction, we go through about 60 ECGs together and discuss them.

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Interventional cardiologists in some countries have embraced radial-artery access for placing catheters aimed at the coronaries into patients. Dr. Jolly, a cardiologist at McMaster University in Hamilton, Canada, cited a greater than 90% rate among French interventionalists and a greater than 95% rate in Canada. But as recently as last summer, U.S. cardiologists used radial access for a mere 4% of their coronary catheterizations, based on data collected by the National Cardiovascular Data Registry, said Dr. Edward J. McNulty, an interventional cardiologist at Kaiser Permanente San Francisco.

From: Internal Medicine News

My lecture titled Emergency EKGs for Emergency Phsyicians is now available online for your viewing and listening pleasure. It was a hit and some people missed it. So now you can download it and read it and listen to the audio on your own time.

The American Heart Association has updated the ACLS guidelines over the past few years. Here is a quick summary the new changes in th 2011 guidelines:

Circulation, Circulation, Circulation

No more mouth to mouth CPR . This was changed in 2008, but it is being re-emphasized. If you see someone down in the parking lot, ask them if they are ok, if they don't respond, just start chest compressions. NO mouth to mouth. No more "look, listen, and feel" for breathing. Just start compressions. This doesn't apply to hospitalized patients or ER patients. In the hospital, you can have someone bag them right away and intubate them. You don't have to ignore airway. Now it's CAB, instead of ABC. (Chest compressions, airway, breathing). If they aren't getting compressions, they aren't circulating blood, and their brain is dying quickly. Rate should be 100/minute. Good, deep, hard compressions. Minimize interuptions in chest compressions as much as possible. Don't delay shock.

A 58 year old female comes in complaining of crushing chest pain that began at 6AM. It's now 9AM. You are the ER physician, what do you think of this EKG and what do you want to do?

A 70 year old male comes in complaining of chest pain. His blood pressure is 80 systolic and his oxygen saturation is in the 80s while on supplemental oxygen. He feels nauseated and his heart rate was as low as 30, but improved with atropine to about 50. What is going on here? What can we do about it?

A 50 year old patient comes in complaining of chest pain. You are worried about a heart attack. You get the following EKG:

What does this patient have? And is it something to worry about?

(updated for 2010)
Diluadid Deficiency Angina is a new medical problem I have discovered since working in cardiology. This is a underdiagnosed, serious medical problem that is difficult to diagnose with a hefty financial burden in various parts of the country (especially the inner city) and should be addressed more seriously. You don't want to miss this if you are an Emergency Medicine physician.

A 40 year old male comes in the ER saying he had an episode of chest pain lasting a few minutes. The ER staff gets an EKG and you see the following:

What would you do next? What are your thoughts?

I was tasked with writing "board style questions" after giving a series of lectures. A lot of people have asked that I publish these on my blog and give answers and explanations. The questions are written in USMLE/Comlex Step 2 and 3 format, and may also be found on Internal Medicine In-Service exams. Here are the first few questions in a "Board Review Series".

Mom brings in her 24 year old daughter and says that she is not sure what happens, but the daughter suddenly goes into convulsions and starts shaking and having a seizure. You attach the EKG machine for fun, then you capture the following over the next 10 seconds. Is this artifact and shaking or something very bad?

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A 20 year old patient comes in to the ER complaining that he was playing soccer, and the ball hit him in his chest. He feels like "I got the wind knocked out of me" and is doing well otherwise. He has no medical history, vitals are stable. One of the brightest ER interns decides to get an EKG, and you see the following:

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I just turned 34 this year and thought I needed to establish care with a physician. Plus I really wanted to know my numbers. Everyone should know their credit score, their lipid panel, their fasting glucose, their blood pressure, their TSH, and their Vitamin D level. These figures will tell you all you need about your health and what you need to do.

I recommend to all my 30-something friends, go see your doctors and get your numbers! Don't wait for one of these silent killers to strike! More...