It's cold out! People have heart attacks when it's cold out! You can avoid the cold weather heart attack! But how?

Studies have shown that Christmas, New Year's Eve, and winter months in general have the highest rates of heart attacks of all the days and months of the year. Why? Even in warmer climates, people have more heart attacks during the winter. Why? More...

A website from Stanford University Medical school teaching faculty in an attempt to revive the art of physical exam. Great site check it out!

http://stanford25.wordpress.com/

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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A question that we get asked all the time, "Can you still have a heart attack if your stress test was negative?" Or sometimes people want to know what kind of warranty they have if they just had a negatve stress test. "So does this mean I can't have a heart attack?"

Any one at any time can have a heart attack! More...

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.

Every few years you have a very strange patient interaction that leaves you shocked and sort of delineates why we have a health care crisis in our country. This was from many years ago, but is very pertinent.

"Hello sir, my name is Dr. Alo. What brings you into the hospital today?"

"I couldn't sleep."

"What do you mean, sir?"

"I just couldn't fall asleep."

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.

(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.

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".

Back in May of 2008, the American Heart Association changed the CPR and resuscitation protocols. You no longer have to do mouth-to-mouth CPR and if it is an in-hospital arrest, you don't have to intubate right away.

They have done research and have found that doing proper chest compressions, in and of itself, provides plenty of air exchange. The air exchange is not the problem, the problem is circulation. They need blood to circulate the oxygen, so you have to do compressions. 

They also found that if you keep telling people to do mouth to mouth, they are less likely to help out. They just walk away quickly. That doesn't help anyone.

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