Conference Summary 7/27

EKG
1) STEMI criteria - the 2013 definition for STEMI is ST elevation in 2 contiguous leads of ≥2 mm (0.2 mV) in men or ≥1.5 mm (0.15 mV) in women in leads V2–V3 and/or of ≥1 mm (0.1 mV)  in other contiguous chest leads or the limb leads.  
2) ECG lead placement - white to right (right arm lead), red to ribs (left leg lead), smoke above fire (left arm lead).  That's how I remember where to place the monitor's ECG leads on the patient's chest.      
3) Limb lead reversal - look for inverted P waves in lead I.  Don't confuse it with dextrocardia - in limb lead reversal, the R wave progression is normal whereas in dextrocardia it is reversed!

Early pregnancy problems
1) Discriminatory zone - sac consistently visualized by ultrasound, measured in mIU/mL: 1,000-2,000 for a transvaginal sonogram, 6,500 for a transabdominal sonogram.    
2) Hyperemesis gravidarum - first line agent is a combination of pyridoxine and doxylamine.
3) Asymptomatic bacteriuria - Always treat it: Amoxicillin 500mg TID or Ampicillin 250mg QID.
 

CQI/Intern Curriculum - attachment from JAMA
1) Acute aortic dissection management - Control dP with arterial vasodilators (nitroprusside, nicardipine) and dt with beta blockers (esmolol, metoprolol). Use both!
2) Acute type A aortic dissection presentation -  35% of patients are normotensive upon presentation.
3) Acute jaundice - there three different types: hemolytic, hepatocellular, and obstructive.

Atraumatic Musculoskeletal Complaints - attachment from Journal of Neurosurgery-Spine
1) Spinal epidural abscess - MR spine is the gold-standard test.  CRP elevates before the WBC..   
2) Septic arthritis - Up to 30% of patients with septic arthritis do not have a synovial WBC > 50k.  

Dissociated ramblings - attachment from the department of infectious disease
1) Synovial lactates -  A few studies suggest that a synovial lactate > 10 mmol/L is highly suggestive of septic arthritis.  Not all hospitals are equipped to perform synovial lactates as many machines are only designed to do this for blood samples, not synovial fluid.  
3) Idioventricular rhythm - ever wonder why after ROSC patients enter a slow, wide-complex rhythm after the arrest?  The electrical origin of this rhythm are the Purkinje cells.  Because of their proximity to the ventricular cavities, they are able to use cavitary blood (oxygenated) for metabolism - rather than relying on blood coming from the coronary arteries!  This is also seen in the cath lab not infrequently and is thought of as a reperfusion arrhythmia.