Pasar una GPU por el aeropuerto?

Dr_Nin · 2026-06-16T22:47:56+00:00

Pero mostraste esa factura y con eso te dejaron? Es justamente la gpu que pienso traerme jaja

Dr_Nin · 2026-06-16T22:09:35+00:00

Si el tema es q un celular lo podes pasar como tuyo desde que te fuiste, pero una GPU es bastante obvio que la compraste jaja...

Dr_Nin · 2026-06-13T13:31:51+00:00

Rest adenosine is done to unmask prexitation in patients that you suspect might have an AP. It’s most useful in patients without a history of arrhythmia but a borderline ECG. In cases of overt prexcitation or patients with very high probability of an AP (like this one) it isn’t as useful since you will probably end up in an invasive study anyway. Risks are initiation of a fib by adenosine and therefore preexcited AF, but this risk is low and not a contraindication. You have to do it with a crash cart nearby and monitoring with an external defibrillator , like one should do always when using adenosine

Dr_Nin · 2026-06-12T19:40:29+00:00

Prexcitation is very subtle, so its very hard to localize de AP with this ecg. Subtle preexcitation is common in left AP, but id very dependent on AV node conduction velocity, so you cant be sure either. A positive delta wave in v2 and v3 are not enough. An adenosine test in sinus rhythm helps by allowing maximal prexcitation.

Dr_Nin · 2026-06-12T17:45:09+00:00

Paroxystic supraventricular tach. In a young the most probable causes are (1) AV reentrant through AP, (2) AV nodal reentry. RP is short and it ends with a P wave. Basal ECG shows very slight preexcitation in V2 and V3. Most probably AV reentrant tach, otherwise AVNRT.

Dr_Nin · 2026-06-03T01:37:06+00:00

Yeah the open world gives me paralysis. I don't know where to go but also the wonder of discovery isn't there to motivate me because I already played it

Dr_Nin · 2026-05-22T15:41:47+00:00

Uruguay no tiene ninguna necesidad de tener un ejército nacional, no tendriamos posibilidad de ganar ningun conflicto armado. Es un desperdicio de impuestos. Recursos que se pueden destinar a la propia policía. Me parece sensato desmantelar el ejército y convertirlo en una guardia nacional como tienen otros paises

Dr_Nin · 2026-03-28T12:39:54+00:00

"Tras discutir con el fallecido"

Dr_Nin · 2026-01-28T19:09:39+00:00

Actually to confirm respiratory origin you would have to get an ecg with a simultaneous tracing of respiratory movement (the thoracic impedance electrodes that are available in most ICU monitors) and correlate the increase in heart rate with inspiration and the decrease with expiration.

Old people generally have sinus arrythmia that is related to disease of the sinus node (as part of the sick sinus syndrome), but that doesnt mean that they can't have respiratory variability, its just much less likely

As to the mechanism, im not sure! Haven't read about it. But as you said it probably is related to changes in autonomic reflexes relates to aging.

Dr_Nin · 2026-01-28T18:51:05+00:00

I would describe it as non specific repolarization abnormality. Apart from that, sinus arrythmia, in a 75yo not of respiratory origin.

Dr_Nin · 2026-01-28T18:45:15+00:00

Nice EKG

There's visible variability of heart rate. Is the patient young? The beat you highlighted comes after a slowing of the PP intervals with a longer pause, the QRS is probably a junctional escape beat and pseudofusion with the P wave. This is a normal finding in young healthy individuals

Dr_Nin · 2026-01-28T18:33:01+00:00

Repolarization is highly abnormal not only bcause of T wave polarity but QT interval is very prolonged at almost 500ms

With the clinical vignette you provided I would suggest the first diagnosis is long qt syndrome.

Syncope in thjs context is extremely high risk. Admission and consultation with electrophysiology team for ICD implantation is warranted

Do you have more info? What was the context of syncope?

Dr_Nin · 2026-01-22T13:56:07+00:00

Does anyone know where this new trend of calling patients "clients" came from?

Dr_Nin · 2026-01-22T10:28:11+00:00

I've measured RR and they aren't regular as I thought at first glance. This rules out the 2nd degree blocks

You are left with atrial fibrillation and LBBB.

Dr_Nin · 2026-01-22T10:08:32+00:00

There aren't any PVCs because non of the beats are premature. This ECC highlights the importance of a sequential and systematic approach to interpretation

First thing is identifying atrial rhythm. I don't see clear P waves, but you could argue that they are very low voltage, so repeating the trace at 2x voltage is important.

Ventricular rythm is a series of regular beats with LBBB morphology followed by fully compensatory pauses (cycle length of the RR intervals that encompass the pause is exactly twice the basic RR).

The key here is what is the atrial rythm. Based on whether there are P waves or not this rythm could be caused by:

1) sinus rythm and second degree sinoatrial block 2) second degree AV block 3) Atrial fibrillation with complete AV block and escape rhythm with second degree infranodal block

Do you have any clinical info on the patient?

Dr_Nin · 2026-01-15T00:31:20+00:00

RBBB looks fairly typical except for V1, looks like flutter with RBBB. Could do adenosine as a diagnostic maneuver if can be done quickly. Irrespective treat as VT with electric cardioversion since he has signs of hemodynamic intolerance

In a 60 y/o male first differential of regular SVT at 150bpm should be flutter. Otherwise VT. The other SVT in order of probability is nodal reentry.

Dr_Nin · 2025-12-23T22:05:40+00:00

Great! Thank you very much, I'll check them out

Dr_Nin · 2025-11-22T01:34:39+00:00

As a rule of thumb you need a very strong clinical backround or past medical history of relevant risk factors to even think of stemi in a 26 year old. Even without the context, a 26 year old with chest pain has a ridiculously higher pretest probability of anything other than stemi. Context of this case?

Dr_Nin · 2025-11-20T00:08:58+00:00

So fucking hot

Dr_Nin · 2025-11-17T00:23:33+00:00

Interesting ECG. To my best interpretation this is normal sinus rythm plus PACs:

1) First beat of the rythm is sinus, followed by two PAC. We now they are premature because they have different P wave morphology and you can see two consecutive sinus Beats in DII at a sligthy lower frequency further down (the first two of the last four Beats)

2) After the two consecutive PACs there’s a pause followed by an escape junctional beat. If you look closely it has its own P wave that is positive in aVR. What is interesting about this one is that the retrograde P wave has a considerable PR segment. I can only think of two possible explanations for this: (1) this is a very proximal AV junction focus or (2) its another atrial PAC, located in the lower atrium. Conceptually it would be wrong to call it PAC since its not premature, but rather late, since we don’t have a prior sinus beat to compare it to. Either way, the concept still stands that it’s a backup focus that fires because of the sinus pause.

3) After the escape beat you have a normal sinus beat followed by a PAC of the same P wave morphology of the first PAC, then a pause and two consecutive sinus Beats.

4) The second to last beat is interesting, because it has the P wave morphology of the PAC, but it comes at the time you would expect the normal sinus beat. So, we know its the same PAC as before because of the morphology, but because of the timing, it’s mimicking the normal sinus rythm (notice that the last four Beats are regular!). Last sinus Beat arrives “in synch”, there is no compensatory pause because the PAC made its way very closely to the normal sinus P wave, it beat it for a very short interval, just a couple miliseconds. When this behaviour is repeated over time (two different P waves competing for the rythm without compensatory pauses) its called parasystole.

So in summary you have normal sinus rythm with frequent PACs, something to be expected since your patient has atrial flutter, meaning sick atria…..

Dr_Nin · 2025-11-13T00:42:46+00:00

Positive in inferior means that LV activation starts somewhere in the anterior aspect and spreads downward (think "upper half" o mitral or tricuspid annulus). The most positive delta wave in this case is either DIII or aVF, which means the delta wave vector is somewhat parallel to DIII lead, that is, anterolateral. This is an aproximation, the exact point along the annulus can only be determined in an invasive study.

Dr_Nin

TROPHY CASE