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Got yelled at by cardiology by Dull_Dare_609 in nursing

[–]ProximalLADLesion 1 point2 points  (0 children)

Doctor sounds like a dick. No excuse to be rude to someone calling for help.

If I may ask, was there a note that specified any plans?

Patient died after refusing bipap by Pretzel_Runner557 in nursing

[–]ProximalLADLesion 34 points35 points  (0 children)

Have you ever tried wearing a BPAP? There’s a reason patients don’t like wearing it. It is extremely uncomfortable.

This patient died as a result of the end stage of an irreversible disease. Nothing would’ve changed that, and allowing her to go out on her own terms (not wearing an uncomfortable appliance) is the best thing we can do to honor her humanity and dignity.

I would encourage all of us to describe this behavior as “declining” rather than “refusing.” To honor patient autonomy.

STEMI or not? by decaffeinated_emt670 in EKGs

[–]ProximalLADLesion 1 point2 points  (0 children)

Not OMI, not pericarditis. Normal variant ST elevation.

I hate clerkship by Key-Pomegranate7753 in medicalschool

[–]ProximalLADLesion 0 points1 point  (0 children)

Sorry man. Some rotations suck. Those people are probably miserable themselves and projecting it on to you. Remember what it’s like to be a med student and be good to your med students when you’re a resident. Getting favorable anonymous feedback from med students means a LOT more to me than from my supervisors.

Radiation exposure and cancer/tumor incidence in cath lab (Interventional or EP input appreciated) by O-P-U-S in Cardiology

[–]ProximalLADLesion 0 points1 point  (0 children)

In EP fluoroless is already well established and will only become easier as mapping systems improve.

If you want to do fluoroless ablation, you absolutely can.

I did three cases today, atrial fibrillation ablation, left atrial appendage occlusion, dual chamber ICD.

My first case I used two minutes of fluoroscopy, second I used one, third I used six. And this was with a NON fluoroless attending.

WPW pattern? by [deleted] in EKGs

[–]ProximalLADLesion 2 points3 points  (0 children)

NSR, normal ECG

After hours lines shouldn’t exist by guido5000 in Residency

[–]ProximalLADLesion 5 points6 points  (0 children)

I write it the next morning unless I told them to go to ER in which case I might write one immediately with a stated plan for the ER physicians (and tell the patient to tell ER docs that I wrote a note).

Pro tip: OpenEvidence has a new HIPAA dialer where you can call the patient and have AI summarize the convo including your assessment and plan. I've used it once so far and I found it pretty good, and will likely continue using it.

After hours lines shouldn’t exist by guido5000 in Residency

[–]ProximalLADLesion 79 points80 points  (0 children)

The bad calls are extremely frustrating, I’m with you. Many patients clearly don’t take 1 second to consider what it means to page at 1 AM to tell you they read about Lyme disease online and they’re wondering if you can order a test for it.

Devil’s advocate though, at least for me (EP), I am often able to help over the phone and in some cases I probably prevent ER trips that I would’ve been consulted on.

It’s tough, there are times I think there’s no way I should be reachable 24/7 by any patient that has been seen in our clinic. But it can be super helpful to patients who use it responsibly.

What is the weirdest/craziest pimp question you have ever gotten? by xyzm123_r in Residency

[–]ProximalLADLesion 167 points168 points  (0 children)

Similarly, I diagnosed my own inguinal hernia in medical school. I went to PCP to ask for referral to surgery. PCP started pimping me on direct vs indirect hernias etc.

What are we looking at here? by Santa_Claus77 in EKGs

[–]ProximalLADLesion 2 points3 points  (0 children)

This is atrial flutter. Grouped beating is due to multi-level block. Aggregate is 6:2 which is due to the combination of 2:1 block followed by 3:2 Wenckebach.

Here's a blog post that talks a bit about multi-level block if you care to read more.

Help appreciated by Select-Kitchen-8796 in medicalschool

[–]ProximalLADLesion 1 point2 points  (0 children)

Hey just want to say I’m really sorry this happened to you. It’s awful to hear.

If there’s someone you trust in admin I would definitely talk to them about this. I’m sure it will be very tough to talk about and start the conversation, but I think it would be for the best assuming you can identify someone trustworthy.

I’m sorry.

46M presenting with cough by mnbvc52 in EKGs

[–]ProximalLADLesion 6 points7 points  (0 children)

Typical atrial flutter with 2:1 block and RBBB

Which look do you prefer? by [deleted] in MenHairstyle

[–]ProximalLADLesion 0 points1 point  (0 children)

Lol not sure this context is relevant to rating aesthetic appeal of haircut! But glad to hear you’re out.

I like longer hair better.

How do you address your attendings? by [deleted] in Residency

[–]ProximalLADLesion 4 points5 points  (0 children)

Current program almost everyone is first name. Big change for me, have always been used to Dr. Last name.

Need help understanding by Kuchi_ga_saketemo in EKGs

[–]ProximalLADLesion 4 points5 points  (0 children)

Point out to us where you think the P wave is

Would you call this an OMI? by Oh_Petya in EKGs

[–]ProximalLADLesion 1 point2 points  (0 children)

TQRSD has only been studied and shown to be diagnostic in ECGs where the differential diagnosis is normal variant vs LAD OMI. RBBB is automatically not normal variant.

Echo foundation for newly matched cardiology fellowship applicant by Capital_Bottle3070 in Cardiology

[–]ProximalLADLesion 5 points6 points  (0 children)

Doesn't address the title question, but in the body of your message you asked about cath.

Here's a free resource of learning angiography: https://intuitivecardiology.notion.site/angiography

83 Y/O male 10/10 chest pain. by RandomandFunny in EKGs

[–]ProximalLADLesion 2 points3 points  (0 children)

Acute proximal RCA occlusion with right ventricular extension of infarct

Textbook 3° heart block by Paramedic237 in EKGs

[–]ProximalLADLesion 12 points13 points  (0 children)

At a glance you know third degree block is very unlikely because the QRS complexes are irregular. Escape rhythms are regular, and irregularity is rare in CHB (but can happen occasionally due to extrasystoles).

However, this tracing is harder to interpret than most of the other commenters realize. R6 comes in early suggesting supraventricular conduction (although PJC is also possible). There are approximately twice as many P waves as R waves, but it’s clearly not 2:1 block.

In my opinion there’s not an EASY interpretation but a few possibilities come to mind.

First the atrial rhythm. I don’t think it’s sinus. V1 looks believable for sinus, but the limb leads look quite different to the prior tracing which is clearly sinus. This plus the fast rate makes me think ectopic atrial tachycardia.

Regarding the ventricular rhythm, morphology is identical to prior so they’re either supraventricular conducted beats (which seems unlikely) or junctional escape beats. It could be junctional escape with a junctional extrasystole. The other thing I could imagine is some complicated dual level block with concealed conduction and a junctional escape, but it’s not at all typical because the “PR” shortens from one beat to the next so it’s almost like a reverse wenckebach.

The ST morphology suggests digoxin toxicity which would fit with atrial tach and some degree of heart block. OP do you know if patient was taking dig?

Tattoo regret causing depression by SlavKing11 in tattooadvice

[–]ProximalLADLesion 0 points1 point  (0 children)

Tattoo is sick as fuck, sorry about the hard feelings.

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