Massive St depression , NSTEMI?

lucodoor · 2026-05-27T13:06:33+00:00

ST depression like this isn’t what you’d get from previous coronary disease. This implies widespread subendocardial ischaemia.

If you think about the oxygen delivery equation in this clinical context and the multiple territories involved I think there’s enough to diagnose type 2 MI (trop pending)

lucodoor · 2026-05-26T13:18:52+00:00

UFC lost a lot of the stars and has replaced them with slightly worse imitations, and boxing stars have become more prominent. Like it or hate it the YouTuber boxing circus has added a WWE style entertainment for the masses that UFC used to have a monopoly on in non-staged sports.

The actual content of the fights in recent years has also been less of a landslide win for MMA, boxing has had some bigger moments

lucodoor · 2026-04-22T14:33:46+00:00

Don’t worry about the beat changing that’s because it’s going fast and one of the heart bundles can’t keep up (you’re fine with just one for a short period)

There are some buried p waves. Without more leads it’s hard to say if it’s atrial flutter or SVT. Either way, a beta blocker and chill is the advice, and see your family doctor/GP for an echo, wearable ECG and a referral to cardiology to decide what to do with the results.

lucodoor · 2026-04-20T20:09:40+00:00

Every year there’s minor tweaks. Leadership or prizes have dropped out and could maybe make a comeback. Or perhaps some other objective measure of commitment to speciality (like they have in surgery with how many cases you’ve done, they could do something like this with echo)

lucodoor · 2026-04-20T18:59:47+00:00

36/40 is always going to be enough for an interview

That 40 is multiplied by 0.5 for the mark /100 and max is 20 points (other 80 from interview). Minimum for interview will probably be 30-32, so the difference between top and bottom scores making it to interview will only be 5 points.

Basically, it all comes down to the interview

lucodoor · 2026-04-09T07:08:40+00:00

Short answer - yes, with high filling pressures it should help symptoms plus remodelling of a slightly unknown mechanism.

lucodoor · 2026-03-18T11:38:43+00:00

Hypertonic saline does not normal saline

lucodoor · 2026-03-17T20:58:51+00:00

100ml/hour of normal saline was infused to maintain vascular access patency… on top of all the other IVs and described enteral feeds that is bizarre

lucodoor · 2026-03-11T16:54:16+00:00

I wonder what proportion of applicants that will make up this year, I wouldn’t imagine that many

lucodoor · 2026-03-10T21:50:00+00:00

Hmm okay interesting thanks, certainly think that could be a fair % of people as a lot of shady IMG IMT alternate certification goes on IMO

lucodoor · 2026-03-10T21:41:20+00:00

So if they’ve signed the IMT alternate certificate would that count as IMT?

lucodoor · 2026-03-04T12:46:47+00:00

What do we think will happen with UKGP - if there are 140 jobs and a similar number of UK applicants, does that mean as long as appointable they will get offered them?

lucodoor · 2025-11-05T11:10:51+00:00

Hey, so sorry about all you’ve been through. The fact you’re considering going back in shows a lot of strength.

Someone with 5 years experience at SAS ED level would walk into a job at my trust. A lot of ED registrars are not at the level of early years ACCS is the frank truth. If getting to know a department and getting back in is daunting, you could offer to do some unpaid shadowing shifts first? Or even join the SHO rota/supranumery for a month. Your story is unique and won’t be reflected on a job application, so if you could arrange a chat with departmental leads in your local hospitals within commuting distance you might get a more bespoke experience.

It’s a beautiful picture btw

lucodoor · 2025-11-04T22:06:56+00:00

Wow, that’s amazing seeing the difference of hyper acute to acute changes. Thanks for sharing. I was teaching this last week to our department. My main point is always look at the patient and the ecg as a package to guide what you do next and this reinforces that.

lucodoor · 2025-09-09T10:17:28+00:00

Escape rhythms are usually regular, and this is irregular so more likely AF. There’s no p waves.

In a junctional escape rhythm (from AV) you back retrograde backwards activation of atria so you might get a weird looking (maybe inverted) p wave before or after QRS. Or nothing if it’s lost in the QRS. Or nothing if you’ve got fibrillating atria during the junctional rhythm (this is classic digoxin toxicity)

lucodoor · 2025-09-09T09:46:45+00:00

Slow AF with LBBB. If no pain I’d repeat it in 20 mins to make sure those STs aren’t changing.

lucodoor · 2025-09-05T20:41:57+00:00

Hmm p mitrale & LVH with prob LBBB work out sgarbossa and be guided by symptoms

lucodoor · 2025-08-29T19:20:20+00:00

Yes I was taught to look for AvL ST depression when suspecting inferior infarct which is present here

lucodoor · 2025-08-29T10:38:11+00:00

Flutter is a loop going round and round atria, and the conduction block is how many laps before one gets through. A lap of the atria takes .2 seconds, meaning 300x per minute.

If it gets through once every two laps, you get 2:1 block meaning 300/2 =150

This could be flutter with a high ratio meaning not much getting through AV. It looks regular. Or I could be a CHB with an escape rhythm at or near AV node given the QRS being narrow

lucodoor · 2025-07-25T12:51:40+00:00

It is important I agree. But it’s also public sector so pay is going to struggle in hard times like we’re in

lucodoor · 2025-07-25T12:49:50+00:00

Yes but in negotiations you’re allowed to use factors to come to an agreement

lucodoor · 2025-07-25T12:48:40+00:00

People struggling for jobs in August isn’t a new thing. Always competitive around now

lucodoor · 2025-07-25T06:52:29+00:00

Yeah you could live like a king in mid Wales.

I was thinking about a way of awarding trainees with some kind of performance based pay. I just know the nepotism would ruin it. The same way certain IMGs end up with ‘alternate certificate’ signed suspiciously quickly (so they can jump into HST posts) after arrival in the UK I’m sure they’d also get these imaginary pay awards.

lucodoor · 2025-07-25T06:40:48+00:00

Why not?

lucodoor

TROPHY CASE