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Electrocardiography

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163

15. 12-Lead ECG System

Fig. 15.1. (A) The 10 ECG leads of Waller. (B) Einthoven limb leads and Einthoven triangle. The Einthoven triangle is an approximate description of the lead vectors associated with the limb leads. Lead I is shown as I in the above figure, etc.  
bem.fi
over 5 years ago
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193

Hyperkalemia Explained Clearly

Dr. Seheult illustrates key hyperkalemia causes, pathophysiology, EKG/ECG changes (including peaked T waves) and potential arrhythmias. This is video 1 of 2 ...  
youtube.com
about 5 years ago
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30

Echocardiography - Wikipedia, the free encyclopedia

Echocardiogram, often referred to as a cardiac echo or simply an echo, is a sonogram of the heart. (It is not abbreviated, as ECG is an abbreviation for an electrocardiogram.) Echocardiography uses standard two-dimensional, three-dimensional, and Doppler ultrasound to create images of the heart.  
en.wikipedia.org
about 5 years ago
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146

ECG Interpretation - Atrio-Ventricular Block

http://www.acadoodle.com Atrial depolarisation is transmitted to the ventricular myocardium by the AV node and intraventricular conducting system. The time between the onset of atrial depolarisation and the release of depolarisation into the ventricular myocardium from the terminal branches of the conducting system is represented by the PR interval on the ECG. Dysfunction of the AV node or diffuse damage to components of the ventricular conducting system can result in a delay or even failure of transmission of atrial depolarisation into the ventricular muscle mass. This situation is referred to as atrioventricular or AV block. Three degrees of AV block are recognised. First degree AV block is defined by transmission of all P waves to the ventricular myocardium but with prolongation of the PR interval beyond the upper limit of normal on the ECG. Second degree AV block is defined by failure of conduction of some P waves into the ventricles. In third degree or 'complete' AV block, no P waves are transmitted to the ventricular myocardium. Acadoodle.com is a web resource that provides Videos and Interactive Games to teach the complex nature of ECG / EKG. 3D reconstructions and informative 2D animations provide the ideal learning environment for this field. For more videos and interactive games, visit Acadoodle.com Information provided by Acadoodle.com and associated videos is for informational purposes only; it is not intended as a substitute for advice from your own medical team. The information provided by Acadoodle.com and associated videos is not to be used for diagnosing or treating any health concerns you may have - please contact your physician or health care professional for all your medical needs.  
ECG Teacher
over 6 years ago
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136

Acadoodle.com - Time and the ECG (Section 1.5, Part 1)

http://www.acadoodle.com Acadoodle.com is a web resource that provides Videos and Interactive Games to teach the complex nature of ECG / EKG. 3D reconstructions and informative 2D animations provide the ideal learning environment for this field. For more videos and interactive games, visit Acadoodle.com Information provided by Acadoodle.com and associated videos is for informational purposes only; it is not intended as a substitute for advice from your own medical team. The information provided by Acadoodle.com and associated videos is not to be used for diagnosing or treating any health concerns you may have - please contact your physician or health care professional for all your medical needs.  
ECG Teacher
over 6 years ago
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Time and the ECG (Section 1.5, Part 2)

http://www.acadoodle.com Acadoodle.com is a web resource that provides Videos and Interactive Games to teach the complex nature of ECG / EKG. 3D reconstructions and informative 2D animations provide the ideal learning environment for this field. For more videos and interactive games, visit Acadoodle.com Information provided by Acadoodle.com and associated videos is for informational purposes only; it is not intended as a substitute for advice from your own medical team. The information provided by Acadoodle.com and associated videos is not to be used for diagnosing or treating any health concerns you may have - please contact your physician or health care professional for all your medical needs.  
ECG Teacher
over 6 years ago
13
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ECG Interpretation - Bundle Branch Block

http://www.acadoodle.com Isolated dysfunction or damage of either of the main branches of the bundle of His is commonly observed in clinical practice. The pattern of ECG changes associated with right and left bundle branch block are predictable and you must be able to recognise them on the ECG. Complete right bundle branch block (RBBB) and complete left bundle branch block (LBBB) produce prolongation of the qrs complex and predictable morphological changes on the ECG. Acadoodle.com is a web resource that provides Videos and Interactive Games to teach the complex nature of ECG / EKG. 3D reconstructions and informative 2D animations provide the ideal learning environment for this field. For more videos and interactive games, visit Acadoodle.com Information provided by Acadoodle.com and associated videos is for informational purposes only; it is not intended as a substitute for advice from your own medical team. The information provided by Acadoodle.com and associated videos is not to be used for diagnosing or treating any health concerns you may have - please contact your physician or health care professional for all your medical needs.  
ECG Teacher
over 6 years ago
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11

ECG Abnormalities

 
almostadoctor.com - free medical student revision notes
over 6 years ago
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85

How to record an ECG - OSCE Guide | Geeky Medics

A step by step OSCE guide demonstrating how to record an ECG  
Geeky Medics
over 6 years ago
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142

Intro to EKG Interpretation - Myocardial Infarctions (Part 2 of 2)

A review of the EKG findings in MIs, including their morphological classification, a determination of their age, and localization to region of the heart and ...  
YouTube
almost 6 years ago
Foo20151013 2023 7owyf5?1444773963
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Benchmarking Outpatient Referral Rates

Introduction GPs for a little while have been asked to compare each other’s outpatient referrals rates. The idea is that this peer to peer open review will help us understand each others referral patterns. For some reason and due to a natural competitive nature of human behaviour, I think we have these peer to peer figures put to us to try to get us to refer less into hospital outpatients. It’s always hard to benchmark GP surgeries but outpatient referral benchmarking is particularly poor for several reasons It's Very Difficult to Normalise Surgeries Surgeries have different mortalities morbidities ages and other confounding factors that it becomes very hard to create an algorithm to create a weighting factor to properly compare one surgery against another. There Are Several Reasons For The Referral I’ll go into more detail on this point later but there are several reasons why doctors refer patients into hospital which can range from: doctors knowing a lot about the condition and picking up subtle symptoms and signs lesser experienced doctors would have ignored; all the way to not knowing about the condition and needing some advice from an expert in the condition. We Need To Look At The Bigger Picture The biggest killer to our budget is non-elective admissions and it’s the one area where patient, commissioner and doctor converge. Patients want to keep out of hospital, it’s cheaper for the NHS and Doctors don’t like the lack of continuity when patients go in. For me I see every admission to hospital as a fail. Of course it’s more complex than this and it might be totally appropriate but if we work on this concept backwards, it will help us more. Likewise if we try to reduce outpatient referrals because we are pressurised to, they may end up in hospitalisation and cost the NHS £10,000s rather than £100s as an outpatient. We need to look at the bigger picture and refer especially if we believe that referrals will lead to less hospitalisation of patients further down the line. To put things into perspective 2 symptoms patients present which I take very seriously are palpitations in the elderly and breathlessness. Both symptoms are very real and normally lead to undiagnosed conditions which if we don’t tackle and diagnose early enough will cause patients to deteriorate and end up in hospital. Education, Education, Education When I first went into commissioning as a lead in 2006 I had this idea of getting to the bottom of why GPs refer patients to outpatients. The idea being if we knew why, we would know how to best tackle specialities. I asked my GPs to record which speciality to refer to and why they referred over a 7 month period. The reason for admission was complex but we divided them up into these categories: 2nd care input required for management of the condition. We know about the condition but have drawn the line with what we can do in primary care. An example of this is when we’ve done a 24 hour tape and found a patient has 2sec pauses and needs a pace maker. 2nd care input required for diagnosis. We think this patient has these symptoms which are related to this condition but don’t really know about the diagnosis and need help with this. An example of this is when a patient presents with diarrhoea to a gastroenterologist There could be several reasons for this and we need help from the gastroenterologist to confirm the diagnosis via a colonscopy and ogd etc. Management Advice. We know what the patient has but need help with managing the condition. For example uncontrolled heart failure or recurrent sinusitis. Consultant to Consultant Referral. As advised between consultants. Patient Choice. Sometimes the patient just wants to see the hospital doctor. The results are enclosed here in Excel and displayed below. Please click on the graph thumbnail below. Reasons For Referrals Firstly a few disclaimers and thoughts. These figures were before any GPSI ENT, Dermatology or Musculosketal services which probably would have made an impact on the figures. There are a few anomalies which may need further thought eg I’m surprised Rheumatology for 2nd input for diagnosis is so low, as frequently I have patients with high ESRs and CRPs which I need advise on diagnoses. Also audiology medicine doesn’t quite look right. The cardiology referral is probably high for management advise due to help on ECG interpretation although this is an assumption. This is just a 7 month period from a subset of 8-9 GPs. Although we were careful to explain each category and it’s meaning, more work might need to be done to clarify the findings further. In my opinion the one area where GPs need to get grips with is management advice as it’s an admission that I know what the patient has and need help on how to treat them. This graph is listed in order of management advice for this reason. So what do you do to respond to this? The most logical step is to education GPs on the left hand side of this graph and invest in your work force but more and more I see intermediary GPSI services which are the provider arm of a commissioning group led to help intercept referrals to hospital. In favour of the data most of the left hand side of the graph have been converted into a GPSI service at one point. In my area what has happened is that referrals rates have actually gone up into these services with no decline in the outgoing speciality as GPs become dis-empowered and just off load any symptoms which patients have which they would have probably had a higher threshold to refer on if these GPSI services were not available. Having said that GPSI services can have a role in the pathway and I’m not averse to their implementation, we just have to find a better way to use their services. 3 Step Plan As I’m not one to just give problems here are my 3 suggestions to help referrals. To have a more responsive Layered Outpatient Service. Setting up an 18 week target for all outpatients is strange, as symptoms and specialities need to be prioritised. For example I don’t mind waiting 20 weeks for a ENT referral on a condition which is bothering me but not life threatening but need to only have a 3 week turn over if I’m breathless with a sudden reduction in my exercise tolerance. This adds an extra layer of complexity but always in the back of my mind it’s about getting them seen sooner to prevent hospitalisation. Education, education, education It’s ironic that the first budget to be slashed in my area was education. We need to education our GPs to empower them to bring the management advice category down as this is the category which will make the biggest impact to improving health care. In essence we need to focus on working on the left hand side of this graph first. Diagnose Earlier and Refer Appropriately The worst case scenario is when GPs refer patients to the wrong speciality and it can happen frequently as symptoms blur between conditions. This leads to delayed diagnosis, delayed management and you guessed it, increased hospitalisation. The obvious example is whether patients with breathlessness is caused by heart or lung or is psychogenic. As GPs we need to work up patients appropriately and make a best choice based on the evidence in front of us. Peer to peer GP delayed referral letter analysis groups have a place in this process. Conclusion At the end of the day it's about appropriate referrals always, not just a reduction. Indeed for us to get a grip on the NHS Budgets as future Clinical Commissioners, I would expect outpatient referrals to go up at the expense of non-elective, as then you are looking at patients being seen and diagnosed earlier and kept out of hospital.  
Raza Toosy
over 7 years ago
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279

EKG Practice - emdocs

EKG Practice: Nine EKGs with teaching points and pearls, by Ray Fowler, MD.  
emdocs.net
over 5 years ago
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Principles of Medical Physiology

This book has been specifically designed with the needs of the student in mind. Lengthy explanations are avoided and the material is presented in a concise form that not only makes it easy to understand but also easy to remember and reproduce, which is precisely what the student needs. Key features - Short chapters are organized in the sequence preferred by most physiology teachers - The contents of each chapter are tailored to provide just enough material for a single lecture (occasionally two lectures), making it very handy for teachers. (The book contains 120 chapters) - Basics of relevant physics and chemistry are made extremely simple. This is welcomed by both physiology teachers and students, for efficient teaching and learning - Schematic diagrams in 3D perspective are employed to elucidate difficult anatomical concepts, including the gross structure of the brain - Simple analogies of difficult concepts are given, often comically illustrated. Apparent paradoxes are highlighted and simple answers are provided - Difficult topics are presented with elegant simplicity and brevity without compromising on the core concepts. These include membrane electrophysiology, electromyography, hemostatic balance, electrocardiography, cardiac output, hemodynamics, respiratory mechanics, counter-current multiplier system, body fluid and electrolyte balance, gastric acid secretion, calcitropic hormones, fetoplacental unit, memory and learning, synaptic transmission and sensorimotor mechanisms  
books.google.co.uk
over 5 years ago
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Pleurisy - American Family Physician

Pleuritic chest pain is a common presenting symptom and has many causes, which range from life-threatening to benign, self-limited conditions. Pulmonary embolism is the most common potentially life-threatening cause, found in 5 to 20 percent of patients who present to the emergency department with pleuritic pain. Other clinically significant conditions that may cause pleuritic pain include pericarditis, pneumonia, myocardial infarction, and pneumothorax. Patients should be evaluated appropriately for these conditions before an alternative diagnosis is made. History, physical examination, and chest radiography are recommended for all patients with pleuritic chest pain. Electrocardiography is helpful, especially if there is clinical suspicion of myocardial infarction, pulmonary embolism, or pericarditis. When these other significant causes of pleuritic pain have been excluded, the diagnosis of pleurisy can be made. There are numerous causes of pleurisy, with viral pleurisy among the most common. Other etiologies may be evaluated through additional diagnostic testing in selected patients. Treatment of pleurisy typically consists of pain management with nonsteroidal anti-inflammatory drugs, as well as specific treatments targeted at the underlying cause.  
aafp.org
over 4 years ago
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ECG with muscle tremor

This ECG shows the type of interference you would see when the patient has a muscle tremor.  
Rhys Clement
almost 11 years ago
Stemi and nstemi ecg illustration pu
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The importance of pre-hospital ECGs

The last issue of Prehospital Emergency Care (PEC) published a couple of articles about prehospital ECGs, including this one: A Prospective Evaluation of the Utility of the Prehospital 12-lead Electrocardiogram to Change Patient Management in the Emergency Department.  (If you have access to this journal or article, please let me know--I can't find any way to…  
PreHospitalFOAM
over 6 years ago
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Summary of ECG Abnormalities

  Abnormality  
almostadoctor.com - free medical student revision notes
over 6 years ago
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The basics of the ECG in 5 min

An overview of what the ECG records  
YouTube
over 6 years ago