November 2016


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David L. -

What about bradycardia changes to look for in ECG? You completely missed blocks especially the subtle ones that residents need to look out for and often overlook like tri-fascicular block (1st degree AVB, LAFB/LAD and RBBB). The patient may be going in and out of complete hear block and if you're only looking for tachy-arrhythmias, Brugada, HOCM etc you'll miss a life threatening diagnosis.

David L. -

One item that I find useful in history is the fluid history especially in elderly people whose thirst mechanism isn't great (over 70's). It's amazing how many older people live on only two cups of tea a day. Then, when they go to the mall, they don't like to use the public wash rooms and so don't even drink that. Add in a little splanchnic "steal" when they have lunch at the food court and over they go. A good pointer to this is to ask about post-prandial drowsiness which happens if you're subclinically dry. (Used to happen to me the meal after every shift, until I learnt to always have a water bottle with me. I never had time to go to the break room to drink.)

David G. -

Thanks for the useful tip! I've been making a robust Evernote folder on all things syncope. I will include your "fluid hx in elderly" to my mix of questions/considerations when taking hx. Thanks again.

Gatebe K. -

Hi can you post the link to the ECG changes that was mentioned in the audio?

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