31 January 2012

Med in Small Doses - Cardiac Arrhythmias Overview

 
Disorder of heart rate (slow: bradycardia or fast: tachycardia) or rhythm. Can occur at Sino-atrial node, Atria or Ventricles.

Can be broadly split into tachyarrhythmias and bradyarrhythmias. More on each category later in the week.

PATHO: Problems with the Heart's electrical conduction system.

Causes: (STRIDES)
S tructural Abnormalities
T hyroid Disease
R heumatic Heart Disease
I schaemia
D rugs (e.g. digoxin, CCB, B-Blockers)
E lectrolytes (e.g. K+, Ca2+, Mg2+)
S ocial Drugs (e.g. Caffeine, Cocaine)

CFs: Asymptomatic, Palpitations, Sweating, De-compensated (Low BP, LoC, Chest pain, pulmonary oedema), Syncope, Dyspnoea, Sudden Death. 

Ix: Best investigation is ECG. Note Bundle Branch Blocks effects ECG interpretation. Read a Quick Guide to ECG to understand the basics behind reading and interpreting ECGs. 
FBC and U&E. Holter monitor, echocardiogram & coronary angiography.

General Tx: Please note that these are very basic principles. Please seek the appropriate medical advice or the specific regimen that goes with certain arrhythmias.Lifestyle management including management of some modifiable causes, medications, electrical therapy (defibrillation or cardioversion), insertion of pace-maker.

Asystole: treatment "Have some asystole "TEA": 
T ranscutaneous pacing
E pinephrine
A tropine

26 January 2012

Overland to Endeavour


Usually I keep this blog away from personal adventures, and stick with the facts and figures of medicine. At times however, I feel that there are certain experiences worth sharing. With it being Australia Day, it seemed even more relevant that I share this experience. I had the great opportunity during last December to participate on-board the STS Young Endeavour from Hobart to Sydney. Before I go any further, I'll tell you a bit about the Young Endeavour.

STS Young Endeavour is sail training ship used by the Young Endeavour Youth Scheme for the Youth of Australia. It is operated by the Australian Navy and can include up to 30 youth crew on any single voyage. The aim of the scheme is to build leadership, foster teamwork, develop life-long friendships and create a strong sense of community responsibility.
The vessel is brigantine rigged, with a 32-metre (105 ft) tall mainmast, and ten sails with a total area of 511 square metres (5,500 sq ft).

But first we must go Overland
Before I got to get under-way on that fantastic voyage, I took some time out to explore some of Tasmania's natural treasures, one of them being the Overland Track. The Overland Track is one of Australia's most well known tracks, running 65kms from Cradle Mountain to Lake St Clair. Along this track you will encounter all types of scenery and terrain; from the rocky sides of mountains to waterfalls surrounded by lush rainforest.

It has it all.

I can honestly say I have not been to too many more beautiful or diverse places in the world. The greatest gift I got from the track was its' quietness. I had the opportunity to get away from noise that generally accompanies my day to day life, and allowed it me to reflex on what had occurred throughout the year.

Like everybody, medical students and doctors similarly can get caught up with all the things going on around us. So I add this reminder to you,

Take the time to enjoy the simple things in life and the small pleasures that give you joy, and shed those things which are little more distractions.

Aye Captain
Young Endeavour similarly pushed me to rethink, my attitude towards the world and myself. Each morning we were given many inspirational quotes from the Captain to begin our day. There is one quote for me that really stood out, which we were told right before climbing for our first time to the top of the 32m foremast.

Start by doing what's necessary, then what's possible, and suddenly you are doing the impossible. Francis of Assisi

These simple, yet powerful set of words, can be carried everywhere through your life, which at the end of day I feel can be summed up as;

Give everything a go.

Aside from climbing the foremast the Young Endeavour threw many challenges at me personally and the youth crew team, which I could literally spend hours going in to. So rather than doing that I'll just give you a snapshot of some of my highlights.
  • Participating in Mawson's 100th Tribute
  • Stopping in at fantastic locations like Wineglass Bay & Eden
  • Crossing the Bass Strait entirely on Sail Power
  • Furling (i.e. tying up) sails during the middle of the night, along the yards
  • Command Day - Where the Youth Crew take control of Young Endeavour for 24hrs. The Captain kindly reminded before we started that we were responsible for a $22 million ship.
  • Having a fantastic time with a great bunch of people.


So why am I mentioning all of this?
Well the Ballot is open again for voyages from July to December 2012 and I would like to see as many young Australians as possible have a chance to jump on-board this amazing vessel.


If you are a past Youth Crew or Staff member go to youngendeavouraa.org to stay in the loop and participate in future events.

That's all from me for now. Hope you had a great Australia Day.

25 January 2012

Med in Small Doses - Asthma


This is part of the Med in Small Doses series, which aims to give you a snapshot of a disease or disorder.  


Inflamed small airways due to hypersensitivity. Multifactorial – genetics + environmental influences

PATHO: Inflammation (T2H, IL-5, etc) → bronchoconstriction → oedema → ↑ mucus secretion → smooth muscle hypertrophy → damage to epithelium and shedding.


CFs: Classic Triad - Wheeze, Cough (dry, or productive of mucoid or pale yellow sputum), Dyspnoea. Nasal mucosal swelling, ↑nasal secretions

RFs: mnemonic - FEAR UP
F amily history
E czema
A cid reflux
R hinitis (allergic)
U rticaria
P olyps (nasal) 

Ix: Chest x-ray, Allergy testing, Eosinophil count 
Spirometry: ↓ FEV1/FVC, ↓ PEF, ↓ FVC 

The different PFTs:
SPIROMEtry
S pirometry
P EFR
I nhalation tests:
R eversibilty of
O bstruction with beta-agonist
M etacholine challenge
E xhaled NO 

Tx & Mgmt: Monitoring & scheduled visits, education and avoid triggers.
Relief vs prevention, B2-Agonists: airway dilation. Glucocorticoids: anti-inflammatory. 

Treatment of Status Asthmaticus: (severe acute asthma) 
  1. Oxygen
  2. Nebulised salbutamol
  3. IV hydrocortisone
  4. Oral prednisolone 
Mnemonic
A drenergics
S teroids
T heophyllines (althouigh not used as much now though)
H ydration
M ask
A ntibiotics if necessary.

Rule of 2's
Treatment needs to be changed if there are more than:
  • 2 uses of relief inhalers per week
  • 2 nocturnal awakenings per month
  • 2 canisters of relief inhaler used per year
For a review of respiratory pathology checkout an Introduction to Respiratory Pathology & Pulmonary Tumours.