A useful mnemonic for acute asthma -
I forgot the Magnesium!
And remember severity.....there are a large number of unnecessary asthma deaths because people get the severity wrong.....and remember for next year if you are reaching for magnesium you should DEFINITELY have used a phone first.....HELP
The consultant on my ward taught me a useful alternative to 'pointing away or pointing towards' method I previously used to interpret L or R axis deviation on ECG:
1. Look at limb leads 1 (0 degree/to the left) and aVF (90 degree/downwards)
2. Estimate the resultant vector of the two:
(a) In normal axis, both will be positive, as the resultant vector is somewhere in between left and inferior
(b) In left axis deviation, 1 will be positive (left) and aVF negative (upwards), hence the resultant is WAY TOO LEFT
(c) In right axis deviation, 1 will be negative (right) and aVF positive (downwards), hence resultant is somewhere on the RIGHT
(d) I've never seen both negative, but that would make it very very right
Rephrase: Look at R wave in limb lead 1 and aVF. if resultant is between -30 and +90. its normal. -30 to -90 is left. >90 is right.
Yikes. sounds easier when drawn than explained in words!
Is there a way of explaining this visually? Anyone got any suggestions on this? For such a small part of medicine the axis of the ECG seems to take up a lot of angst amongst students....images to me and I'll post them if you would like
Posting a 2nd one because this is interesting.
After the derm lecture we had, I saw eczema herpeticum in the ward.
Patient with chronic eczema and recent cold sore on the lip presented with severe headache, pain/itchy/burning face rash and inability to open left eye actively. Eyes are painless. Able to shut eyes tight.
I was told that if there is involvement of the NOSE dorsum and tip, the CORNEA is likely to be affected too as these are supplied by the same nerve (nasociliary branch of opthalmic nerve). Turned out these were all not affected.
However, I still don't know why he couldn't open his eyes.
At least the treatment is still the same - IV aciclovir!
But if you have any idea what might cause him to have one-sided lid opening apraxia, let me know :)
Looking for how the ECG changes with different axes...there is an interactive thingy on this website. Move the arrow and the ECG changes accordingly
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