if i look back, i am lost
let's talk about Bridgerton tea, my ask is open
ojovivo
RMH
will byers stan first human second
Aqua Utopia｜海の底で記憶を紡ぐ
noise dept.
macklin celebrini has autism
official daine visual archive
Cosimo Galluzzi
Love Begins
art blog(derogatory)
$LAYYYTER
shark vs the universe
Fai_Ryy
🪼
NASA
d e v o n
No title available
No title available
seen from Türkiye
seen from United States
seen from United States
seen from United States
seen from Italy
seen from United States
seen from Malaysia
seen from Malaysia
seen from United States
seen from Canada
seen from United States
seen from Vietnam
seen from United States
seen from United States
seen from China
seen from Netherlands
seen from United States
seen from Canada
seen from United States
seen from United States
@rolandpmjr
Celebrated my 29th trip around the sun with a spontaneous weekend trip to Chi-town! Went on a river cruise, took in the city views from 103 floors high, saw a giant bean, and caught the most epic sunset on the Chicago skyline. Thanks to everyone for the birthday greetings! 🥂🥳🌆 (at Chicago, Illinois) https://www.instagram.com/p/CUT5QX0Lv6H/?utm_medium=tumblr
Keys in hand and officially a homeowner! It’s been a long journey that started at the beginning of the year and it’s been fun to watch it grow from the ground up! 🎉🍾 Swipe to see the 7 month journey in 7 seconds ➡️ (at Southern Highlands) https://www.instagram.com/p/CDaf0YWHSqu/?igshid=4p417dfxv73q
Today we lost our bestest friend and the goodest boy. Thank you Preston for filling our lives with joy and happiness for over 13 years. Thank you for showing us unconditional love and unwavering loyalty. I hope you’re having all the treats and belly rubs and ear scratches and you’re running around to your heart’s content in puppy heaven. Rest In Peace munchkin. https://www.instagram.com/p/CBhiUVaHPnT/?igshid=1gw5oyynqfxms
Over the past few days I’ve been reflecting and thinking of what words to write in this post when it has actually been quite simple: thank you. Thank you to the doctors, NPs, pharmacists, respiratory therapists, social workers, and techs from all disciplines. Thank you to all the nurses: the ER nurses, the floor nurses, the tele and other ICU nurses. Most of all, thank you to my SICU family. Our trauma surgeons and NPs, PMA docs, hospitalists, techs, and nurses—those I worked with just last week, those who have come and gone, and everyone in between for taking me in and teaching me everything I know about how to be a nurse. Thank you for all the memories we’ve made and all the experiences we’ve had— good, bad, and indifferent that have shaped the kind of person and the kind of nurse I have become. As I spread my wings and fly the coop and pursue new adventures, I’ll never forget where I came from. My SICU family, it’s been a pleasure working with all of you. From the bottom of my heart, thank you. (at Renown Regional Medical Center) https://www.instagram.com/p/Bp82p1Hnh1O/?utm_source=ig_tumblr_share&igshid=17q4c60b5u4d5
WHO DID THIS 😂😂😂
ECG: quick and dirty
I’ve had countless sessions and lectures on ECGs. I don’t know how many websites I have bookmarked, or how many times my eyes glazed over reading Dubin. I’m also terrible at cardiology. I was on my way to accepting my fate of being horrible at ECGs forever, until I had a life changing session on ECGs taught by a great ER doc. I want to post it here because it was probably the most useful thing I learned in med school, and it will stick with me for the rest of my career.
WHEN LOOKING AT ECGs FOR THE FIRST TIME:
1. One ECG is never enough. Always get old ones for comparison. If none available, do another one. Because. One ECG is never enough.
2. RATE. Look at the number on top of the printed ECG. It’s stupid not to use that number. Yes, you should know the rule, 300-150-100-75-60-50. People say you shouldn’t trust the machine because… well, it’s a machine, and it can make mistakes. This is true. I don’t like to look at their “diagnosis” until I have gone through it myself. But the rate is just a number. Plus you should be able to eyeball it and be able to tell if it’s tachy, brady, etc. If the machine is telling you it’s 200 and if it looks tachy, then it’s probably the right number.
3. RHYTHM. Is there a p-wave for every QRS and a QRS for every p-wave? Is the p-wave upright in lead II and down in aVR? Good. Done. BOOM. It’s sinus rhythm. ***if you cannot clearly see the p-waves then you cannot call sinus. move on.
4. AXIS. Again, look at the number at the top of the page. If it’s between 0 and +90, then it’s normal axis. If the number isn’t provided, or if your preceptor doesn’t believe in the convenience of machines/technology, look at the QRS complex of lead I and lead II.
up in lead I, up in lead II: normal axis
up in lead I, down in lead II: left axis deviation (most common causes are left anterior hemi block and left ventricular hypertrophy)
down in lead I, up in lead II: right axis deviation (most common causes are right ventricular hypertrophy…PE)
5. did someone say HYPERTROPHY?
look at V1
is the R wave tall? (greater than 7mm?) right ventricular hypertrophy.
is the S wave tall? (greater than 11mm?) left ventricular hypertrophy.
6. P-waves
look at lead II
is it wide? left atrial enlargement.
is it tall? right atrial enlargement.
7. PR interval
should be between 0.12 sec and 0.2 sec (3-5 small boxes). I used to always get this interval and QRS complex (less than 0.12 sec) mixed up. Think: atria depolarizing + shit getting to ventricles is gonna take longer than ventricles depolarizing. [2 things happening] versus [1 thing happening]. [0.12 sec-0.2 sec] versus [<0.12 sec].
long PR interval means there’s some sort of block at the AV node.
1st deg block. PR interval is long. everything else is normal. cool.
2nd deg block
type I: PR interval progressively gets long. eventually a dropped QRS.
type II: PR interval is constant, but randomly dropped QRS.
3rd deg block “complete block”
there is no association between P waves and QRS. they run separately. **QRS does NOT have to be wide. Just look for P wave/QRS complex disassociation. I sometimes get this and 2nd deg type II mixed up. The only difference I try to remember is that PR interval is constant in 2nd deg type II, but is variable in 3rd deg.
8. QRS complex
narrow or wide?
narrow: good. signal coming from somewhere above ventricles.
wide: think BBB (bundle branch block)
LOOK AT V1 ONLY.
if the last deflection of QRS is DOWN, then it’s a left BBB
if the last deflection of QRS is UP, then it’s a right BBB. super easy. no more of this bunny ears crap.
9. ST segment
always look from J point, and compare with the isoelectric line of T-P segment (NOT PR interval).
elevated/depressed… STEMI… duh. indicates ACUTE ischemic changes.
look for reciprocal changes of the heart. if ST elevation in lateral leads, could see ST depression in the septal leads. PAILS:
posterior up, anterior down
anterior up, inferior down
inferior up, lateral down
lateral up, septal down.
LBBB can look like STEMI. How to tell?
disconcordant changes is normal. (QRS and STEMI on opposite sides of the isoelectric line.)
concordant changes is abnormal.
massive discordance is abnormal. (STEMI is greater than 5mm)
this isn’t that important. Moving on.
Inferior STEMI. Could right ventricle be involved?
DO NOT GIVE NITRO DO NOT GIVE NITRO DO NOT GIVE NITRO.
order a 15 lead
is STE in lead III > lead II? likely RV involvement
INFERIOR MI? 15 LEAD NO NITRO
INFERIOR MI? 15 LEAD NO NITRO
INFERIOR MI? 15 LEAD NO NITRO
10. T waves
is it inverted? indicates recent ischemic changes.
11. Q waves
is it significant? indicates old ischemic changes. will likely be present if followed rule number 1 of reading ECGs. (1 ECG is never enough= look at old ECGs).
I literally go through this list of 11 points in my head when I’m reading an ECG, regardless of whether or not I have an atrial flutter jumping at my face or if I see a massive anterolateral STEMI. Obviously I needed background knowledge on ECGs and the physiology of the heart before constructing this list, but this basic checklist has been very, very useful to me so far. It might look lengthy, but it doesn’t take a lot of time at all- a patient is not likely going to have all these issues with their heart.
Anyway. I still don’t love ECGs, but it feels pretty wonderful to be able to be able to evaluate it in a systematic manner, and get the theory behind interpreting the scribbles of an ECG reading. I don’t get these moments as much as I would like to, but it’s that crosspoint where my classroom learning actually meets real-life applications that gives me happy brain-gasms for days. I love knowing things and more importantly, knowing why.
This is Medblr gold. Reblogging for anyone staring down the barrel at 1 July.
I learned a lot here.
I need venous access. I can’t give you a butterfly.
Hug
Hyperkalaemia ECG changes in 15 seconds.
High levels of potassium destabilise the cardiac membrane causing arrhythmia’s which lead to cardiac arrest. This can be a real life-saving opportunity if you can catch and treat it!
I made this as an experiment while learning a bit more about After Effects to animate my medical illustration. Hope it’s useful!
this is a good visual for potassium’s effect on EKG’s
An illustrated overview of the H's & T's, AKA the reversible causes of cardiac arrest.
Next time you face a cardiac arrest, perhaps spacemen with diarrhoea will help you save a life… see what I’m talking about with my illustrated guide to the H’s & T’s AKA reversible causes of cardiac arrest: https://artibiotics.com/blog/hs-and-ts
A great illustration. It’s so important to know these in a code.
To my favorite woman on the entire planet, the one who keeps me humble, the one who without her love, encouragement, and support I’d be nothing, Happy Mother’s Day! Love you mom! 💐🌹🌺🌻 (at Oranjestad, Aruba)
There isn’t a greater feeling of success and validation of my knowledge, abilities, and skills in critical care nursing than this specialty certification right here. 💪🏽 #CCRN
Atlantis, Bahamas 🇧🇸 Glacier Beach, Iceland 🇮🇸 Ensenada, Mexico 🇲🇽 Roatan, Honduras 🇭🇳 Amsterdam, Netherlands 🇳🇱 Heidelberg, Germany 🇩🇪 Vancouver, Canada 🇨🇦 Oranjestad, Aruba 🇦🇼 and all the adventures in between, 2017 was lit! Here's to more adventures in 2018! Wishing everyone a very Happy New Year! #NYE2018 #newyears #happynewyears (at Miami, Florida)
Merry Christmas! Hope y'all had a good one! 🎄🎅🏻🎁 #merrychristmas #christmas2017 #happyholidays (at Fashion Island)
Happy 60th birthday, Ma! (at Maggiano's Little Italy)
Turning 25 in the Caribbean isn't so bad. Thanks for all the birthday love! (at Renaissance Aruba Resort & Casino)
