Happy World Heart Day! ❤❤❤
Heart disease is the world’s number one killer but new advances help us better understand how to keep hearts beating better and for longer💪
@fitbit is driven by the desire to make the world a healthier place, which includes your heart health!
If you own a @fitbitsg Sense, you are able to use the Electrocardiogram (ECG) app to assess your heart rhythm for atrial fibrillation (AFib), a heart rhythm irregularity. It’s so simple to use, all you have to do is open the app on your smart watch, hold your fingers on the corners around the watch while being still for 30 seconds. After assessing your heart rhythm, you’ll receive a reading from the app showing you if your heart rhythm appears normal or signs of AFib.
Let's work towards keeping our heart healthy with better nutrition, ample sleep, activity and stress management💟🌈
#fitbit #fitbitsense #fitbitsg
ecg reading 在 Dr 文科生 Facebook 的精選貼文
上次同大家分享COVID現有的不同治療方案
今日跟大家分享下當一個國家COVID爆發時需要大量接種COVID疫苗時面對的困難和難題
***以下內容只作分享用途,所有臨床診斷的考慮請跟隨個別醫院指引***
首先講講全球最常見較為有效而又打了很多劑的疫苗
Adenovirus vector: AZ and J&J
mRNA: Pfizer-BNT and Moderna
至於另一款疫苗如Novavax或台灣高端由於打的人數不多,就沒有太多數據分享
第一件事要認清的是,由於Delta的出現,疫苗並非神藥,以往大家期望的群體免疫在original或alpha上可能可以達到,但在delta蔓延的今日,似乎有難度。
根據大名鼎鼎的NEJM的研究,兩劑AZ對symptomatic infection的保護率大約為67%、而Pfizer-BNT的保護率大約為88%。不過可惜的是同時間有一些研究,例如牛津大學研究發現當接種疫苗過一段時間後,保護力會漸減,BNT尤其受到時間的影響。
另外,初步數據顯示針對delta,疫苗並不能像alpha或original一樣大幅減少打完疫苗的人的病毒含量。打了疫苗的人的病毒含量跟沒打的相當接近,不過疫苗對防止出現病徵和重症或死亡非常有效,只耐何疫苗來得太遲,delta搶先在世上出現。同時初步數據顯示Delta似乎較alpha/original更大機會出現重症和住院的機會,尤其於年輕人身上,不過這需要更多數據支持。
這代表面對惡名昭彰的Delta,我們不能再依靠打疫苗去保護他人,因為疫苗並不能夠阻止delta asymptomatic transmission。當打完疫苗後的病毒量一樣高時,唯一可以做的便是靠打疫苗保護自己,減低自己感染、住院、重症和死亡風險。
不過當大量接種疫苗時,便會出現一些罕有的副作用,這些副作用醫護人員必須Alert的,而處理這些懷疑的副作用亦對醫療系統造成沉重的負擔。但目前所有大型研究都顯示,疫苗副作用造成對醫療系統的負擔跟任由COVID爆發的社會和醫療成本相比是兩個不同級數的事。
================================
VITTS - Vaccine-induced immune thrombosis thrombocytopenic syndrome
在adenovirus vector的疫苗身上被發現罕有地會出現這種病症。初步數據是懷疑因為出現platelet factor 4 (PF-4) antibodies,原理跟HITTS (Heparin Induced thrombotic thrombocytopenic syndrome)類似。
VITTS多數會出現Cerebral Venous Sinus或Splanchnic thrombosis,但亦可在一般常見的血栓位置,例如DVT or PE but much less likely
一般臨床上可能會出現劇烈頭痛/腹痛/成因不明的瘀血(Petechiae)等等,較常於第一劑的4-42日內出現,亦較常見於年輕女性身上 機率視乎人種和年齡和研究的地方,歐洲數據為約0.00034%的機會出現。同時驗血報告中亦會發現血小板偏低和D-dimer偏高以及positive anti-PF4。
不過值得注意的是即使病發初期血小板和d-dimer正常都不一定沒有VITTS,個別個案可以於24-48小時後才出現這些features,視乎clinical suspicion, serial review and FBC might be indicated
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心肌炎及心包炎Myocarditis and pericarditis
在mRNA疫苗身上發現的已知罕有副作用,常見炎第二針後的年輕男性(30歲以下)身上,大多於接種第二針後第1-5日後出現,多以心口痛、心悸、暈厥(Syncope)、呼呼短促(SOB)等呈現,病發機率視乎人種、年齡和性別,美國數據為Myocarditis/Pericarditis - 12.6/million = 0.000126% (American Heart Association)
成因未完全了解,但似乎跟免疫系統激活的過程有關(詳情refer AHA report)。大部分患者病情相對輕微,個別患者可能有ECG dynamic changes, ST elevation, troponin rise, mild reduced LvEF on echo,但大部分患者都在短期內出院with full recovery (96% as per AHA)
值得注意的是,myocarditis在歷史上的其他疫苗例如流感、乙肝、天花(small pox)等等都有罕有的機會出現,約10-20 individual/100000 per year
同時感染COVID或其他病毒性感染的話亦可能會出現myocarditis,臨床懷疑的話或需要ECG, troponin, CXR, +/- echo +/- cardiac MRI
=================================
任何醫療選擇都有風險,當一個國家進行社區大型接種時,便需要處理這些問題,英美兩大國的經驗其實為世人提供了好多寶貴實用的資訊,好讓大家不用走冤枉路。
隨著時間的過去,愈來愈多數據和研究讓大家自行分析,多讀書多看研究才不會被任何人誤導,緊記保持批判性思考,無論任何人的高見都別不經消化和思考去接受。
Reference for further reading
1. ATAGI statement ATAGI statement regarding COVID-19 vaccines in the setting of transmission of the Delta variant of concern
https://www.health.gov.au/news/atagi-statement-regarding-covid-19-vaccines-in-the-setting-of-transmission-of-the-delta-variant-of-concern
2. NEJM - Effectiveness of Covid-19 Vaccines against the B.1.617.2 (Delta) Variant
https://www.nejm.org/doi/full/10.1056/NEJMoa2108891
3. Oxford University Studies Preprint - Vaccines still effective against Delta variant of concern, says Oxford-led study of the COVID-19 Infections Survey
https://www.ox.ac.uk/news/2021-08-19-vaccines-still-effective-against-delta-variant-concern-says-oxford-led-study-covid
4. AHA - Myocarditis With COVID-19 mRNA Vaccines
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.056135
Photo: internet
ecg reading 在 Facebook 的最佳貼文
#40weekspregnant #40weeks2dayspregnant #10monthspregnant
EDD: 22 June 2021
𝙏𝙬𝙤 𝙙𝙖𝙮𝙨 𝙤𝙫𝙚𝙧𝙙𝙪𝙚 and still counting 😅
Thought I’ll just post some updates here to give u guys some sense of relieves from all the silence 🥲 So this is what it’s like if you’re planning to have your labour done here in HKL (my first time here too)…
🟠 21 𝙅𝙪𝙣𝙚 2021
10am+ 👉🏻 Got myself registered for admission
11am+ 👉🏻 Nurses performed ECG to check baby’s heart rate while waiting for bed’s availability in the ward
12pm+ 👉🏻 Was told to wait at home bcs bed might only be available after 7pm bcs currently ward is full [𝙢𝙖𝙣𝙮 “𝙥𝙖𝙣𝙙𝙚𝙢𝙞𝙘-𝙞𝙣𝙨𝙥𝙞𝙧𝙚𝙙” 𝙗𝙖𝙗𝙞𝙚𝙨 𝙢𝙖𝙙𝙚 𝙙𝙪𝙧𝙞𝙣𝙜 𝙩𝙝𝙞𝙨 𝙩𝙞𝙢𝙚 😹]
5pm+ 👉🏻 Nurse called to inform there’s finally bed available and asked to “check in” immediately
6pm+ 👉🏻 Given some orientation in the ward, was told no outside food, no visitors, different classes of beds available and where to get new linen if you’ve stained your clothes/ bed
7pm+ 👉🏻 Set up branula on my hand. Changed to hospital attire (for all pregnant mom) and settle down for the day (night)
🟠 22 𝙅𝙪𝙣𝙚 2021
👉🏻 Did a tablet induce
👉🏻 Finger Test to check dilation, only 1cm opening. It’s a bloody mess and horrifying procedure for the first time me 😅
👉🏻 Doc decided to proceed with induction using 𝙁𝙤𝙡𝙚𝙮 𝘽𝙪𝙡𝙗 (to insert balloon) - another similar Finger Test procedure 🥵 This will help to ripen / soften the cervix and dilate better. Will leave it for 12 hours, in the meantime I’ll do some walking in the room
👉🏻 Had my first contraction. It started from the lower abdomen and the pain was excruciating. I tried to hold it by doing some deep breath but damn, it didn’t last me long enough. I end up telling the nurse I need some pain relief
👉🏻 I was given a jab on my butt and the pain subside, I fell into deep sleep till the next morning (𝙩𝙝𝙖𝙩 𝙬𝙖𝙨 𝙥𝙧𝙤𝙗𝙖𝙗𝙡𝙮 𝙩𝙝𝙚 𝙗𝙚𝙨𝙩 𝙨𝙡𝙚𝙚𝙥 𝙄 𝙚𝙫𝙚𝙧 𝙝𝙖𝙙 𝙨𝙞𝙣𝙘𝙚 𝙄 𝙜𝙤𝙩 𝙥𝙧𝙚𝙜𝙣𝙖𝙣𝙩🤣)
👉🏻 Bloody discharge is normal after that
🟠 23 𝙅𝙪𝙣𝙚 2021
👉🏻 Woke up still feeling a lil bit drowsy. And it’s 4cm dilation now, but the opening didn’t improve further, it stayed the same throughout the day, so I was not allowed to proceed with labour yet
👉🏻 Decided to continue with more walking in the room
👉🏻 Doc removed the balloon 12 hours later from the first insert
👉🏻 No further contraction throughout the day, maybe there is (based on ECG reading) but it’s very mild and bearable
👉🏻 Bloody discharge still continue, constant changing of linen and “sarong” to keep my space clean and comfortable 😂
🟠 24 𝙅𝙪𝙣𝙚 2021
5am+ 👉🏻 Showered. Washed my hair. Was reluctant at first bcs there’s no hot water and the water was as cold as ice! But I can’t withstand my messy and oily hair anymore. Now feeling clean, fresh and good 🥰
6am+ 👉🏻 Doc came to check. Another finger test! 𝘽𝙮 𝙣𝙤𝙬, 𝙄’𝙢 𝙪𝙨𝙚𝙙 𝙩𝙤 𝙞𝙩 𝙖𝙡𝙧𝙚𝙖𝙙𝙮, 𝙟𝙪𝙨𝙩 𝙝𝙖𝙫𝙚 𝙩𝙤 𝙗𝙞𝙩𝙚 𝙢𝙮 𝙩𝙚𝙚𝙩𝙝 𝙬𝙝𝙚𝙣𝙚𝙫𝙚𝙧 𝙩𝙝𝙚𝙮 𝙙𝙤 𝙞𝙩 🤯 No improvement. Dilation is still at 4cm. They’ll check again 6 hours later 😮💨
🤰🏻 𝙄𝙩’𝙨 𝙗𝙚𝙚𝙣 4 𝙙𝙖𝙮𝙨 𝙞𝙣 𝙩𝙝𝙚 𝙝𝙤𝙨𝙥𝙞𝙩𝙖𝙡, 𝙙𝙞𝙙𝙣’𝙩 𝙚𝙭𝙥𝙚𝙘𝙩 𝙢𝙮 𝙨𝙩𝙖𝙮 𝙩𝙤 𝙗𝙚 𝙩𝙝𝙞𝙨 𝙡𝙤𝙣𝙜 𝙗𝙘𝙨 𝙄 𝙩𝙝𝙤𝙪𝙜𝙝𝙩 𝙄 𝙬𝙖𝙨 𝙩𝙤𝙡𝙙 𝙣𝙤 𝙢𝙖𝙩𝙩𝙚𝙧 𝙬𝙝𝙖𝙩 𝙄 𝙢𝙪𝙨𝙩 𝙜𝙞𝙫𝙚 𝙗𝙞𝙧𝙩𝙝 𝙤𝙣 22 𝙅𝙪𝙣𝙚 2021, 𝙘𝙖𝙣𝙣𝙤𝙩 𝙚𝙭𝙘𝙚𝙚𝙙 😵💫 𝘽𝙪𝙩 𝙙𝙤𝙘 𝙠𝙣𝙤𝙬𝙨 𝙗𝙚𝙨𝙩 𝙡𝙖𝙝.. 𝙄’𝙢 𝙟𝙪𝙨𝙩 𝙙𝙚𝙖𝙙 𝙗𝙤𝙧𝙚𝙙 𝙝𝙚𝙧𝙚.. 𝙀𝙫𝙚𝙣 𝙩𝙝𝙚 𝙥𝙖𝙩𝙞𝙚𝙣𝙩 𝙣𝙚𝙭𝙩 𝙩𝙤 𝙢𝙚 𝙖𝙡𝙧 𝙜𝙤𝙩 𝙙𝙞𝙨𝙘𝙝𝙖𝙧𝙜𝙚𝙙 𝙡𝙖𝙨𝙩 𝙣𝙞𝙜𝙝𝙩. 𝙉𝙤𝙬 𝙄’𝙢 𝙖𝙡𝙡 𝙖𝙡𝙤𝙣𝙚 𝙞𝙣 𝙩𝙝𝙞𝙨 𝙘𝙤𝙡𝙙 24/7 𝘼𝘾 𝙧𝙤𝙤𝙢…
🌈 Overall experience was quite pleasant here. The two - bedded AC room, the quieter environment due to Covid, the close monitoring of medical team towards pregnant mothers (performing ECG & BP every few hours).. Couldn’t ask for more lah for a GH standard 💯
The only thing I wished I could have now is better food, at least 𝙝𝙤𝙩 𝙖𝙣𝙙 𝙗𝙞𝙜𝙜𝙚𝙧 𝙥𝙤𝙧𝙩𝙞𝙤𝙣 𝙖𝙣𝙙 𝙖 𝙜𝙤𝙤𝙙 𝙘𝙤𝙢𝙥𝙖𝙣𝙞𝙤𝙣! But I know this is not possible, that’s why I said it’s a wish! 😂 Trust me, the food portion here is too little, can only last me a good 2 hours! I’m already craving for more meat 😆
☀️ Today is another brand new day to restart. Let’s hope labour can happen soon so I can go home to my family ❤️
#pregnancyjourney #jennslifeaftercancer #spreadlovecreatehope #babydiverinthemaking #cancersurvivor #ovariancancer #stage3
ecg reading 在 EKG/ECG Interpretation (Basic) : Easy and Simple! - YouTube 的推薦與評價
MINT Merch: https://teespring.com/stores/mint-nursing (Thank you for the support)A VERY USEFUL book in EKG: (You are welcome! ... <看更多>