Flutters and Fibrillations - CRASH! Medical Review Series

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(Disclaimer: The medical information contained herein is intended for physician medical licensing exam review purposes only, and are not intended for diagnosis of any illness. If you think you may be suffering from any medical condition, you should consult your physician or seek immediate medical attention.)

[@cmetube]

I passed, but it wasn't because of watching your video; it was because of learning some pearls here and there that I was missing from my 20 different necessary sources of study. What a total B of an exam. Hardest exam ever. Great videos. Your geekiness is a true blessing. Only you could be geekier than I. You are a saint and a true blessing to the entire universe! Thank you sooo much, Paul!

[@saralicious9142]

ooo what are those sources

[@GuadalupeGuacamole]

Who disliked this? You fool.

[@rozdede]

I think he got too excited... With anxiety hand shake etc s/he mis-clicked

[@dr.ranjusreemandal2512]

seriously😑

[@SaiKrishna-ew2wr]

People who are jealous?

[@DrDinooshDeLivera]

Jealousy is a disease, get well soon :)

[@cmetube]

There's consistently one hater in all of his videos. Could be a jealous one or someone he trained with or works with or even an ex, who knows? Some people in medicine are creeps.

[@RT-ql7qn]

Great videos!Helped me to pass the test! I think it would be useful too add a video on genetics for step 3....

[@DrDinooshDeLivera]

Thank you Dr. Bolin!

[@Sam_1964]

excellent presentation

[@woloabel]

Monday October 3, 2022. There is the 4k Quality being used commonly now by some Creators. Cardiology: Flutters and Fibrillations; yes beautiful when video has MP4 Quality and Resolution is suitable to Investigation (Science is a Fine Observation). Anyway. Let's goooooo. Pathology herein: Atrium of Heart: 1) Atrial Fibrillation (AFib) is Uncoordinated Electrical Conduction of the Atrium (Dysfunctional Ectopic Sinoatrial {SA] Node) giving rise to an Irregular Pulse/Rhythm; Aetiology: Acute Causes (PIRATES Mnemonic): 1) Pulmonary Disease (Very Common), 2) Ischemia (MI and Most Common), 3) Rheumatic Heart Disease, 4) Anemia and Atrial Myxoma, 5) Thyrotoxicosis, 6) Ethanol (Alcoholism), and 6) Sepsis; and in Chronic Causes: 1) Hypertension (Possibly Most Common), 2) Valvular Diseases (Very Common), 3) Congestive Heart Failure (CHF and Most Common); Dx: Electrocardiography (EKG) with No P Waves and an Erratic and Low-Amplitude Pre-QRS Activity; Px/EKG Morphology is an Irregularly Irregular Pulse implying Uncoordinated Ventricular Contractions; Laboratories and/or Investigations Relevant: 1) CXR (Pneumonia, COPD, and CHF Investigations); 2) Echocardiography for Valvular Heart Disease; and 3) Thyroid Function Test (TFT) for Hyperthyroidism Exclusion and is Least Common; Complications of AFib: 1) Mural Embolism (Stasis and Thrombosis [TIA] Association), 2) Hemodynamic Instability (Hypotension and Shock) or Homeostasis Collapse; tx/Mx: 1) Rate Control via Calcium Channel Blockade (Calcium Channel Blockers/Antiarrhythmic [Class IV]/Benzothiazepines Diltiazem or Verapamil [Nondihydropyridines are Contraindicated]) slowing AV Conduction and the Goal is a Resting Rate of Less than 80 Beats Per Minute. (Beta Adrenergic Blockers and Inotropic Agent Digoxin are Second Line Medical Agents); and 2) in Anticoagulation (Stroke Prophylaxis due to Significant Association), Anticoagulant/Coumarin Agent Warfarin is Indicated First Line (Antiplatelet Agents Clopidogrel is Possible when Contraindication for Warfarin and/or Hypersensitivity)'; 3) International Normalized Ratio (INR) Monitoring is Indicated (Effective Therapeutic Goal is 2-3 while 1 is Normal) 4) EKG Monitoring (or Holter Assessment); and 5) Cardioversion is Possible with the Caveat of a Left Atrial Thrombus (Transesophageal Echocardiography (TEE) to Exclude LA Thombi); In An Emergency Scenario (AFib with Hemodynamic Instability [Hypotension, CHF or Weak Pulses]), Immediate Progressive Cardioversion at 100J is Indicated until a Sinus Rhythm is Achieved; For AFib with Rapid Ventricular Response (Palpitations, Chest Pain, Hypotension and/or Syncope), CCB are mainstay. In the Event of AFib with a Stroke/Transient Ischemic Attack (TIA Patient shows Confusion, Hemiparalysis, Aphasia, Paresthesia and/or Loss of Conscious [LOS]) Stroke Protocol is Indicated. Stroke Risk Assessment using CHADS-2 Criteria is Useful herein (Previous Stroke History is most Indicative of Risk of Stroke; and Diabetes Mellitus, Age (> 75), Hypertension (140/90 mmHg), CHF are also Important) permitting a Presumptive Annual Stroke Risk Picture. Antiplatelets for Anticoagulation Therapy/Prophylaxis otherwise Aspirin is Indicated if Low Risk of Stroke while Anticoagulant/Coumarin Agent Warfarin is Indicated for High Annual Risk of Stroke. For 2) Atrial Flutter (AF) is an Atrial Tachycardia (Abnormal Atrial Activity due to Reentrant Conduction Anomaly with a Possible Complication (Cx) of Ventricular Tachycardia (VT); EKG is the Method/Modality of Diagnosis showing a "Saw tooth" (A Serrated/Dentiform ) Pattern in P Waves pre-QRS Complex Morphology; SSx: 1) Palpitations, 2) Dyspnea/Shortness of Breath (Reduced CO), 3) Lightheadedness (due Decreased Cardiac Output), and 4) Syncope/Hypotension is Possible (Advanced Manifestation of Low CO); Tx: 1) Identical to AFib, 2) However, AF can be Cured via Radiofrequency Ablation (RFA); and Ventricle Anatomy: 1) Ventricular Fibrillations (VFib) is a Medical Emergency which Presents as a Hemodynamically Unstable and Pulseless Patient (Severe Cardiac Output Insufficiency due to no Genuine Ventricle Contraction); Dx: 1) Clinical and 2) EKG with distinct Irregular Sinusoidal Wave Pattern to be Differentiated From Ventricular Tachycardia (VT) with discernible Regular QRS Complexes and Asystole (Absence of Contraction); SSx: 1) LOC, 2) Hypotension (Cardiogenic Shock). Tx: 1) IV Access (Immediate Infusion of Fluid and Medication), 2) Cardiopulmonary Resuscitation (CPR), and 3) Cardiac Defibrillator for Full Power Defibrillation (120J-200J); 4) Response Check by Assessing Rhythm if any and 6) Continue CPR Rounds up to 5 (Amiodarone/Epinephrine Infusion Possible). Prognosis: Poor (Death is Common). Goodness, the CPR is such a bulwark of Treatment when essentially is no treatment at all. MD Paul W. Bolin, Herz haette Ewigkeit, man wuerde seliger sein nicht!. Heil!

[@doctorcool001]

keep it up thts way more helpful than i expected!

[@frankjoya4234]

Fantastic lecture

[@edris.alkozi]

Outstanding

[@erithivictoria8339]

Woooa... This is wonderful!!! Is it possible to get the slides?

[@cmetube]

Every other medical professional who isn't an MD simply doesn't know enough and it's quite scary that they even handle patients and some dispense meds. I'm so proud of other MD's like yourself that are well educated. Our country needs more doctors and fewer nurses or allied health workers. Doctors are the bread and butter health to the world. Our states and federal governments should be doing more to train and license more doctors instead of putting harmful roadblocks in their way. Keep up the good work. You are a blessing to every medical professional in the world!!!

[@masohvincents3621]

so sad the sound has disappeared even on this updated one. I used the subtitles, but it is not the same thing, I wonder who is doing this to your wonderful videos.

[@venkataccount]

Thanks dr.paul. You r awesome

[@ihsansalman5865]

Thanks for this nice lecture.

[@eugeniosramos]

Keep those great videos coming!

[@rolandosantisteban3754]

Thank you for the video!!!

[@aveinabdul-rahman7330]

Hope you doing (congestive heart failure)next 😭

[@brookeharrison9809]

Thank you!!

[@user-eg6tf7cg6y]

Just wow 🤩 thanks 🙏🏻

[@SadamKhan-nn4vy]

hi dear.... u r awesome wht u r doing.... dear Paul... plz tell me whta new in these videos....i think u have uploaed cardio section already

[@ferasaljohani4357]

Its CHA2DS2VASC now!

[@imeneimaya1960]

Miss u dr

[@Fred-xl3dk]

nice one my boss

[@yassirabdal-star7885]

great

[@ezatkhalil4879]

awesome

[@bikepoor8381]

Are the PDFs or PowerPoints available anywhere to work along with the videos?

[@plityzhao5841]

are ccbs the best choice to control the heart rate of AF??

[@khalidiology5813]

plity zhao no

[@karunakark4883]

Sir, I have a doubt regarding abim exam, I am from India and doing post graduation in internal medicine here, can I directly appear for abim exam or should clear the Usmle for abim..

[@hudaabdella8579]

İsn't the HR at 16:07 140?

[@realblackbetty2204]

😃first