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Writer's pictureDr. Chris Le
May 10, 2020

Vaccine Hesitancy | Clinical Pearls

Title: Vaccine Hesitancy

Presenter(s): Dr. Taj Jadavji

Date: March 8, 2020

PEARL: Common beliefs that give rise to vaccination hesitancy

  • Distrust of organization and industry

  • Fear

  • A desire to do things “naturally”

  • A desire to preserve individual freedom

  • Religious concerns

PEARL: Starting a firm and presumptive discussion

  • Begin presumptive rather than participatory


DISCLAIMER: This post contains my interpretation of the presentation. This post is not intended as medical advice. If you have medical concerns, contact a health care provider for assessment. If there are any copyright concerns, please contact me directly to remove the relevant material.

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Writer's pictureDr. Chris Le
May 10, 2020

Strategic Approach to Syncope for the Office Practitioner | Clinical Pearls

Title: Strategic Approach to Syncope for the Office Practitioner

Presenter(s): Dr. Vu Kiet Tran

Date: March 7, 2020

PEARL: Was their syncope aborted ventricular tachycardia?

  • Aborted sudden cardiac death

PEARL: New differential for syncope:

  • Fatal: cardiac arrhythmia (and medications), hemorrhage, sepsis/shock

  • Non-fatal: vasovagal, orthostatic hypotension (and medications), psychogenic

PEARL: Malignant ventricular arrhythmia:

  • WPW

  • Long QT syndrome

  • Short QT syndrome

  • Brugada syndrome

  • ARVC

  • Catecholaminergic VT

PEARL: DDx for Syncope and others:

  • Syncope and chest pain: aortic dissection, ruptured AAA, STEMI, acute PE

  • Syncope and headache: SAH, intra-parenchymal hemorrhage

  • Syncope and shortness of breath: pneumothorax, PE

  • Syncope and abdo pain: ruptured AAA, ruptured viscous

  • Syncope and bleeding: UGIB, LGIB

  • Syncope and rash: anaphylaxis, sepsis

  • Syncope and nothing else: TIA, stroke (ischemic or hemorrhagic), hypoglycemia

  • Sepsis mimics: seizures, drop-attacks, conversion syndromes, psychogenic syncope, malingering

PEARL: Syncope is cardiac issue, seizure is neurologic.

  • PRO TIP: seizure will have post-ictal, drowsy, confused, don't know where they are

  • PRO TIP: seizure will tend to bite tongue lateral, syncope tends to be anterior

PEARL: Focused complete history for syncope:

  • HPI: Age >65 yo; associated CP, SOB, palpitations (present: more concerning for cardiac); exertional syncope (present: concerning for cardiac - aortic stenosis, HCOM, AVRC), prodrome (absence - cardiac until proven otherwise, present - maybe vasovagal)

  • PMHx: CHF, previous syncope episodes, baseline/existing heart disease

  • FHx: premature sudden death; ARVC, WPW, Brugada, long QT

  • PsychHx: anything?

  • Meds: drugs that prolong QT

  • Ix: abnormal ECG

PEARL: Things to look for on ECG:

  • Arrhythmias/blockers

  • Ischemias

  • PE

  • Short PR/LGL/WPW

  • Long QT syndrome

  • Short QT syndrome

  • ARVD

  • Brugada syndrome

  • HCOM

  • Pulmonary hypertension

PEARL: Importance of H+P and ECG:

  • H+P and ECG = 76% diagnostic yield

PEARL: Comments on workup:

  • ECG: if normal, further cardiovascular testing has little yield

  • Pregnancy test: women of child-bearing age

  • D-dimer, myoglobin, CK: not useful

  • Echo: indicated for structural heart disease or abnormal ECG

  • Exercise stress testing: indicated for ischemic heart disease, exertional syncope

  • 24 Holter: a negative Holter does not rule out arrhythmogenic etiology

  • Neurologic testing: indicated for neurologic symptoms/signs +/- seizures +/- carotid bruits

  • EEG, CT, MRI, carotid bruit: not recommended as routine syncope workup (non-neuro!)

  • CT head: not indicated unless focal neuro symptoms or seizures

DISCLAIMER: This post contains my interpretation of the presentation. This post is not intended as medical advice. If you have medical concerns, contact a health care provider for assessment. If there are any copyright concerns, please contact me directly to remove the relevant material.

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Writer's pictureDr. Chris Le
May 10, 2020

Capacity Assessment | Clinical Pearls

Updated: May 15, 2020

Title: Capacity Assessment

Presenter(s): Dr. Lesley Charles

Date: March 7, 2020

PEARL: Relevant Legislative Acts in Alberta

  • Personal Directives Act

  • Personal Directive: name an agent to make [non-financial] decisions for them

  • Powers of Attorney Act

  • Enduring Power of Attorney: name a trusted person to make financial decisions

  • Adult Guardianship and Trusteeship Act (AGTA)

  • Granting powers of surrogate decision making

  • Continuum of decision-making

  • Designed to provide as much autonomy as possible

PEARL: Cognitive assessment does not necessarily determine capacity

  • Cognitive test: usually for memory (dementia)

  • Capacity involves ability to understand info and appreciate consequences of decision

PEARL: Complex situation unlikely to benefit from capacity assessment


DISCLAIMER: This post contains my interpretation of the presentation. This post is not intended as medical advice. If you have medical concerns, contact a health care provider for assessment. If there are any copyright concerns, please contact me directly to remove the relevant material.

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