Nathaniel Water Spout

I love summer!! Its a beautiful, gorgeous day in the big bad city! Beware the T-storms later tonight!

Thanks to Dr. Elizabeth Weinstein from Indiana University School of Medicine for a riveting and wonderful lecture on potentially lethal diseases with easy-to-miss signs and symptoms.

In the same vein, I would like to present a bonus pediatrics pearl. Given that it is so beautiful outside, I’m going to be lazy and provide a link to a pediatrics case that was presented recently in the New York Times Health section in the ‘Think Like a Doctor’ series authored by Lisa Sanders, M.D.

Please, despite my laziness, I am sure you will not be disappointed in reading this article and besides, I think most of us can always use all the pediatric knowledge that we can get. And if you don’t think you do, then you should have a little something called Humble Pie.

It is titled, ‘The Baby Who Won’t Eat.’




For those in our senior core didactics today, the following is to clarify pulsus paradoxus.

Normally, during the inspiratory phase of breathing, blood pressure falls <10 mmHg due to the drop in intrathoracic pressure. This drop in pressure causes increased venous return, causing increased right heart filling, increasing right heart pressure, increasing pulmonary venous pooling. This in turn causes decreased left heart filling, decreased left heart filling, increased heart rate in response and thereby decrease in output and blood pressure.

This all becomes exacerbated in the setting of cardiac tamponade and voila! Pulsus paradoxus.