Not Just Acid Reflux: The Need to Think Worst First

A previously healthy, well-appearing 42-year-old female living in a modern, high-rise apartment in downtown Los Angeles calls 9-1-1 at 5:30 am complaining of worsening of a burning, epigastric pain she had been experiencing for the last three days. She reports associated nausea and non-bloody, non-bilious vomiting, and that she couldn’t manage to get comfortable in bed until she finally decided to call for help at daybreak. During her 9-1-1 call, she reports “pain, like heartburn, that just woke me up again and I had to throw up, … and then I was sweating so much.” Using the Los Angeles Tiered Dispatch System, the 9-1-1-telecommunicator couldn’t discern whether the patient was actually having abdominal or chest pain and opted to dispatch a chest pain (age> 40) dispatch code, launching a paramedic unit from the busy downtown fire station. Upon arrival, paramedics find a young, fit-appearing Hispanic female sitting in her living room, reporting a “burning sensation in her throat.” She tells medics that she has a history of acid reflux but states that she wasn’t having any relief with her usual Tums. She also states that she usually feels like this after drinking alcohol, and that she had a few drinks last night and smoked some marijuana. Her vital signs are within normal limits, her abdominal exam was benign, and she requests “something to help with her reflux,” but she ultimately refuses transport to the ED. No fu...
Source: JEMS Special Topics - Category: Emergency Medicine Authors: Tags: Exclusive Articles Cardiac & Resuscitation Source Type: news

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Authors: Han L, Zhang JJ, Jing HF, Qin L Abstract Acute ST-segment elevation myocardial infarction (STEMI) is one of the most common cardiovascular emergencies. With the improvement of living standards, the incidence and mortality rate of STEMI has shown a significant growth trend. PMID: 30892000 [PubMed - as supplied by publisher]
Source: Journal of Biological Regulators and Homeostatic Agents - Category: Biomedical Science Tags: J Biol Regul Homeost Agents Source Type: research
Authors: Cai WW, Hu J, Wang H, Zhu GJ, Chen S, Chen XP Abstract Coronary artery bypass grafting (CABG) is an effective scheme for treatment of myocardial ischemia. Hypoxemia is a common complication of CABG, which can affect surgical effect and prognosis and even induce multiple organ failure. To explore the clinical efficacy of bi-level positive airway pressure ventilation in the treatment of CABG-associated hypoxemia, 216 patients who were admitted to our hospital between August 2015 and April 2017 and developed CABG-associated hypoxemia were selected and randomly divided into 2 groups, an observation group (n=10...
Source: Journal of Biological Regulators and Homeostatic Agents - Category: Biomedical Science Tags: J Biol Regul Homeost Agents Source Type: research
Conclusion: Substitution of parenteral thiamine in individuals with suspected WE is a well-established treatment regimen. However, suggestions according to guidelines vary widely. Furthermore, hardly any evidence-based recommendations exist on a more general use of thiamine as a preventative intervention in individuals with AUD. Further research is of utmost importance to raise awareness for this potentially undervalued problem.Eur Addict Res 2019;25:103 –110
Source: European Addiction Research - Category: Addiction Source Type: research
Authors: Lamain-de Ruiter M, Kwee A, Naaktgeboren CA, Louhanepessy RD, De Groot I, Evers IM, Groenendaal F, Hering YR, Huisjes AJM, Kirpestein C, Monincx WM, Schielen PCJI, Van 't Zelfde A, Van Oirschot CM, Vankan-Buitelaar SA, Vonk MAAW, Wiegers TA, Zwart JJ, Moons KGM, Franx A, Koster MPH Abstract OBJECTIVE: To perform an external validation of all published prognostic models for first-trimester prediction of the risk of developing preeclampsia (PE). METHODS: Women
Source: Hypertension in Pregnancy - Category: OBGYN Tags: Hypertens Pregnancy Source Type: research
Peripheral neuropathies are the most frequent neurological complications associated with HIV, within which HIV sensory neuropathy (SN) is the most common form, which affects 30-50% of HIV/acquired immunodeficiency syndrome (AIDS) patients. HIV SN is frequently manifested with hard-to-manage pain and is often under-diagnosed and/or under-treated. Tat, trans-activator of transcription, is a key activator of HIV transcription. Despite that recent studies have highlighted the role of HIV Tat in the pathophysiology of HIV-associated neurocognitive disorders (HANDs), the involvement of HIV Tat in neuropathic pain associated with...
Source: The Journal of Pain - Category: Materials Science Authors: Source Type: research
Recent studies have indicated that the spinal activity of gastrin-releasing peptide (GRP) and its receptor, GRPR, selectively modulate itching behaviors over other somatosensations including pain behaviors. Despite behavioral selectivity, how GRP acts within the spinal cord to selectively convey itch to the brain is not understood. Utilizing a novel ex vivo somatosensory preparation, retrograde labeling of spinal projection neurons, and multiphoton Ca2+ imaging, the activity of excitatory interneurons and projection neurons in the ex vivo spinal cord can be recorded in response to natural stimulation of the skin and pharma...
Source: The Journal of Pain - Category: Materials Science Authors: Source Type: research
Abdominal pain and bowel dysmotility are hallmark symptoms of functional bowel disorders, yet it is unclear how pain and dysmotility are correlated mechanistically. Extrinsic colon afferents (EPANs) provide sensory input to the CNS, and visceral pain is thought to be due to hypersensitivity of these afferents. The enteric nervous system (ENS) acts autonomously to control motility reflexes, but extrinsic nerve pathways coordinate activity between distant regions of the GI tract, and importantly, allow the central nervous system (CNS) to regulate GI functioning.
Source: The Journal of Pain - Category: Materials Science Authors: Source Type: research
There is a dire need for new non-opioid analgesics. However, efforts to develop new pain medicines have thus far met with limited success. This failure is partly due to an overreliance on evoked pain measures in preclinical models. Most preclinical models  do not measure spontaneous pain—the main symptom of chronic pain in humans. Here we show our progress towards developing and validating a fully-automated and user-friendly spontaneous pain measurement tool by training a machine learning model to detect and quantify facial grimacing in mice.
Source: The Journal of Pain - Category: Materials Science Authors: Source Type: research
Dissecting the spinal circuitry of pain and itch has been limited by a lack of genetic tools to label discrete subpopulations of spinal neurons. In particular, markers for spinal projection neurons are lacking, and thus the contributions of spinal projection neurons to somatosensation are largely unknown. Currently the only known marker for spinal projection neurons is neurokinin-1 receptor (NK1R), which captures the majority of spinal projection neurons. While neurotoxic ablation studies have provided evidence demonstrating the importance of NK1R spinal projection neurons to itch and hyperalgesia, interpretation of these ...
Source: The Journal of Pain - Category: Materials Science Authors: Source Type: research
Optogenetic techniques offer tremendous potential to elucidate the physiological roles of the various subtypes of peripheral sensory neurons. The range of behaviors that can be studied using optogenetics has been limited due to the challenge of delivering light to opsin-expressing cells in freely behaving animals without perturbing normal behaviors. Recent advances in micro-scale light emitting diodes ( μLEDs) and wireless powering technologies have allowed for the development of fully-wireless, implantable light-emitting devices to activate opsins in vivo.
Source: The Journal of Pain - Category: Materials Science Authors: Source Type: research
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