Magnum, P.I.
​An 11-year-old boy with cerebral palsy presented to the emergency department unresponsive. His mother said the child was in his normal state earlier that morning, but was blue and unresponsive when she tried to wake him from his morning nap. A home pulse oximeter reported an oxygen level of 55%.The mother placed the child on oxygen and called 911. He was still unresponsive on arrival, and his physical examination demonstrated flaccid paralysis and a GCS score of 3 with fixed dilated pupils. He was tachycardic with shallow respirations. His initial vital signs were a temperature of 36.9°C, a heart rate of 136 bpm, a ...
Source: The Tox Cave - June 1, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Goodbye to Compounded Analgesic Creams
This study is one of the largest and best-designed study I'm aware of of these creams, and the findings are pretty clear: such creams benefit patients via placebo mechanisms, aka they don't work.Note that there is a separate body of research on some other topicals which should not be confused with this study. Eg, the 5% lidocaine patch for post-herpetic neuralgia, topical capsaicin for a variety of neuropathies, and at least some topical NSAIDs for osteoarthritis, and topical opioids. I'm not broadly endorsing those either - it's complicated - however they weren't tested here and the take home point is we should stop makin...
Source: Pallimed: A Hospice and Palliative Medicine Blog - February 11, 2019 Category: Palliative Care Source Type: blogs

Alcohol use disorder: When is drinking a problem?
Over the past few months, a conversation about alcohol use has been center stage in the national news. Stories about underage drinking, blacking out, and harmful behavior associated with alcohol use are quite common in many families around the world. The rise of the opioid epidemic in the US has rightly caught our attention, but overshadowed a much more common problem. In the United States, from 2006 to 2010 alcohol-associated deaths accounted for 88,000 deaths annually, or almost 10% of all US deaths. While many people are becoming aware that medication assisted therapy can help treat opioid use disorder, very few know th...
Source: Harvard Health Blog - December 20, 2018 Category: Consumer Health News Authors: Marcelo Campos, MD Tags: Health Source Type: blogs

Live the Wheat Belly lifestyle, get off prescription medications
Take a look at the list of medications people have been able to stop by following the Wheat Belly lifestyle. These represent medications prescribed by doctors to, in effect, “treat” the consequences of consuming wheat and grains. They prescribe drugs to treat inflammation, swelling, skin rashes, gastrointestinal irritation, high blood sugars, airway allergy, joint pain, high blood pressure, leg edema and other abnormal effects caused by wheat and grains. The list includes anti-inflammatory and pain medication, acid reflux drugs, injectable and oral drugs for diabetes, numerous anti-hypertensive agents, asthma i...
Source: Wheat Belly Blog - October 27, 2018 Category: Cardiology Authors: Dr. Davis Tags: News & Updates autoimmune blood sugar bowel flora cholesterol Gliadin gluten-free grain-free grains Inflammation undoctored Weight Loss wheat belly Source Type: blogs

Tropical Travel Trouble 003 Stiff in the Mouth
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog aka Tropical Travel Trouble 003 A 65 yr old woman from Ethiopia is visiting her grandchild for the first time in Europe. She is normally fit and well, physically active with a small-holding in Ethiopia. She does not take any medication and cannot remember the last time she saw a doctor. She presents to you with difficulty chewing 3 days after arriving in the UK. She describes it as being “stiff in the mouth” Questions: Q1. What is the differential diagno...
Source: Life in the Fast Lane - March 5, 2018 Category: Emergency Medicine Authors: Neil Long Tags: Clinical Cases Tropical Medicine tetanus Source Type: blogs

The Agony of Withdrawal
​Part 3 in a Four-Part Series​A 26-year-old man presented with fatigue. He complained of body aches, diarrhea, and nausea. His history was significant for chronic back pain, for which he had been prescribed oxycodone that he has taken daily for three years. He reported that he had stopped taking it two days before his visit.He denied other medication or drug use. He was alert but restless and diaphoretic. His ECG showed sinus tachycardia. His labs included a WBC of 12, Hgb of 12, glucose of 89 mg/dL, creatinine of 1.0 mg/dL, sodium of 140 mEq/L, potassium of 3.8 mEq/L, and CK of 140 U/L. He was experiencing opioid with...
Source: The Tox Cave - February 28, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Medtronic ’s Synchromed II Approved to Pump Remodulin Into Veins to Treat Pulmonary Hypertension
The FDA has issued approval for the Implantable System for Remodulin, which is really the Synchromed II drug infusion system from Medtronic, consisting of an implantable pump, controller, and catheter. The system is used to treat pulmonary arterial hypertension by delivering Remodulin (Treprostinil) into the vein at the superior caval-atrial junction. The pump is implanted under the skin of the abdomen and programmed to deliver the drug at a desired rate. The pump’s drug chamber can be refilled via an injection through the skin whenever the reservoir runs low. Medtronic has engineered the pump to achie...
Source: Medgadget - January 30, 2018 Category: Medical Devices Authors: Editors Tags: Cardiac Surgery Cardiology Medicine Source Type: blogs

MKSAP: 36-year-old woman with facial pain
A 36-year-old woman is evaluated for a 1-week history of recurrent episodes of facial pain that are 1 to 3 seconds in duration and occur spontaneously dozens of times throughout the day. The pain is sharp, severe, and located in the right infraorbital area. During this same period, she has developed worsening bilateral lower extremity weakness and urinary incontinence. The patient has an 18-year history of relapsing-remitting multiple sclerosis treated with interferon beta-1a; she also takes baclofen to control spasticity. She has had no nausea, photophobia, phonophobia, nasal congestion, nasal drainage, or ocular/visual c...
Source: Kevin, M.D. - Medical Weblog - May 20, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Neurology Source Type: blogs

Neurodegeneration with Brain Iron Accumulation (NBIA): MRI
Discussion by Dr MGK Murthy, Dr A Satish& Dr GA prasad Neurodegeneration with brain iron accumulation (NBIA) -NBIA disorders have typically symmetrical accumulation of Iron in parts of grey matter which normally are rich in Iron content , i. e. Basal ganglia (Globi pallidi /Putamen) / Thalamus / Midbrain (Substantia nigra / Red nuclei) cerebellum (Dentate nuclei) with each of the appx 10 varieties demonstrating relatively unique pattern , Permitting imaging classificationThis group of inherited neurologic disorders in which iron accumulates in the ba...
Source: Sumer's Radiology Site - March 31, 2017 Category: Radiology Authors: Sumer Sethi Source Type: blogs

Medications that Increase the Risks of Falling
Falls are the leading cause of both fatal and non-fatal injuries for adults 65 and older, and research suggests that those taking four or more medications are at an even greater risk than those who don ’t.ByAlzheimer's Reading RoomWhat ’s the Difference Between Alzheimer’s and DementiaHow to Test Your Memory for Alzheimer's and DementiaHow to Get Answers To Your Questions About Alzheimer's and Dementia“Falls are the leading cause of both fatal and non-fatal injuries for adults 65 and older, and research suggests that those taking four or more medications are at an even greater risk than those who do...
Source: Alzheimer's Reading Room, The - February 1, 2017 Category: Neurology Tags: alzheimer's care care of dementia patients dementia care health help alzheimer's help with dementia care medications falls Prescription Medications Risks risk of falling senior care Source Type: blogs

Dementia Care, Which Drugs Increase the Risk of Falling
Medications can increase the risk of falls and falling; and, are a major cause of injuries and death in older adults.By Bob DeMarcoAlzheimer's Reading RoomDuring the entire 8 and a half years, 3,112 days, that I was taking care of my mother, I worried about her falling.Falls can result in hip injuries, head injuries, or something worse.If you loved one is falling, or complaining of "dizziness" check out the list of medications below; and then, consult with your personal care doctor.Problems with Balance, Walking, Falling an Early Sign of DementiaThe drugs older people take can make them more susceptible to fallin...
Source: Alzheimer's Reading Room, The - September 7, 2016 Category: Neurology Tags: alzheimer's care Alzheimer's Dementia dementia care dementia falls dementia help for caregivers family caregiving help alzheimer's help with dementia care memory care searches related to falling Source Type: blogs

The Rigid Patient
​A 24-year-old man with a history of schizophrenia presented with altered mental status. His mother said he had become more catatonic and rigid over the previous two days. She reported that he was prescribed Abilify 5 mg by mouth daily for three years, but a long-acting depot of Abilify 400 mg had been administered two days before by court order. His vital signs include a heart rate of 120 bpm, blood pressure 140/90 mm Hg, temperature 38.5°C, respiratory rate is 14 bpm, and SPO2 is 98% on room air. The patient is alert and diaphoretic. Pupils are 3 mm. Cogwheeling, rigidity, and two beats of ankle clonus are als...
Source: The Tox Cave - June 2, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

What medications have you been able to stop on the Wheat Belly lifestyle?
I posed this question on the Wheat Belly Facebook page recently and received an overwhelming response. Here, I share a partial list of the responses: medications people have been able to stop by following the Wheat Belly lifestyle. Just take a look at this incredible list: these represent medications prescribed by doctors to, in effect, “treat” the consequences of consuming wheat and grains. They prescribe drugs to treat the inflammation, swelling, skin rashes, gastrointestinal irritation, high blood sugars, airway allergy, and other abnormal effects all caused by wheat and grains. The list includes anti-infl...
Source: Wheat Belly Blog - October 6, 2015 Category: Cardiology Authors: Dr. Davis Tags: Wheat Belly Lifestyle asthma cholesterol diabetes drugs gluten grains hypertension prescription medication reflux Source Type: blogs

Does Insurance Cover Botox Injections for Migraine Headaches?
Unfortunately no insurance company covers Botox therapy for generic headaches. Many will cover Botox for chronic migraines, which have been unresponsive to standard preventative therapies. In 2011, the FDA approved Botox for treating chronic migraines which have been unresponsive to an adequate trial of preventative medications. Preventative medications do not include the use of any narcotic pain killers. Insurance companies have made it difficult for patients to obtain Botox payment authorization, by putting in place numerous qualification barriers – if they cover Botox at all. Insurance compan...
Source: Sarasota Neurology - March 3, 2015 Category: Neurology Authors: Dan Kassicieh, D.O. Tags: Migraines / Headache Boto for headaches Botox covered by insurance botox for headaches Botox Headaches Insurance Source Type: blogs

The Shadow Boxer
Conclusion The patient was admitted to a monitored setting with a diagnosis of GHB withdrawal. He had multiple episodes of agitation and combativeness during his admission. He was administered escalating doses of diazepam, a total of 480 mg of diazepam IV during his eight-day hospital stay. The patient recovered in eight days, and was referred to drug rehabilitation.   References 1. Dyer JE, Roth B, Hyma BA. Gamma-hydroxybutyrate withdrawal syndrome. Ann Emerg Med 2001;37(2):147. 2. Tarabar AF, Nelson LS. The gamma-hydroxybutyrate withdrawal syndrome. Toxicol Rev 2004;23(1):45. 3. Craig K, Gomez HF, et al. Seve...
Source: The Tox Cave - October 2, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

The Shadow Boxer
Conclusion The patient was admitted to a monitored setting with a diagnosis of GHB withdrawal. He had multiple episodes of agitation and combativeness during his admission. He was administered escalating doses of diazepam, a total of 480 mg of diazepam IV during his eight-day hospital stay. The patient recovered in eight days, and was referred to drug rehabilitation.   References 1. Dyer JE, Roth B, Hyma BA. Gamma-hydroxybutyrate withdrawal syndrome. Ann Emerg Med 2001;37(2):147. 2. Tarabar AF, Nelson LS. The gamma-hydroxybutyrate withdrawal syndrome. Toxicol Rev 2004;23(1):45. 3. Craig K, Gomez HF, et al. Severe gam...
Source: The Tox Cave - October 2, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Acamprosate For Alcohol: Why the Research Might Be Wrong
Calcium may be curbing the urge to drink. “Occasionally,” reads the opening sentence of a commentary published online last month in Neuropsychopharmacology, “a paper comes along that fundamentally challenges what we thought we knew about a drug mechanism.” The drug in question is acamprosate, and the mechanism of action under scrutiny is the drug’s ability to promote abstinence in alcoholics. The author of the unusual commentary is Markus Heilig, Chief of the Laboratory of Clinical and Translational Studies at the National Institute on Alcohol Abuse and Alcoholism (NIAAA).Acamprosate, in use w...
Source: Addiction Inbox - February 17, 2014 Category: Addiction Authors: Dirk Hanson Source Type: blogs

Despite Critics Dismissal - Off Label Prescribing May Benefit Patients
Over the past several years, the federal government and law enforcement agencies have increasingly investigated and prosecuted large pharmaceutical and medical device companies for off-label marketing. Various media outlets have covered these settlements and cases and others have even conducted their own investigations (e.g., ProPublica. Consequently, a recent article from the Pacific Standard, written by Ford Vox, a rehabilitation physician at Shepherd Center, addressed an investigation conducted by The Washington Post that looked into off-label prescribing. Vox, who treats survivors of acquired brain injury and spina...
Source: Policy and Medicine - October 9, 2013 Category: Health Medicine and Bioethics Commentators Authors: Thomas Sullivan Source Type: blogs

Medications that Increase the Risks of Patient Falls
Falls are the leading cause of both fatal and non-fatal injuries for adults 65 and older. Alzheimer's Reading Room “Falls are the leading cause of both fatal and non-fatal injuries for adults 65 and older, and research suggests that those taking four or more medications are at an even greater risk than those who don’t – perhaps two to three times greater,” said Susan Blalock, Ph.D., an associate professor at the UNC Eshelman School of Pharmacy. In 2007, more than 21,700 Americans died as a result of falls and more than 7.9 million were injured by a fall including over 1.8 million older adults who...
Source: Alzheimer's Reading Room, The - February 14, 2013 Category: Dementia Authors: Bob DeMarco Source Type: blogs