Another deadly and confusing ECG. Are you still one of the many people who will be fooled by this ECG, or do you recognize it instantly?
Submitted and written byDestiny Folk MD, peer reviewed by Meyers, Smith, Grauer, McLarenA man in his early 30s with no significant past medical history was brought to the ED by EMS after being found unresponsive by a friend. EMS arrived and found him awake and alert. He complained of generalized weakness and left lower extremity numbness. He reported that 12 hours prior to arrival he used fentanyl and cocaine. He reported difficulty walking and felt as if his left leg was “asleep.” He denied any chest pain or shortness of breath and stated he felt at his baseline yesterday prior to drug use. On arrival in the ED, he wa...
Source: Dr. Smith's ECG Blog - May 5, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
Simplifying Opioid Conversions
by Drew Rosielle (@drosielle)A Satirical Monologue in One Act:“Ok, 3rd year resident, let’s talk about rotating opioids. What do I mean by ‘rotating’ opioids? It’s just therapeutically switching one opioid with another. It’s um, like, a turnstile, I guess? Anyway--first let’s look at this equianalgesic table. Do you know what equianalgesia means? No? It is the concept that different opioids have the same analgesic power but at different milligram doses due to different potencies. That is, the idea that, say, 50 mg of oral morphine has the same analgesic power as 10 mg of hydromorphone. So 50 mg of oral morphi...
Source: Pallimed: A Hospice and Palliative Medicine Blog - May 2, 2022 Category: Palliative Care Tags: opioid rosielle Source Type: blogs
Should Immediate Manual Testicular Detorsion Become the Standard of Care?
Testicular torsion is a highly time-sensitive event for a patient and the survival of his testicle. The clock is ticking the minute the retracting cremasteric muscle starts the spermatic cord twisting. Does that mean an immediate attempt at manual detorsion should become a standard of care?The technique for detorsion is straight forward and relatively simple. Detorsion is described as opening a book. The twisting or unraveling procedure for the patient's left testicle is counterclockwise and clockwise for the right testicle. Torsion events more commonly occur as an inward twisting of the testicles, and the treatment is ...
Source: M2E Too! Mellick's Multimedia EduBlog - May 2, 2022 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Fentanyl Makes an Already Dangerous Drug Market Deadlier Than Ever
Failure to recognize and respond to how rapidly illegal drug markets have changed with the arrival of illegally manufactured synthetic opioids will continue to put many Americans at risk of exposure to fentanyl, endangering the lives of hundreds of thousands more for years to come. (Source: The RAND Blog)
Source: The RAND Blog - May 2, 2022 Category: Health Management Authors: Bryce Pardo; David Luckey Source Type: blogs
New National Drug Control Strategy Takes Some Positive Steps But Can Go Much Further
Jeffrey A. SingerIn the wake of a Marchreport from the Centers for Disease Control and Prevention (CDC) that drug overdose deaths climbed to a record 106,000 for the 12 months ending November 2021 (last November the agency reported100,000 overdose deaths for the 12 months ending April 2021), the White House Office of National Drug Control Policy published a National Drug Control Strategy today.On the positive side is ONDCP ’s new appreciation for the benefits ofharm reduction for reducing the risk of death and disease from using drugs obtained in the dangerous black market. The strategy includes a&nbs...
Source: Cato-at-liberty - April 21, 2022 Category: American Health Authors: Jeffrey A. Singer Source Type: blogs
A man in his 60s with chest pain. Cardiologist refuses to take to the lab. Obvious STEMI, even with criteria. Yet final diagnosis " NSTEMI " . This happens far too often.
Submitted by Anonymous MD, edits by MeyersA man in his 60s with past medical history of multiple sclerosis and hypertension was brought in by EMS from home for chest pain thatstarted acutely just prior to arrival. He rated the pain at 9/10, describes as pressure, radiates towards the left arm with associated shortness of breath, diaphoresis and had one episode of emesis. He did not have a prior history of CAD or other cardiac disease. His pain improved to 6/10 after EMS gave him 3 sprays of sublingual nitroglycerin and 324 mg of aspirin. Prehospital ECGs:What do you think?Both ECGs are diagnostic of acute LAD OMI...
Source: Dr. Smith's ECG Blog - April 15, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
John Oliver: You Had Me at Over ‐the‐Counter Naloxone
Jeffrey A. SingerJohn Oliver made an excellent case forshifting from a war on drugs to a war on drug related deaths on the March 27, 2022 edition ofLast Week Tonight on HBO. You can view ithere.In a little over 15 minutes, Oliver explained the rationale behind the harm reduction strategy: realism. Harm reduction advocates understand we will never attain a drug‐free society, and that it therefore makes sense to make illicit drug use safer.Oliver called for the Food and Drug Administration to make the opioid overdose antidote naloxone an over ‐the‐counter drug, as I have been sayingsince 2018. In 2019,...
Source: Cato-at-liberty - March 28, 2022 Category: American Health Authors: Jeffrey A. Singer Source Type: blogs
Opioid Equianalgesic Tables are Broken
by Drew Rosielle (@drosielle)I am proposing we do away with equianalgesic table (EAT) as a tool to inform clinical decisions about opioid rotations/conversions. Fundamentally, EATs create too many problems, and there are simpler and safer ways to teach clinicians how to convert between different opioids.Part 1: New Data Can ' t Fix the EATA couple HPM fellows every year ask me which table do I prefer to use —the old EAT or the new one? By the old one, they refer to the table most of us used or were at least deeply familiar with for the last 10-20 years. By the new one, they mean the one created by Dr. Mary Lynn McPherson...
Source: Pallimed: A Hospice and Palliative Medicine Blog - March 21, 2022 Category: Palliative Care Tags: opioid pain rosielle Source Type: blogs
A New and More Dangerous Drug Market Requires a New Approach
Synthetic opioids are likely to increasingly reach illegal drug markets. Failure to recognize and respond to how rapidly drug markets have changed with the arrival of illegally manufactured synthetic opioids will continue to put many at risk of exposure to fentanyl, endangering the lives of hundreds of thousands more Americans for years to come. (Source: The RAND Blog)
Source: The RAND Blog - March 16, 2022 Category: Health Management Authors: Bryce Pardo; David Luckey Source Type: blogs
Blame to go around on the opioid epidemic
The Purdue Pharma settlement gave family members of people who were harmed by opioid prescribingthe opportunity to confront Purdue family members, a dramatic spectacle that represents some measure of justice but casts blame for the disaster of the opioid epidemic on one family. That is not the whole story, or really a true story. Prior to the 1980s, opioids were generally prescribed in the U.S. only for short-term use, after surgery or severe injury, or for people who were terminally ill.In the 1980s, for reasons which are not entirely clear, attitudes in the medical profession began to shift and physicians began to t...
Source: Stayin' Alive - March 14, 2022 Category: American Health Source Type: blogs
Dr. Wakeman ’s Excellent Exposition on the Overdose Crisis
Jeffrey A. SingerSarah Wakeman, MD is the Medical Director of the Massachusetts General Hospital Substance Use Disorder Project and an Associate Professor of Medicine at Harvard University Medical School. She has a wealth of experience treating addiction and has published research on thecomparative effectiveness of various treatment modalities for opioid use disorder.Dr. Wakeman recently gave aninterview to theHarvard Gazette in response to therecent news that overdose deaths for the 12 months ending April 30, 2021 reached a stunning 100,000, 75 percent of which were opioid ‐related, with 85 percent of opioi...
Source: Cato-at-liberty - November 30, 2021 Category: American Health Authors: Jeffrey A. Singer Source Type: blogs
My Unpublished Letter to the Editor on the Tragic Drug Overdose Report
Jeffrey A. SingerOn November 18 theWall Street Journalran a front page story entitled “Drug Overdose Deaths, Fueled by Fentanyl, Hit Record High in U.S. ” It reported on provisional data from the Centers for Disease Control and Prevention that reveal a heartbreaking 100,306 drug overdose deaths for the 12 months running through April 2021, a 29 percent increase over the previous 12 month period.Thereport released by the CDC on November 17 stated that 75,673 of the more than 100,000 overdose deaths were opioid ‐related, up from 56,064 the previous year. The remainder of overdose deaths involved cocai...
Source: Cato-at-liberty - November 23, 2021 Category: American Health Authors: Jeffrey A. Singer Source Type: blogs
August 2021: Adulterant in Fentanyl Complicates OD
A 38-year-old woman with opioid use disorder presented to the emergency department after an unintentional overdose. EMS said the patient was found with decreased respirations, and she was given 2 mg intranasal naloxone. She was awake, alert, and oriented x 3 in the emergency department.She reported that she used one bundle of fentanyl/heroin a day intravenously and that she had recently been hospitalized for four weeks for a wound infection. She stated that she used her usual dosage of fentanyl/heroin on discharge, not realizing how much her tolerance had decreased.She also said the fentanyl contained “tranq" (xy...
Source: The Tox Cave - August 2, 2021 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Historic Lynchings and Voter Registration, China in Space, Firefighters' Mental Health: RAND Weekly Recap
This weekly recap focuses on the link between historic lynchings and voter registration, Afghanistan in the era of fentanyl, supporting firefighters ’ mental health, and more. (Source: The RAND Blog)
Source: The RAND Blog - July 30, 2021 Category: Health Management Authors: RAND Corporation Source Type: blogs
Opioid Settlement Will Do Nothing to Change The Trajectory of The Overdose Rate
Jeffrey A. SingerYesterday a settlement wasannounced between several states and the pharmaceutical distributors McKesson, Cardinal Health, and Amerisource Bergen, along with drug maker Johnson and Johnson, who were accused of contributing to the opioid overdose crisis. The three distributors agreed to pay the states $21 billion over 18 years and Johnson and Johnson agreed to pay $5 billion over 5 years, ostensibly to go towards drug treatment and education programs. Johnson and Johnson and the three distributors continue to dispute the allegations while agreeing to the settlement.Some, like the editors of th...
Source: Cato-at-liberty - July 22, 2021 Category: American Health Authors: Jeffrey A. Singer Source Type: blogs
