Unconscious + STEMI criteria: activate the cath lab?
Case submitted and written by Dr. Mazen El-Baba and Dr. Evelyn Dell, with edits from Jesse McLarenEMS brought a John Doe, in his 30s, who was found in an urban forest near a homeless encampment on a cool fall day. There were no signs of trauma on scene or on the patient. EMS reported an initial GCS of 8 with pupils equal and reactive. The patient had a witnessed generalized tonic-clonic seizure leading to GCS 4.Vitals: HR 45; systolic BP was 110-120; irregular respiratory rate; oxygen saturation was normal; tympanic temperature 30; glucose was 6. In the resuscitation room, the patient had another seizure that stopped after...
Source: Dr. Smith's ECG Blog - January 21, 2023 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
A teenager with chest pain, a troponin below the limit of detection, and " benign early repolarization "
Sent by anonymous, written by Pendell MeyersA male in his teens presented with complaints of chest discomfort and dyspnea beginning while exercising but without obvious injury. He immediately stopped exercising and symptoms started to improve. Later that evening he felt recurrent central chest discomfort, shortness of breath, and vomited. Symptoms have been constant since this second episode, and are still present on arrival, which seems to have been less than 1 to 2 hours from onset of symptoms. No similar symptoms in the past. No prior exertional complaints of chest pain, dizziness, lightheadedness, or undue shortness of...
Source: Dr. Smith's ECG Blog - January 9, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
What does LBBB look like in severe hypothermia? Is there a long QT? Is the QT appropriate for the temperature?
This patient was found down in a Minneapolis winter. He was very cold with frostbitten fingers and toes. He was alert but encephalopathic and delirious and very agitated and could not be adequately calmed with olanzapine and lorazepam, so we intubated him. The first reliable temperature could only be obtained with a Foley thermistor, and it was 26.5 degrees C (79.7 F).His BP was 76/60. K was 2.8 mEq/L.Here was his first ECG:There is sinus bradycardia with left bundle branch block (LBBB), with proportional ST-T, and VERY long QT and a PVC. I measure the QT at 800 ms. Notice that there are ...
Source: Dr. Smith's ECG Blog - January 6, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
A Man With Sudden Onset of Gastroparesis
By HANS DUVEFELT
Leo Dufour is not a diabetic. He is in his mid 50s, a light smoker with hypertension and a known hiatal hernia. He has had occasional heartburn and has taken famotidine for a few years along with his blood pressure and cholesterol pills.
Over the past few months, he started to experience a lot more heartburn, belching and bloating. Adding pantoprazole did nothing for him. I referred him to a local surgeon who did an upper endoscopy. This did not reveal much, except some retained food in his stomach. A gastric emptying study showed severe gastroparesis.
The surgeon offered him a trial of metoclopra...
Source: The Health Care Blog - September 16, 2021 Category: Consumer Health News Authors: Christina Liu Tags: Medical Practice Physicians Primary Care Hans Duvefelt Source Type: blogs
CBD and other medications: Proceed with caution
Products containing cannabidiol (CBD) seem to be all the rage these days, promising relief from a wide range of maladies, from insomnia and hot flashes to chronic pain and seizures. Some of these claims have merit to them, while some of them are just hype. But it won’t hurt to try, right? Well, not so fast. CBD is a biologically active compound, and as such, it may also have unintended consequences. These include known side effects of CBD, but also unintended interactions with supplements, herbal products, and over-the-counter (OTC) and prescription medications.
Doubling up on side effects
While generally considered safe...
Source: Harvard Health Blog - January 11, 2021 Category: Consumer Health News Authors: Katsiaryna Bykov, PharmD, ScD Tags: Drugs and Supplements Marijuana Medical Research Safety Source Type: blogs
Chlorpromazine in Delirium FTW!
by Drew Rosielle (@drosielle)David Hui, Eduardo Bruera, and colleagues havepublished another important delirium trial out of MD Anderson which I thought was worth blogging about in detail.In some ways it ' s related to thesame group ' s RCT a few years ago of lorazepam added to haloperidol for agitation in hospitalized advanced cancer patients with delirium (showing the lorazepam quite effectively reduced agitation via presumably a sedating effect). As I pointed out in the Palllimed post about that trial, while they labeled their patient group as ' agitated delirium in advanced cancer ' , in essence it was really a sedatio...
Source: Pallimed: A Hospice and Palliative Medicine Blog - October 23, 2020 Category: Palliative Care Source Type: blogs
Bread, paper, and other indigestible objects
Olivia posted this incredible story of wheat-free release in the comments on this blog some time back. Her story so powerfully encapsulates how far off course health can go by consuming this thing called “wheat,” that I thought it was worth sharing with everybody again. During her wheat-consuming days, Olivia was clearly suffering body-wide inflammation and other effects that were being ineffectively “treated” by her doctor, effects largely due to the indigestible or only partially-digestible proteins from the seeds of grasses AKA wheat. As often happens, she managed to reverse the entire collection...
Source: Wheat Belly Blog - April 29, 2020 Category: Cardiology Authors: Dr. Davis Tags: Open gluten-free grain-free grains wheat belly Source Type: blogs
Top 25 Psychiatric Medications for 2018
Psychiatric medications are an important part of treatment for many people with mental disorders, such as depression, bipolar disorder, ADHD, schizophrenia, anxiety, and others. They play an important role in helping to alleviate the most serious symptoms, allowing people to better focus on their lives and on other treatment types, such as psychotherapy. Psychiatric medications are an important part of many people’s treatment plans for obtaining the most effective treatment for a mental health concern or mental illness.
It’s good to know what drugs are being prescribed most often for mental disorders in the U.S...
Source: World of Psychology - December 15, 2019 Category: Psychiatry & Psychology Authors: John M. Grohol, Psy.D. Tags: General Medications Psychiatry psychiatric meds psychiatric prescriptions Source Type: blogs
End-Of-Life Comfort Drugs Can Be Confusing
Photo credit Brandon Wong
Dear Carol: My mother, who has advanced dementia, went into a nursing home six months ago. She’s received excellent care but is now declining quickly so that she no longer swallows any type of food. Her doctor has determined that she is ready for hospice and I'm glad for their help. Hospice took her off medications that didn’t seem to be helping and then prescribed some occasional Ativan for agitation and low-dose morphine for pain. Her response has been satisfying to watch since she’s more alert and far more peaceful than she has been...
Read the full column to learn more about drugs ...
Source: Minding Our Elders - November 8, 2019 Category: Geriatrics Authors: Carol Bradley Bursack Source Type: blogs
An Overdose that Happens Hours Later
A 15-year-old girl was brought to the emergency department by EMS after a seizure witnessed by her mother. She admitted that she had ingested "a handful of pills" in a suicide attempt five hours earlier. The mother said her daughter had a history of cutting but no prior suicide attempts.Her past medical history was significant for depression, for which she took bupropion XL, and she reported past alcohol and marijuana use. Her initial vital signs were a temperature of 97.9°F, a pulse of 162 bpm, a blood pressure of 127/65 mm Hg, a respiratory rate of 14 bpm, and a pulse ox of 100% on room air. Her exam was si...
Source: The Tox Cave - November 1, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
The patient with a pocketful of IDs
All of us nurses and physicians in the ED and ICU knew him well. He was a young, 21-year-old. A smart, articulate guy who kept going from one hospital to the next. He had a system down… almost. This young man was a drug seeker. He knew all about seizures and how an Ativan […]Find jobs at Careers by KevinMD.com. Search thousands of physician, PA, NP, and CRNA jobs now. Learn more. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - September 3, 2019 Category: General Medicine Authors: < span itemprop="author" > < a href="https://www.kevinmd.com/blog/post-author/debbie-moore-black" rel="tag" > Debbie Moore-Black, RN < /a > < /span > Tags: Conditions Critical Care Emergency Medicine Source Type: blogs
A Text Message in the Middle of the night. Do you give thrombolytics?
I awoke in the morning and discovered a text with this ECG that was sent 6 hours prior by a former resident:" 60 year old with classic chest pain. The cath lab is occupied for the next 90 minutes. Cards says " not a STEMI " . Thinking of giving lytics. "What do you think?What do you do?I texted back: " Sorry for delay! Was sleeping. This is OMI!! Did you give lytics? Proximal LAD. Great catch! "There is 0.5 mm of ST Elevation in V3-V6. The T-wave in V4 is far too large for the QRS. The LAD occlusion formula would be very high due to the extremely small R-wave in V...
Source: Dr. Smith's ECG Blog - July 16, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
Podcast: What ’s it Like to Work in a Psych Hospital?
It’s a sad fact that many people still think a psych hospital is like what they saw in One Flew Over the Cuckoo’s Nest. But modern psychiatric care is nothing like that. This week’s guest worked for years in a psychiatric emergency facility and joins us to share his thoughts about the experiences he had while employed there.
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About Our Guest
Gabe Nathan is an author, editor, actor, playwright, director and a lover of commas. He has worked as an Allied Therapist and Developmental Specialist at Montgomery County Emergency Service, Inc., a non...
Source: World of Psychology - May 2, 2019 Category: Psychiatry & Psychology Authors: The Psych Central Show Tags: Caregivers General The Psych Central Show Treatment Gabe Howard inpatient psychiatric hospital Vincent M. Wales Source Type: blogs
How Do I Detox From Benzodiazepines?
Detox from Benzodiazepines
Benzodiazepines are highly addictive medications. They are used to help treat anxiety, sleep issues, and even seizures. They work to calm the body and can be a great, helpful tool for many people when used as prescribed. There are many different types of Benzodiazepines, as they differ in strength and onset time. Some Benzodiazepines, such as Librium, is used to help treat symptoms associated with alcohol withdrawal. Detox from Benzodiazepines can be difficult, but it is possible.
The names that people know most commonly know Benzodiazepines as include:
Xanax
Valium
Ativan
Klonopin
They are onl...
Source: Cliffside Malibu - April 26, 2019 Category: Addiction Authors: Jaclyn Uloth Tags: Addiction Addiction to Pharmaceuticals Detox Resources for Alcohol and Drugs/Opiates Substance Abuse benzo benzodiazepines medical detox Source Type: blogs
End-of-Life Comfort Drugs Provided By Hospice Sometimes Misunderstood
Photo credit Sam-x
Dear Carol: My mother, who has advanced dementia, went into a nursing home six months ago. She’s received excellent care but is now declining quickly so that she no longer swallows any type of food. Her doctor has determined that she is ready for hospice and that makes sense to me. Hospice took her off of medications that didn’t seem to be helping and then prescribed some occasional Ativan for agitation and low-dose morphine for pain. Her response has been satisfying to watch since she’s more alert and far more peaceful than she has been. Here’s the problem. I’ve gone to a support group for sev...
Source: Minding Our Elders - March 30, 2019 Category: Geriatrics Authors: Carol Bradley Bursack Source Type: blogs
