Just in the Nic o’ tine
A 21-year-old man presented with palpitations, tremulousness, nausea, and vomiting. He reported ingesting one 14 mg nicotine patch in a suicide attempt. Initial vital signs include heart rate 132 bpm, blood pressure 140/80 mm Hg, temperature 37°C, respiratory rate 26 bpm, and pulse oximetry 100% on room air. Physical examination is remarkable for agitation, fine resting tremor, tachycardia, and pressured speech.
The lethal dose of nicotine is estimated to range from 1 mg/kg to 10 mg/kg. Reports of nicotine toxicity have occurred with the ingestion of as little as one whole cigarette or three cigarette butts in childr...
Source: The Tox Cave - March 2, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Just in the Nic o’ tine
A 21-year-old man presented with palpitations, tremulousness, nausea, and vomiting. He reported ingesting one 14 mg nicotine patch in a suicide attempt. Initial vital signs include heart rate 132 bpm, blood pressure 140/80 mm Hg, temperature 37°C, respiratory rate 26 bpm, and pulse oximetry 100% on room air. Physical examination is remarkable for agitation, fine resting tremor, tachycardia, and pressured speech.
The lethal dose of nicotine is estimated to range from 1 mg/kg to 10 mg/kg. Reports of nicotine toxicity have occurred with the ingestion of as little as one whole cigarette or three cigarette butts in children...
Source: The Tox Cave - March 2, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Why Patient Autonomy Is Critical To Good Health Care
Many of the patients that I treat have brain injuries. Whether caused by a stroke, car accident, fall, or drug overdose, their rehab course has taught me one thing: nobody likes to be forced to do things against their will. Even the most devastated brains seem to remain dimly aware of their loss of independence and buck against it. Sadly, the hospital environment is designed for staff convenience, not patient autonomy.
In the course of one of my recent days, I witnessed a few patient-staff exchanges that sent me a clear message. First was a young man with a severe brain injury who was admitted from an outside hospital. EMS...
Source: Better Health - February 24, 2015 Category: American Health Authors: Dr. Val Jones Tags: Opinion True Stories Atul Gawande Being Mortal Bibs Depression Goals of Health Care Nursing Homes Patient Autonomy Rehabilitation Source Type: blogs
24-Hour tPA Stroke Window Making Physician Lives So Much Better Now.
Dallas, TX - Twenty years of physician suffering ended abruptly Monday after the American Stroke Association (ASA) announced a dramatically expanded 24-hour tPA stroke window protocol to better accommodate doctors' increasingly hectic schedules. "Recent apologies by the American Board of Internal Medicine forced us to reevaluate our priorities as an organization. We now understand just how disruptive our three hour tPA window has been on doctors' lives and for that we are deeply sorry," said ASA President Dr. Jan Fleming. With the new 24-hour window, ASA officials are hoping to give doctors much grea...
Source: The Happy Hospitalist - February 12, 2015 Category: Internal Medicine Authors: Tamer Mahrous Source Type: blogs
In the Nalox“ZONE”
A 27-year-old woman with no past medical history presented to the ED by EMS after being found unresponsive at home by her partner. EMS reported that she was unresponsive with a GCS of 3, pinpoint pupils, and sonorous breath sounds. Naloxone 0.4 mg IV was administered, and the patient became responsive. The patient was delirious, agitated, and tachycardic upon arrival to the ED. She was administered lorazepam 2 mg IV without improvement. Her agitation and delirium were so severe that she was intubated, paralyzed with rocuronium, and started on a midazolam infusion.
What is the appropriate dose of IV naloxone?
No conse...
Source: The Tox Cave - February 2, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
In the Nalox“ZONE”
A 27-year-old woman with no past medical history presented to the ED by EMS after being found unresponsive at home by her partner. EMS reported that she was unresponsive with a GCS of 3, pinpoint pupils, and sonorous breath sounds. Naloxone 0.4 mg IV was administered, and the patient became responsive. The patient was delirious, agitated, and tachycardic upon arrival to the ED. She was administered lorazepam 2 mg IV without improvement. Her agitation and delirium were so severe that she was intubated, paralyzed with rocuronium, and started on a midazolam infusion.
What is the appropriate dose of IV naloxone?
No consensu...
Source: The Tox Cave - January 30, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Cases: Benign Prostatic Hypertrophy (BPH) as a hospice diagnosis?
Conclusion: In this case, a simple condition that is easily treatable in most men became one that we expected to lead to Mr. K’s death. However, the diagnosis that led it to become life-limiting was Mr. K’s dementia, and the heavy burden which BPH treatments would have placed on him. Mr. K’s daughter based her decision on Mr. K’s values, saying that if the father she was raised by was able to see himself in his current condition, he would have wanted both to stay in place and to be allowed to die with dignity. Forced catheterization and antipsychotic treatment might have prolonged his life by years but would have ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - January 6, 2015 Category: Palliative Carer Workers Tags: cases childers emergency care hospice medications POLST urology Source Type: blogs
Thanksgiving Meme Humor Collection
Enjoy this fine collection of Thanksgiving Day humor meme's you won't find anywhere else except on The Happy Hospitalist's Facebook Page, Pinterest and Twitter accounts. Make sure to join today and never miss another day of the humor action again! And don't forget to check out the hospital that closed for the entire Thanksgiving weekend!"Today we are thankful for Ativan. Oh yeah, and Haldol too." "Prepare yourself. Understaffed hospital coming!" "Oh, so you gained 15 pounds of fluid after Thanksgiving? Tell me more about how my dialysis orders are all wrong.""Prepare yourself. Pureed turkey a...
Source: The Happy Hospitalist - November 27, 2014 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs
Hospital Closes for Thanksgiving Weekend. Doctors and Nurses Rejoice!
Denver, CO -- The parking lot was empty at Piedmont Hospital today after security locked the doors, turned off the lights and erected 'No Smoking or Trespassing' signs throughout the campus. Administrators made good on their promise to close the hospital for the extended Thanksgiving holiday weekend allowing all doctors and nurses a rare vacation at home with their families, a strategy in direct competition with Black Friday Hospital Deals. The idea was born after Nurse Jenny, a new graduate who was upset nobody ever told her before she went to nursing school that she'd have to work most holidays for the rest of her...
Source: The Happy Hospitalist - November 27, 2014 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs
Tranks
One of the difficulties with pharmaceutical regulation is the length of follow-up in clinical trials. Typically, drugs are approved based on trials of no more than six months duration. This is true even for drugs that people may take for a long time, even for many years. Sometimes the FDA requires post-marketing surveillance or longer term follow-up studies after a drug has been approved, but they often don't, and these requirements aren't even enforced in many cases.Benzodiazepines are very commonly prescribed tranquilizers. Very common brand names are Xanax, Librium, and Ativan. (Rohypnol, also in the class, is a popular...
Source: Stayin' Alive - September 10, 2014 Category: American Health Source Type: blogs
Joan Rivers Out of ICU and “Comfortable” Likely Ominous
Although we are not participating in the care of comedy legend Joan Rivers, we have noted news reports that her daughter Melissa has said her mother is out of the ICU and being kept comfortable.
Rivers was hospitalized six days ago after suffering cardiac arrest and a prolonged anoxic period (brain without oxygen.) She was placed in a hypothermic coma (lowered body temperature) as is standard for the first 24-48 hours after arrest in an attempt to salvage brain and cardiac function.
However, reading between the lines of this recent statement, this is likely an ominous development and could signal the start of a comfort car...
Source: Inside Surgery - September 4, 2014 Category: Surgery Authors: Editor Tags: Anesthesia Medical News Wire Uncategorized ativan comfort care dying ICU Joan Rivers morphine Source Type: blogs
Cases: Second-Line Anti-emetic Therapies for Refractory Chemotherapy-Induced Nausea and Vomiting (CINV)
Discussion:Nausea and vomiting (NV) are commonly reported side effects with chemotherapy.1 The primary pathway for NV involves the chemotherapy drugs directly stimulating the chemoreceptor trigger zone (CTZ), in the area postrema at the base of the fourth ventricle. Activated receptors in the CTZ transmit signals to the vomiting center in the brainstem to produce NV. Receptors in the CTZ include serotonergic receptor 5-hydroxytryptamine type 3 (5-HT3), dopaminergic (D2) and neurokinin type 1 (NK-1) receptors. In addition, chemotherapy can damage GI mucosa causing local release of 5-HT3 neurotransmitters by gut enteroch...
Source: Pallimed: A Hospice and Palliative Medicine Blog - August 25, 2014 Category: Palliative Carer Workers Authors: Christian Sinclair Source Type: blogs
Gastroparesis Awareness Month: A Day In The Life
This is my second post for Gastroparesis Awareness Month. Read my first post, Tube Love, here. My first post was a love poem to my feeding tube. :-) My second one is a little more serious and a lot longer. I apologize for the length. I have trouble reading lengthy posts myself. But sometimes I’m incapable of summarizing myself, so I have to write posts that are too long for even me to read. I hope you’ll at least be able to skim through the important parts. I’ve tried to break up the text with lots of photos, to see if that helps any.
A DAY IN THE LIFE
My day starts when my morning careg...
Source: Ballastexistenz - August 23, 2014 Category: Autism Authors: Mel Baggs Tags: Adrenal insufficiency Aspiration pneumonia Bronchiectasis Education Feeding tube Food Gastroparesis Life Skills Medical Medical stuff Personal history Treatment adult tubie adult tubies awareness awareness months bipap ce Source Type: blogs
The End Of Days
Sometimes my day is like a book. The first chapter may begin in the darkness of a self imposed corner as a phone call is made. A voice, full with the thickness of slumber, answers unexpectedly.I think today is the day.No matter how many years I have been discussing death I still find myself using poor euphemisms. The bain of medical school teaching, I often struggle with the directness. Your mother will die today. So cold. So hard to muster the courage and keep one's voice strong and confident. I used to shy away from such dire predictions. I no longer do. Better to tel...
Source: In My Humble Opinion - August 20, 2014 Category: Primary Care Authors: Jordan Grumet Source Type: blogs
Research and Reviews in the Fastlane 042
This article challenges the notion that lacerations need to be closed within a specific “golden period” lest they become infected. The authors find that diabetes, wound contamination, length greater than 5 cm and location on the lower extremity are important risk factors for wound infection. Time from injury to wound closure is not as important as previously thought.
Recommended by: Anand Swaminathan
Read More: Goldfinger (More Dogma of Wound Care) (SGEM)
Emergency Medicine, Procedural Sedation
Green SM, Andolfatto G. Managing Propofol-Induced Hypoventilation. Ann Emerg Med. 2014 Jul 11. pii: S0196-0644...
Source: Life in the Fast Lane - August 4, 2014 Category: Emergency Medicine Authors: Jeremy Fried Tags: R&R in the FASTLANE critical care Emergency Medicine Intensive Care literature recommendations research and reviews Source Type: blogs
