An interesting finding, and absence of another, in an intoxicated patient found down
CONCLUSION: Administration of subcutaneous terbutaline obviates the need for intravenous access and should be considered as an alternative to nebulized or inhaled beta-agonists to treat acute hyperkalemia in patients with CKD. As with the use of any beta-adrenergic agonist, close cardiovascular monitoring is necessary to avoid or minimize toxicity during therapy.Hypokalemic effects of intravenous infusion or nebulization of salbutamol in patients with chronic renal failure: comparative study.AULiou HH, Chiang SS, Wu SC, Huang TP, Campese VM, Smogorzewski M, Yang WC SOAm J Kidney Dis. 1994;23(2):266. To exami...
Source: Dr. Smith's ECG Blog - July 1, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
How to Sedate the Violent Patient
The emergency department can be an exciting yet sometimes violent place to work, often because of a patient presenting with excited delirium syndrome (ExDS), the most severe form of agitation. It is associated with the use of sympathomimetics such as methamphetamine, cocaine, and PCP.Patients with ExDS present with sudden onset of aggressive and bizarre behavior. These patients generally demonstrate unexpected physical strength and hyperthermia. This disease process is extremely important for prehospital responders and emergency physicians to recognize because almost two-thirds of the patients with ExDS die at the sc...
Source: The Tox Cave - March 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Patient with severe DKA, look at the ECG
DiscussionSee this post: STEMI with Life-ThreateningHypokalemia and Incessant Torsades de PointesI could find very little literature on the treatment of severe life-threateninghypokalemia. There is particularly little on how to treat when the K is less than 2.0, and/or in the presence of acute MI.Here are the American Heart Association Guidelines: 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular CarePart 10.1: Life-Threatening Electrolyte AbnormalitiesTreatment ofHypokalemia" The treatment ofhypokalemia consists of minimizing further potassium loss an...
Source: Dr. Smith's ECG Blog - February 1, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs
Quiz on statins
Short quiz on statins
Quiz on statins
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Question 1
Which of the following should not be combined with statin?
AFenofibrateBEz...
Source: Cardiophile MD - December 26, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
Combination with statin – Cardiology MCQ
Which of the following should not be combined with statin?
a) Fenofibrate
b) Ezetimibe
c) Gemfibrozil
d) Aspirin
Correct answer: c) Gemfibrozil
If Gemfibrozil is combined with statin, there is increased risk of muscle symptoms and rhabdomyolysis. (Source: Cardiophile MD)
Source: Cardiophile MD - December 12, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology Cardiology MCQ DM / DNB Cardiology Entrance 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 also o...
Source: The Tox Cave - June 2, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
STEMI with Life-Threatening Hypokalemia and Incessant Torsades de Pointes
Conclusions: In the select group of hypokalemic patients studied, potassium infusions of 20 to 40 mmol delivered over 1 hr were safe to administer and effectively increased serum potassium levels in a dosedependent and predictable fashion. Furthermore, these results were independent of the patient's underlying renal function or associated diuretic administration. (Crit Care Med 1991; 19:694)Concentrated Potassium Chloride Infusions in Critically Ill Patients with HypokalemiaThe Journal of Clinical Pharmacology. Volume 34, Issue 11, pages 1077–1082, November 1994Although concentrated infusions of pota...
Source: Dr. Smith's ECG Blog - April 7, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs
To See or Not to See
A
A 17-year-old boy presented to the emergency department after having a seizure. Initial vital signs included a temperature of 38°C, heart rate of 134 beats/min, respiratory rate of 22 breaths/min, blood pressure of 142/93 mm Hg, and pulse oximetry of 97% on room air. His physical exam is significant for tachycardia and pupils are 5 mm bilaterally and reactive to light with horizontal nystagmus. He is awake, confused, and combative.
Paramedics report that his mother found him in his bedroom was acting strangely before he fell to the floor and began convulsing. ED staff administered 2 mg intravenous lorazepam, ...
Source: The Tox Cave - January 4, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Funtabulously Frivolous Friday Five 122
Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old fashioned medical trivia…introducing Funtabulously Frivolous Friday Five 122
Question 1
What is a Clay-shoveler’s fracture and how do you get one?
+ Reveal the Funtabulous Answer
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Fracture through the spinous process of a vertebra occurring at any of the lower cervical or upper thoracic vertebrae, classically at C6 or C7.
Originally described in Australia associated with (no prizes for...
Source: Life in the Fast Lane - October 23, 2015 Category: Emergency Medicine Authors: Neil Long Tags: Frivolous Friday Five adrenal crisis adrenal insufficiency botulism clay shoveler's fracture erythema multiforme rhabdomyolysis Source Type: blogs
Water Intoxication Case in Hiker
While emphasis is often placed on keeping athletes and outdoor enthusiasts properly hydrated, too much water can be just as dangerous. Exercise-associated hyponatremia (EAH), a form of water intoxication, results in an extreme, and potentially fatal, sodium imbalance.In the latest issue of Wilderness & Environmental Medicine, investigators detail the case of a hiker who died as an illustration of the potential danger of endurance exercise and excessive water intake lowering serum sodium to a dangerous level. There have been several deaths from EAH associated with various sports. This is one of few reported fatalit...
Source: The A and P Professor - October 5, 2015 Category: Physiology Authors: Kevin Patton Source Type: blogs
Altered Mental Status after a Handful of Pills
Credit
John Nakamura Remy
A 30-year-old woman presented with altered mental status. Her boyfriend reported that she took a handful of unknown pills about two hours before. Initial vital signs include a temperature of 38°C, heart rate of 130 beats/min, respiratory rate of 18 breaths/min, blood pressure of 112/83 mm Hg, and pulse oximetry of 97% on room air.
Her physical exam is significant for pupils 6 mm bilaterally and reactive to light, dry mucous membranes and skin, and decreased bowel sounds. She was alert but confused. Her initial ECG showed a sinus tachycardia with a rate of 133 and a QRS of 89 and QTc of 443....
Source: The Tox Cave - October 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Altered Mental Status after a Handful of Pills
Credit
John Nakamura Remy
A 30-year-old woman presented with altered mental status. Her boyfriend reported that she took a handful of unknown pills about two hours before. Initial vital signs include a temperature of 38°C, heart rate of 130 beats/min, respiratory rate of 18 breaths/min, blood pressure of 112/83 mm Hg, and pulse oximetry of 97% on room air.
Her physical exam is significant for pupils 6 mm bilaterally and reactive to light, dry mucous membranes and skin, and decreased bowel sounds. She was alert but confused. Her initial ECG showed a sinus tachycardia with a rate of 133 and a QRS of 89 and QTc of...
Source: The Tox Cave - October 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
