Long distance runners beware of hyponatremia
As physicians, if we know that our patients plan marathon running (or longer), we have a responsibility to warn them about fluid intake. Alex Hutchinson writes regularly about the science of running in a column called Sweat Science. Today his publication – How to Avoid Overdrinking: Researchers release new guidelines on preventing and treating hyponatremia. appeared on the Runner’s World website.
I have had a great interest in teaching about hyponatremia for many years. In my standard lecture I mention the problem of hyponatremia occurring in long distance runners. Alex writes about the new g...
Source: DB's Medical Rants - July 24, 2015 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Don’t Smoke ’Em if You Got ’Em
A 22-year-old man with no past medical history presented to the emergency department with altered mental status. He was brought in by police who reported using a TASER on him three times after he became violent with them. His friends report he smoked K2. His initial vital signs included a temperature of 99.9°F, a heart rate of 137 bpm, blood pressure of 151/76 mm Hg, a respiratory rate of 22 bpm, and pulse oximetry of 98% on room air. The patient was agitated and combative, and was placed in four-point restraints.
K2 is a synthetic cannabinoid. Other commonly used synthetic cannabinoids include spice, moon rocks, com...
Source: The Tox Cave - July 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Don’t Smoke ’Em if You Got ’Em
A 22-year-old man with no past medical history presented to the emergency department with altered mental status. He was brought in by police who reported using a TASER on him three times after he became violent with them. His friends report he smoked K2. His initial vital signs included a temperature of 99.9°F, a heart rate of 137 bpm, blood pressure of 151/76 mm Hg, a respiratory rate of 22 bpm, and pulse oximetry of 98% on room air. The patient was agitated and combative, and was placed in four-point restraints.
K2 is a synthetic cannabinoid. Other commonly used synthetic cannabinoids include spice, moon rocks, comat...
Source: The Tox Cave - July 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
The Hugest of the Huge Hematomas
Welcome to our new series, “Guts and Gore.” That title should serve as a warning that some of the videos we will use as teaching tools may be controversial and not for weak stomachs. We hope, however, that part of why you became an emergency provider was to handle sticky situations like the ones we will present. People like us have the ability to ignore blood and copious discharge, and instead focus on saving and improving the lives of our patients. Rarely are you thanked for this ability, and we hope this series on guts and gore will improve your technique, even when the going gets tough.
The Approach
n Proper i...
Source: The Procedural Pause - June 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
The Hugest of the Huge Hematomas
Welcome to our new series, “Guts and Gore.” That title should serve as a warning that some of the videos we will use as teaching tools may be controversial and not for weak stomachs. We hope, however, that part of why you became an emergency provider was to handle sticky situations like the ones we will present. People like us have the ability to ignore blood and copious discharge, and instead focus on saving and improving the lives of our patients. Rarely are you thanked for this ability, and we hope this series on guts and gore will improve your technique, even when the going gets tough.
The Approach
n Proper iden...
Source: The Procedural Pause - June 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Pharmagangsters
Sidney Wolfe (Nader's health care raider) in the new BMJ tells the outrageous story of rosuvastatin. As you undoubtedly know, there are several medications in the statin class, very widely prescribed for the primary and secondary prevention of heart disease and stroke. They lower LDL ("bad" cholesterol) and probably have anti-inflammatory properties that contribute to their effect.There is controversy over whether these medications in general are overprescribed, but that's beside the point here. Rosuvastatin was approved much later than other drugs in the class, it's still under patent (I won't mention the brand name) and ...
Source: Stayin' Alive - March 20, 2015 Category: American Health 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 g...
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 gamma-h...
Source: The Tox Cave - October 2, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
A Very Wide Complex
What do you think of this ECG from a critically ill patient?See BelowI can only give minimal information in order to protect identity: this patient had such severe rhabdomyolysis (CK nearly 100,000) that continuous renal replacement therapy (i.e., continuous dialysis), in addition to Calcium and shifting therapy, could not lower his K enough to prevent cardiac arrest (other futility complicated this picture) . This was severe hyperkalemia. There are no P-waves. The QRS is bizarrely wide. In places, it looks nearly like a sine wave. The last K was drawn 20 minutes before the ECG, and was 7.9 mEq/L. (...
Source: Dr. Smith's ECG Blog - August 7, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
A Hot Topic
A 58-year-old man presented unresponsive following a seizure at home. His brother stated that he became progressively confused over the course of a few hours and then started shaking. EMS reports tonic-clonic seizures that resolved following administration of 5 mg of midazolam IM.
The patient was unresponsive and hyperthermic on arrival. He was intubated for airway protection, covered with ice packs, and administered normal saline intravenously. His rectal temperature is 41.9˚C (107.4˚F), blood pressure is 94/45 mm Hg, heart rate is 160 beats/minute, and the respiratory rate is 16 breaths/minute with an oxygen saturatio...
Source: The Tox Cave - June 23, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
A Hot Topic
A 58-year-old man presented unresponsive following a seizure at home. His brother stated that he became progressively confused over the course of a few hours and then started shaking. EMS reports tonic-clonic seizures that resolved following administration of 5 mg of midazolam IM.
The patient was unresponsive and hyperthermic on arrival. He was intubated for airway protection, covered with ice packs, and administered normal saline intravenously. His rectal temperature is 41.9˚C (107.4˚F), blood pressure is 94/45 mm Hg, heart rate is 160 beats/minute, and the respiratory rate is 16 breaths/minute with an oxygen saturat...
Source: The Tox Cave - June 23, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
United Church Observer: Through the Cracks: For Adults With Developmental Disabilities Gaps Remain
The United Church Observer article, Through the cracks, by Kevin Spurgaitis, tackles issues relating to the lack of available care for adults with severe developmental disabilities including autism disorders. Simply by addressing, and shining a spotlight on the lack of places that can provide permanent residential care to those with autism disorders they have helped to address the hard realities faced by many with severe developmental disorders including severe autism. I was interviewed by telephone by Kevin Spurgatis, who was exceptionally courteous and respectful, qualities which show up in t...
Source: Facing Autism in New Brunswick - March 21, 2014 Category: Autism Authors: H L Doherty Source Type: blogs
Terbutaline and Albuterol for Lowering of Plasma Postassium
CONCLUSION: We conclude that in patients with terminal renal failure undergoing maintenance hemodialysis, intravenous bicarbonate is ineffective in lowering plasma potassium rapidly, and epinephrine is effective in only half the patients, whereas insulin in glucose is a fast and reliable form of therapy for hyperkalemic emergencies. Plasma aldosterone levels are appropriate in relationship to plasma potassium levels, and levels of other potassium-influencing hormones are generally normal. ADDepartment of Medicine, Kantonsspital, Aarau, Switzerland.PMID3052050 6 PubMed ...
Source: Dr. Smith's ECG Blog - December 6, 2013 Category: Cardiology Authors: Steve Smith Source Type: blogs
How Manipulated Clinical Evidence Could Distort Guidelines - the Case of Statins for Primary Prevention
This study excluded many patient for whom the statins were not contraindicated or warned against: uncontrolled hypertension; type 1 or type 2 diabetes mellitus on insulin or with a HgBA1C at least 10%; and body weight more than 50% "desirable limit for height." (Based on the official contraindications and warnings for commonly used statins, e.g., see contraindications for Lipitor here, active liver disease, pregnancy for likely to become pregnant, nursing mothers, hypersensitivity to the medicine; and warnings: use of cyclosprine or strong CYP3A4 inhibitors, uncontrolled hypothyroidism, renal impairment.) Thus ...
Source: Health Care Renewal - December 3, 2013 Category: Health Medicine and Bioethics Commentators Tags: American College of Cardiology American Heart Association clinical trials conflicts of interest evidence-based medicine guidelines manipulating clinical research review articles Source Type: blogs
Former Bayer Employee Can Proceed With Whistleblower Lawsuit
A federal appeals court has given a former Bayer employee a second chance at pressing a whistleblower lawsuit that accuses the drugmaker of illegally and deceptively marketing its Baycol cholesterol drug. However, the suit can only proceed on the grounds that Bayer cheated the US Department of Defense, not federal healthcare programs such as Medicare and Medicaid, of millions of dollars.
The lawsuit, which was filed seven years ago by a former market research manager named Laurie Simpson, may become a coda in the troubled saga of the cholesterol pill. Amid controversy, Bayer withdrew Baycol in 2001 after 52 deaths and hund...
Source: Pharmalot - October 16, 2013 Category: Pharma Commentators Authors: esilverman Source Type: blogs
