The Agony of Withdrawal
​Part 3 in a Four-Part Series​A 26-year-old man presented with fatigue. He complained of body aches, diarrhea, and nausea. His history was significant for chronic back pain, for which he had been prescribed oxycodone that he has taken daily for three years. He reported that he had stopped taking it two days before his visit.He denied other medication or drug use. He was alert but restless and diaphoretic. His ECG showed sinus tachycardia. His labs included a WBC of 12, Hgb of 12, glucose of 89 mg/dL, creatinine of 1.0 mg/dL, sodium of 140 mEq/L, potassium of 3.8 mEq/L, and CK of 140 U/L. He was experiencing opioid with...
Source: The Tox Cave - February 28, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Sleep Problems, and Solutions
I might have mentioned before that I have problems sleeping. This isn ' t new. I have had problems sleeping since my 30s. But its only recently that it has gotten much more complicated than just a bit of insomnia. Add in things like:Back pain so it can be really hard to get comfortable to sleep at all.Fibromyalgia which causes both fatigue and insomniaRheumatoid painSleep apnea and an evil CPAP machine which keeps me awakeShould I go on? I can....In the past, I have been known to get up and wash the dishes and clean the kitchen in the middle of the night because I couldn ' t sleep. Trust me, I have been all over the house ...
Source: Caroline's Breast Cancer Blog - April 6, 2017 Category: Cancer & Oncology Tags: lack of sleep Source Type: blogs

Chronic Daily Headache: What is the cause? (2014 Am Fam Physician review)
What is the definition of chronic daily headache?Chronic daily headache is defined as the presence of a headache on 15 days or more per month for at least 3 months. What are the causes?The most common types of chronic daily headache are chronic migraines and chronic tension-type headaches. If a red flag for a secondary cause of headache is present, magnetic resonance imaging (MRI) of the head should be performed. All patients should be asked about medication overuse, which can increase the frequency of headaches. Patients who overuse medications for abortive therapy for headache should be encouraged to stop the medications...
Source: Clinical Cases and Images - Blog - September 9, 2014 Category: Universities & Medical Training Tags: Neurology 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

Standardize drug names and reduce the risk of medication errors
Ever get confused over the names of medicines? I do. There’s Zantac and Xanax. Zanaflex and Zaleplon. But Zanaflex is also known as tizanidine. Tizanidine functions very differently than Zantac and its other name, ranitidine, even though they sound alike. Every drug has (at least) two names — one proprietary, and one generic. Proprietary names are created to sound catchy by the original manufacturer, almost always under a patent. The generic names are more like chemical names, in that drugs of the same class that are similarly purposed will have common suffixes, like the cholesterol controlling pills known as  s...
Source: Kevin, M.D. - Medical Weblog - December 5, 2013 Category: Family Physicians Tags: Meds Medications Source Type: blogs