Six reasons to avoid fluoroquinolones in the critically ill

Six reasons to avoid fluoroquinolones in the critically ill

| August 1, 2016 | Reply

    Fluoroquinolone antibiotics already carry warnings about the risks of QT prolongation and torsades de pointes, tendonitis and tendon rupture as well as central nervous system effects, including peripheral neuropathy and exacerbation of myasthenia gravis. The FDA had recently updated the labels to state that “the serious risks posed by fluoroquinolones generally outweigh their benefits for […]

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Is Immodium the poor man’s methadone?

Is Immodium the poor man’s methadone?

| July 23, 2016 | Reply

  Loperamide is the active ingredient in Immodium, an over-the-counter antidiarrheal agent which also has μ-opioid receptor agonist activity. With therapeutic oral dosing, loperamide acts on μ-opioid receptor in the gastrointestinal tract and does not enter the central nervous system. At recommended doses, opioid effects on the central nervous system are not observed, there is no […]

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Ticks suck !

Ticks suck !

| June 14, 2016 | 1 Reply

  There are numerous tickborne diseases that  can infect humans and cause disease. Several different tick species are responsible for transmitting these diseases and can be found throughout different geographic regions of the United States. In addition, some tick species can transmit more than one disease. Symptoms can be similar among the tickborne diseases and […]

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Altered Mental Status for DUMMIES – Part II                     “The Approach”

Altered Mental Status for DUMMIES – Part II “The Approach”

| March 22, 2016 | Reply

  In our last discussion of Altered Mental Status for DUMMIES – Part I we talked about easy to remember mnemonics which can aid you in the approach to the differential in the patient with altered mental status. Today we’ll begin to discuss the “approach” when beginning your evaluation and work-up.     altered mental […]

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Altered Mental Status for DUMMIES – Part I “The Differential”

Altered Mental Status for DUMMIES – Part I “The Differential”

| March 5, 2016 | 2 Replies

  For inexperienced providers in the emergency department, the evaluation of the altered patient can be difficult. These patient are often unable to provide an accurate history and one must often rely on the information obtained from family, friends, pre-hospital care providers or nursing home staff. The approach to altered mental status can seem overwhelming […]

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Dangerous New Street Drugs: W-18

Dangerous New Street Drugs: W-18

| February 16, 2016 | Reply

   In the midst of the opioid epidemic, there has emerged another potentially more dangerous drug – W-18. This synthetic opioid is thought to be 100 times more potent than fentanyl and 10,000 x more potent than morhpine.   In a single drug seizure in Calgary in August 2015, W-18 was detected in a tablets […]

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Basic Neuroanatomy for the Critically Ill from SMACC

Basic Neuroanatomy for the Critically Ill from SMACC

| February 16, 2016 | Reply

  Basic Neuroanatomy for the Critically Ill from Social Media and Critical Care

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Visual Diagnosis # 16

Visual Diagnosis # 16

| February 15, 2016 | Reply

  This 48 yr old male presented to the emergency department with severe mid-epigastric pain worsening over the past 3 days. He describes associated nausea and vomiting without diarrhea or fever. No urinary symptoms. He admits to daily tobacco and alcohol use. He denies any recent illnesses or trauma. His abdominal exam is diffusely tender […]

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Do you DEWshine ?

Do you DEWshine ?

| January 29, 2016 | Reply

  This article is from the Tennessee Poison Center posted on January 26, 2016 by Donna Seger, MD Medical Toxicologist  This past week, the Tennessee poison center was involved in the care of 4 teenagers from Robertson County who drank Mountain Dew mixed with racing fuel (aka Dewshine). Racing fuel (used for drag racing) is almost 100% […]

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Zika Virus

Zika Virus

| January 29, 2016 | Reply

  Zika virus is an emerging mosquito-borne virus that was first identified in Uganda in 1947. In 2014, Zika virus was documented in Chile — the first incidence of the infection in Latin America. As of the most recent data, the countries in Latin America that have reports of Zika virus infections now include Brazil, Guatemala, […]

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Why is Zika virus spreading so quickly?

Why is Zika virus spreading so quickly?

| January 29, 2016 | Reply

Why is Zika virus spreading so quickly?    

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SEPSIS SMACCDOWN

SEPSIS SMACCDOWN

| January 23, 2016 | Reply

Sepsis SMACCdown

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Is this on your radar ?    Case # 1

Is this on your radar ? Case # 1

| January 23, 2016 | Reply

    Is this on your radar ? When first evaluating a patient and creating a differential diagnosis, if t’s not on your radar it may likely get missed.       Case #1 A 47 yr old female presents to the emergency department via private vehicle from home for evaluation of headache and neck pain. She […]

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Ocular Ultrasound For Detection Of Increased Intracranial Pressure

Ocular Ultrasound For Detection Of Increased Intracranial Pressure

| December 8, 2015 | Reply

      Ultrasound measurement of the optic nerve sheath diameter is a simple non-invasive procedure, which is a useful tool in the assessment of elevated intracranial pressure.         Early identification of elevated ICP (intracranial pressure) is critical to ensuring timely and appropriate management. However, there are few diagnostic methods available for detecting […]

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Visual Diagnosis # 15

Visual Diagnosis # 15

| August 30, 2015 | Reply

    A 45 yr old male presents with left foot pain. The patient claims he had a mechanical slip and fall down the stairs last night and his body weight fell on his left foot, which was folded beneath him. His left foot is edematous with some mild ecchymosis noted laterally. Patient is unable to weight-bear.   […]

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ECG Case Quiz # 5

ECG Case Quiz # 5

| August 8, 2015 | Reply

  A 23-year old male presents to the emergency department with symptoms of dizziness and palpitations. He was playing basketball one hour ago, when after a brief sprint down the court he felt quite dizzy and short of breath. He sat down to rest, but the symptoms persisted. He has no cardiac Hx or risk […]

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the HINTS exam

the HINTS exam

| July 21, 2015 | Reply

  The HINTS exam is a three-part, rapid beside oculomotor test used to help differentiate central from peripheral vertigo. HINTS stands for Head Impulse, Nystagmus and Test of Skew. The test consists of three parts: 1 – Patients with peripheral vertigo will have abnormal (positive) head impulse testing, while patients with central vertigo typically have […]

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Visual Diagnosis # 14

Visual Diagnosis # 14

| July 21, 2015 | Reply

  A 44 year-old male is brought in by EMS after an accidental heroin overdose. The patient was found sitting in his car unconcious and apneic with pin-point pupils and drug paraphernalia in the vehicle. The patient was resuscitated with 2 mg of intranasal Narcan (Naloxone) followed by another 2 mg as an intramuscular injection. […]

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Visual Diagnosis # 13

Visual Diagnosis # 13

| July 21, 2015 | Reply

  A 45 yr-old male arrives via ambulance in the emergency department found lying on the sidewalk unresponsive but with stable vital signs and no acute signs of trauma. The patient is very well known to EMS and emergency department staff and has a history of chronic alcohol abuse. Upon arrival in the emergency department […]

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Visual Diagnosis # 12

Visual Diagnosis # 12

| July 21, 2015 | Reply

  A 39 year-old female presents to the emergency department by ambulance from home with worsening dyspnea and fatigue over the past 3 days. She is 6 days post-partum after an uncomplicated full-term vaginal delivery. This is her first pregnancy, during which she had developed gestational hypertension in the last 6 weeks of her pregnancy […]

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