Is Immodium the poor man’s methadone?

  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 …

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Ticks suck !

  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 …

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Dangerous New Street Drugs: W-18

   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 …

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Visual Diagnosis # 16

  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 …

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Do you DEWshine ?

  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 …

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Zika Virus

  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 …

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Visual Diagnosis # 15

    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 …

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ECG Case Quiz # 5

  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 …

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the HINTS exam

  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 …

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Visual Diagnosis # 14

  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 …

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Visual Diagnosis # 13

  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 …

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Visual Diagnosis # 12

  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 …

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