Keywords: carbon monoxide, CO, hyperbarics, HBO (PubMed Search)
CO is formed from the incomplete combustion of carbon materials, eg. fires, stoves, portable heaters CO reversibly binds hemoglobin, producing carboxyhemoglobin (HbCO). This causes oxygen to bind more tightly to hemoglobin, releasing less in the tissues. Because of this, it affects the organs with the highest oxygen requirements most profoundly (eg. brain and heart).
Symptoms are mainly neurological and cardiovascular, but may include a wide variety of non-specific symptoms. The initial symptoms of CO poisoning may include headache and flu-like illness progressing to confusion, agitation, lethargy, seizures and coma.
Place patients on 100% oxygen to decrease the half-life of HbCO. Though controversial, HBO therapy is thought to decrease the incidence of neurologic sequelae. HBO therapy should be considered for patients with a HbCO level above 20%, severely symptomatic patients with lower levels, and pregnant patients. Remember that pulse oximetry will not be accurate.
Keywords: Drugs of abuse, salvia, sage (PubMed Search)
This is a psychoactive herb which can induce strong dissociative effects by stimulation of the kappa receptor. It has become increasingly well known and available in modern culture, and popularized by YouTube Salvia (also known as Sage, Diviner's Sage, Magic Mint, or Sally D) is usually smoked, but can be chewed or ingested.
The high it produces is very intense, but lasts only approximately 10 minutes. Currently many states have enacted legislation against it, including Fla, IL, KA, MI, MO, ND, OK and VA, but it is available over the internet.
The following video demonstrates clinical effects of drug.
Although it is amusing, this is not meant to condone use.
(if you can not view the embeded video here is the link)
Keywords: ICP, intracranial pressure, antihypertensive, nitroprusside, nitroglycerin, hydralazine (PubMed Search)
Several antihypertensive agents raise intracranial pressure. Normal cerebral blood flow (CBF) is constant within normal cerebral perfusion pressure (CPP) ranges, recalling that CPP=MAP-ICP.
If CPP is outside the range in which autoregulation occurs, e.g. due to a structural lesion, ischemic stroke, or head trauma, CBF decreases and can adversely affect the patient.
In patients with ischemic stroke or intracerebral pathology, labetalol or esmolol may be used to lower blood pressure without raising ICP. Nicardipine is recommended for use in patients with ischemic stroke or SAH but not in patients with brain injury
If the patient has NO structural abnormalities, but has hypertensive encephalopathy, nitroglycerin, nitroprusside, labetalol, esmolol, or nicardipine may be used.
Keywords: Lidocaine, pediatrics, anesthesia (PubMed Search)
Topical Lidocaine for local anesthesia
Disclosure: I have no financial or invested interest in the product or the company.
1. Pharmacist's Letter 2008 24(9):240912
2. Cregin R. Improving pain management for pediatric patients undergoing nonurgent painful procedures. ASHSP April 15 2008;Vol 65(8):723-7.
3. Kaweski S. Topical Anesthetic Creams. Plastic and Reconstructive Surgery. June 2008; Vol 121(6):2161-5.
Keywords: drug interactions, disulfiram, bactrim, tinidazole, metronidazole (PubMed Search)
Other common medications that produce this reaction:
1. Sulfonylureas: chlorpropamide, tolbutamide, glyburide
2. Cardiovascular medications: Isosorbide dinitrate, nitroglycerin
Weathermon R, Crabb DW. Alcohol and Medication Interactions. Alcohol Research and Health. 1999 (23);1:40-54.
Keywords: drugs of abuse, heroin (PubMed Search)
Keywords: sedation, propofol, ketamine (PubMed Search)
"Ketofol" (Ketamine plus propofol)
Keywords: prolonged QT, arrhythmia, adverse effect, antiarrhythmics, antibiotics, antipsychotics (PubMed Search)
Other factors that are associated with prolonged QT include: bradycardia, female sex, genetics, and electrolyte abnormalities.
Kannakeril PJ, Roden DM. Drug-Induced long QT and torsade de pointes: recent advances. Current opinions in cardiology. Jan 2007;22(1):39-43.
Horn JR, Hansten PD. Drug Interactions and QT Interval Prolongation. Pharmacy Times Dec 2004. pp66.
Keywords: antiepileptics, suicide, carbamezepine, felbamate, gabapentin, lamotrigine, levetiracetam, valproate, pregabalin (PubMed Search)
SUICIDE RISK WITH ANTIEPILEPTICS
Drugs in the analysis included:
Carbamazepine (Carbatrol, Equetro, Tegretol, Tegretol XR)
Valproate (Depakote, Depakote ER, Depakene, Depacon)
Interestingly, other agents including varenicline (a partial nicotinic antagonist, for smoking cessation), levetiracetam (Keppra), zolpidem (Ambien), oseltamivir (Tamiflu), isotretinoin (Accutane), and other agents have been noted to have an increased rate of bizarre and aggressive behavior.
Keywords: amiodarone, torsades, hypothyroidism, toxicity, adverse effects, medication induced (PubMed Search)
Did you know how many toxicities and adverse effects amiodarone has? Many are severe, and many VERY common.
1. CARDIAC: hypotension with rapid infusion, prolonged QT, torsades
2. NEUROLOGIC problems occur in 20-40%, including malaise, ataxia, and peripheral neuropathies
3. ENDOCRINE: hypothyroidism and hyperthyroidism
4. GI problems occur in 25%
5. OPHTHALMOLOGIC disturbances include optic neuropathy, papilledema, and photosensitivity
6. SKIN: blue grey pigmentation
7. PULMONARY: pulmonary fibrosis