ACLS H's and T's of PEA

Hypo/Hyper Kalemia

Hypothermia

Hypovolemia

Hypoxia

H+ acidosis

Hypoglycemia

Tamponade

Tension pneumothorax

Thrombosis

Toxins

Trauma

Born to Run by Christopher McDougal

Absolutely fascinating chapter on the anthropology of running, explaining how our species adapted to running after we split from chimps, giving up speed and strength in exchange for endurance. The best answer he has for this is persistence hunting, though the evidence for this is rather slim.

I wish I had run barefoot my entire life, but now, with my achilles tendinitis, I don't really know where to go. My achilles have to stretch over large bone spurs on my heals, themselves probably a result of shoe wearing. At least I won't feel the need to buy new running shoes so often.

Still Life with Woodpecker by Tom Robbins

Author reminds me of my dad, saying so many things that just don't make sense yet with some really profound wisdom interspersed.

The most important subject that this book stirred in me was "how to make love last", and taking about what that exciting mystery is in new romances and what happens to it later on. Romance in solitude, romance in mystery, romance in new things and forgotten things. Overall hopeful, but with plenty of realism. Reminds us that the mystery will tempt us in "the next pair of eyes that smile at us". But in the end, as in real life, there is no single answer for how to make love stay.

December Snow Week!

Ol' Blue  It's all melted now, but it was fun while it lasted. One morning, Sarah's Subaru got stuck on the berm that the plow made between street and driveway but Ol'Blue made it and got her to work despite its two wheel drive. Think it was a combination of pure snow tires and a bit more clearance. View image

© 2013 Dropbox

UTI's in the Elderly

Treatment of asymptomatic bacteriuria is not appropriate for the following populations: women (premenopausal, nonpregnant), diabetics, the elderly, nursing home residents, or patients with spinal cord injury or indwelling urethral catheters.

 

"Bacteriuria in a population sample of women: 24-year follow-up study. Results from the prospective population-based study of women in Gothenburg, Sweden"

Bengtsson C, Bengtsson U, Björkelund C, Lincoln K, Sigurdsson JA

Scand J Urol Nephrol. 1998;32(4):284.

 

So don't screen these women in the first place, and if you find bacteria, don't treat because it doesn't reduce recurrence, perhaps recurrence with a symptomatic strain. It may also lead to antibiotic resistance.

Haldol for delirium

Delirium is an altered mental status that is transient by nature, acute in onset, and can be caused by etiologies in 12 different categories.

drug intoxication , drug withdrawal, metabolic/endocrine disturbance, TBI, seizures, intracranial infection, systemic infection, intracranial neoplasm, systemic neoplasm, cerebrovascular disease, organ insufficiency, other CNS disorders, other systemic diseases.

 

Because I had a patient with delirium, I read two articles about the pharmacological treatment of it.

 

 

"Efficacy and safety of haloperidol versus atypical antipsychotic medications in the treatment of delirium"

Yoon et all

Found that haldol, risperidone, olanzapine, and quetiapine were equally effictive in improving the symptoms of delirium.

Patients over 75 did not respond as well to olanzapine.

Weaknesses of the study include that there was no placebo, no randomization, high dropout rate.

 

 

"Pharmacovigilance in Hospice/Palliative Care: Net Effect of Haloperidol for Delirium"

Crawford et all

119 participants, all on hospice with significant age or poor physical functional status.

Mean dose of 2.1mg/day

1 in 3 patients experienced benefit at 48hrs after starting haldol.

 

 

 

 

Prevention of Contrast-Induced Nephropathy: An Overview by Ellis and Cohan

Be especially careful in patient with GFR less than 60.

AKI

CKD

 

 

1. reduce dose

2. no clear evidence for low osmolality agents yet, maybe soon

Also consider carbon dioxide for vascular studies

3. pre-hydrate with IV fluids

4. weak evidence for N-acetylcysteine 600mg BID for two days before

5. hemodialsis vs hemofiltration, may work, but only in exceptional circumstances