Is 50% dextrose as good as 10% dextrose for treating symptomatic hypoglycemia?
If the patient is disoriented, but becomes oriented before the full dose of dextrose is given, is it appropriate to continue to treat the patient as if the patient were still disoriented? If your protocols require you to keep giving dextrose, do the same protocols require you to keep giving opioids after the pain is relieved? Is there really any difference?
50% dextrose has problems.... Read more »
Kiefer MV, Gene Hern H, Alter HJ, & Barger JB. (2014) Dextrose 10% in the treatment of out-of-hospital hypoglycemia. Prehospital and disaster medicine, 29(2), 190-4. PMID: 24735872
Levy SB, & Rosh AJ. (2006) Images in emergency medicine. Dextrose extravasation causing skin necrosis. Annals of emergency medicine, 48(3). PMID: 16934641
Despite the prevalence and impact of problem gambling, few summaries or guidelines address treatment.Searching the guideline.gov website shows no recent additions to the guideline literature.A guideline was published by the Singapore Ministry of Health in 2011. This guideline is still relevant and highlights some of the key elements of a problem gambling treatment program.I will summarize some of these key elements from this source titled: "Management of gambling disorders". In their summa........ Read more »
Lee KM, Chan HN, Cheah B, Gentica GF, Guo S, Lim HK, Lim YC, Noorul F, Tan HS, Teo P.... (2011) Ministry of Health clinical practice guidelines: management of gambling disorders. Singapore medical journal, 52(6), 456. PMID: 21732000
Regular readers of this blog had a heads up last year on the development of orexin receptor antagonists for the treatment of insomnia.I posted a review of an Italian clinical drug trial in humans with insomnia paired with polysomnography. This study used three different doses of a orexin receptor antagonist (10 mg 30 mg and 60 mg).In a second post, I reviewed a sleep lab study of the effects of an orexin antagonist drug compared to zolpidem (Ambien) on sleep architecture.This second study found ........ Read more »
Michelson D, Snyder E, Paradis E, Chengan-Liu M, Snavely DB, Hutzelmann J, Walsh JK, Krystal AD, Benca RM, Cohn M.... (2014) Safety and efficacy of suvorexant during 1-year treatment of insomnia with subsequent abrupt treatment discontinuation: a phase 3 randomised, double-blind, placebo-controlled trial. Lancet neurology, 13(5), 461-71. PMID: 24680372
Bennett T, Bray D, & Neville MW. (2014) Suvorexant, a dual orexin receptor antagonist for the management of insomnia. P , 39(4), 264-6. PMID: 24757363
There are several news articles today criticizing a study because the patients might be deprived of a drug that has not been adequately studied in humans. This criticism is coming from journalists – the people who publicized the fraudulent vaccines research by Andrew Wakefield, who was trying to sell his competing vaccine and was being paid to produce negative research by lawyers suing the vaccine companies.
The real controversy is that this untested drug became the standard of care ........ Read more »
Larabee TM, Liu KY, Campbell JA, & Little CM. (2012) Vasopressors in cardiac arrest: a systematic review. Resuscitation, 83(8), 932-9. PMID: 22425731
Woodhouse SP, Cox S, Boyd P, Case C, & Weber M. (1995) High dose and standard dose adrenaline do not alter survival, compared with placebo, in cardiac arrest. Resuscitation, 30(3), 243-9. PMID: 8867714
Herlitz J, Ekström L, Wennerblom B, Axelsson A, Bång A, & Holmberg S. (1995) Adrenaline in out-of-hospital ventricular fibrillation. Does it make any difference?. Resuscitation, 29(3), 195-201. PMID: 7667549
Ong ME, Tan EH, Ng FS, Panchalingham A, Lim SH, Manning PG, Ong VY, Lim SH, Yap S, Tham LP.... (2007) Survival outcomes with the introduction of intravenous epinephrine in the management of out-of-hospital cardiac arrest. Annals of emergency medicine, 50(6), 635-42. PMID: 17509730
Olasveengen, T., Sunde, K., Brunborg, C., Thowsen, J., Steen, P., & Wik, L. (2009) Intravenous Drug Administration During Out-of-Hospital Cardiac Arrest: A Randomized Trial. JAMA: The Journal of the American Medical Association, 302(20), 2222-2229. DOI: 10.1001/jama.2009.1729
Olasveengen TM, Wik L, Sunde K, & Steen PA. (2011) Outcome when adrenaline (epinephrine) was actually given vs. not given - post hoc analysis of a randomized clinical trial. Resuscitation. PMID: 22115931
Jacobs IG, Finn JC, Jelinek GA, Oxer HF, & Thompson PL. (2011) Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomised double-blind placebo-controlled trial. Resuscitation, 82(9), 1138-43. PMID: 21745533
Hagihara A, Hasegawa M, Abe T, Nagata T, Wakata Y, & Miyazaki S. (2012) Prehospital epinephrine use and survival among patients with out-of-hospital cardiac arrest. JAMA : the journal of the American Medical Association, 307(11), 1161-8. PMID: 22436956
Hayashi Y, Iwami T, Kitamura T, Nishiuchi T, Kajino K, Sakai T, Nishiyama C, Nitta M, Hiraide A, & Kai T. (2012) Impact of early intravenous epinephrine administration on outcomes following out-of-hospital cardiac arrest. Circulation journal : official journal of the Japanese Circulation Society, 76(7), 1639-45. PMID: 22481099
Glover BM, Brown SP, Morrison L, Davis D, Kudenchuk PJ, Van Ottingham L, Vaillancourt C, Cheskes S, Atkins DL, Dorian P.... (2012) Wide variability in drug use in out-of-hospital cardiac arrest: A report from the resuscitation outcomes consortium. Resuscitation. PMID: 22858552
Donnino, M., Salciccioli, J., Howell, M., Cocchi, M., Giberson, B., Berg, K., Gautam, S., Callaway, C., & , . (2014) Time to administration of epinephrine and outcome after in-hospital cardiac arrest with non-shockable rhythms: retrospective analysis of large in-hospital data registry. BMJ, 348(may20 2). DOI: 10.1136/bmj.g3028
Callaham M, Madsen CD, Barton CW, Saunders CE, & Pointer J. (1992) A randomized clinical trial of high-dose epinephrine and norepinephrine vs standard-dose epinephrine in prehospital cardiac arrest. JAMA : the journal of the American Medical Association, 268(19), 2667-72. PMID: 1433686
Brown CG, Martin DR, Pepe PE, Stueven H, Cummins RO, Gonzalez E, & Jastremski M. (1992) A comparison of standard-dose and high-dose epinephrine in cardiac arrest outside the hospital. The Multicenter High-Dose Epinephrine Study Group. The New England journal of medicine, 327(15), 1051-5. PMID: 1522841
Choux C, Gueugniaud PY, Barbieux A, Pham E, Lae C, Dubien PY, & Petit P. (1995) Standard doses versus repeated high doses of epinephrine in cardiac arrest outside the hospital. Resuscitation, 29(1), 3-9. PMID: 7784720
Gueugniaud PY, Mols P, Goldstein P, Pham E, Dubien PY, Deweerdt C, Vergnion M, Petit P, & Carli P. (1998) A comparison of repeated high doses and repeated standard doses of epinephrine for cardiac arrest outside the hospital. European Epinephrine Study Group. The New England journal of medicine, 339(22), 1595-601. PMID: 9828247
Vandycke C, & Martens P. (2000) High dose versus standard dose epinephrine in cardiac arrest - a meta-analysis. Resuscitation, 45(3), 161-6. PMID: 10959014
Stiell IG, Hebert PC, Weitzman BN, Wells GA, Raman S, Stark RM, Higginson LA, Ahuja J, & Dickinson GE. (1992) High-dose epinephrine in adult cardiac arrest. The New England journal of medicine, 327(15), 1045-50. PMID: 1522840
Callaway, C. (2012) Questioning the Use of Epinephrine to Treat Cardiac Arrest. JAMA: The Journal of the American Medical Association, 307(11), 1198. DOI: 10.1001/jama.2012.313
Several drug classes hold promise for reduction in pathological gambling behavior.However, there are very few published randomized and controlled clinical drug trials in gambling subjects.Searching clinical trials and gambling on PubMed yields only one small open-label proof of concept trial for the drug tolcapone within the last year.This study found evidence that this COMT inhibitor drug reduced gambling symptoms and was accompanied by fronto-parietal activation on fMRI imaging.However, on sea........ Read more »
Grant JE, Odlaug BL, Chamberlain SR, Hampshire A, Schreiber LR, & Kim SW. (2013) A proof of concept study of tolcapone for pathological gambling: relationships with COMT genotype and brain activation. European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology, 23(11), 1587-96. PMID: 23953269
Pathological gambling (PG) is a pattern of gambling characterized by loss of control and large gambling debts.The near-miss phenomenon in gambling is the gaming scenario where gamblers sense they were very close to winning.This near-miss phenomenon can be programmed into slot machines. For example, a gambler might be presented frequently with four cherries when five cherries would result in a huge payout.The response to the near-miss in PG is often a sense that a big win is just around the corne........ Read more »
van Holst RJ, Chase HW, & Clark L. (2014) Striatal connectivity changes following gambling wins and near-misses: Associations with gambling severity. NeuroImage. Clinical, 232-9. PMID: 25068112
There is an excellent review article by Dr. Bentley Bobrow and Dr. Gordon Ewy on the best management of sudden cardiac arrest from the bystander to the ICU (Intensive Care Unit).
They point out something that we tend to resist learning. Cardiac arrest that is not due to respiratory causes does not need respiratory treatment. A person who is unresponsive and gasping is exhibiting signs of cardiac arrest, not signs of respiratory problems.... Read more »
Ewy, G., & Bobrow, B. (2014) Cardiocerebral Resuscitation: An Approach to Improving Survival of Patients With Primary Cardiac Arrest. Journal of Intensive Care Medicine. DOI: 10.1177/0885066614544450
Prof. Mancini computationally models HIV and other viruses’ dynamics and explains its clinical relevance.... Read more »
Mancini, E., Castiglione, F., Bernaschi, M., de Luca, A., & Sloot, P. (2012) HIV Reservoirs and Immune Surveillance Evasion Cause the Failure of Structured Treatment Interruptions: A Computational Study. PLoS ONE, 7(4). DOI: 10.1371/journal.pone.0036108
This study is interesting for several reasons.
In a system that claims excellence, the most consistent way to identify the study group is by documentation of a protocol violation - but it is not intended as a study of protocol violations.
This may hint at some benefit from epinephrine (Adrenaline in Commonwealth countries), but that would require some study and we just don't study epinephrine. We only make excuses for not studying epinephrine.
The atropine results suggest that the ........ Read more »
Roberts, J. (2011) InFocus: Dissecting the ACLS Guidelines on Cardiac Arrest from Toxic Ingestions. Emergency Medicine News, 33(10), 16-18. DOI: 10.1097/01.EEM.0000406945.05619.ca
Koller, A., Salcido, D., Callaway, C., & Menegazzi, J. (2014) Resuscitation characteristics and outcomes in suspected drug overdose-related out-of-hospital cardiac arrest. Resuscitation. DOI: 10.1016/j.resuscitation.2014.05.036
This happens many times every day. A patient falls and may have hit her head, but there is no change from her normal mental status. To complicate matter, she takes an anticoagulant.
There are no clear signs of serious trauma. so should we automatically go to the trauma center?
What can help us decide?... Read more »
Hamden K, Agresti D, Jeanmonod R, Woods D, Reiter M, & Jeanmonod D. (2014) Characteristics of elderly fall patients with baseline mental status: high-risk features for intracranial injury. The American journal of emergency medicine. PMID: 24929771
Anecdotal reports have linked traumatic brain injury with later violent death including death by suicide.Few large epidemiological studies have been published on this association.However, a recent Swedish population study published in JAMA Psychiatry provides valuable insight into this issue.Seena Fazel and colleagues from the University of Oxford, University College London and the Karolinksa Institute examined a large database of over 200,000 patients with TBI.Cases of TBI were identified from ........ Read more »
Fazel S, Wolf A, Pillas D, Lichtenstein P, & Långström N. (2014) Suicide, fatal injuries, and other causes of premature mortality in patients with traumatic brain injury: a 41-year Swedish population study. JAMA psychiatry, 71(3), 326-33. PMID: 24430827
Sleep problems are common following traumatic brain injury (TBI).In a previous post, I reviewed a study of the risk factors for sleep disorders following TBI.The most severe TBI is a risk factor for hypersomnia. Anxiety and depression following TBI increase risk for insomnia complaints.Few large studies of treatment for sleep problems after TBI exist. However, a recent manuscript outlined the potential benefit of treatment of sleep disorders in a series of 12 subjects.Catherine Wiseman-Hake........ Read more »
Wiseman-Hakes C, Murray B, Moineddin R, Rochon E, Cullen N, Gargaro J, & Colantonio A. (2013) Evaluating the impact of treatment for sleep/wake disorders on recovery of cognition and communication in adults with chronic TBI. Brain injury : [BI], 27(12), 1364-76. PMID: 24070180
A new study from Colombia sees Blastocystis as a quasi-ubiquitous organism.... Read more »
Londoño-Franco AL, Loaiza-Herrera J, Lora-Suárez FM, & Gómez-Marín JE. (2014) [Blastocystis sp . frequency and sources among children from 0 to 5 years of age attending public day care centers in Calarcá, Colombia]. Biomedica : revista del Instituto Nacional de Salud, 34(2), 218-27. PMID: 24967927
Klimeš V, Gentekaki E, Roger AJ, & Eliáš M. (2014) A large number of nuclear genes in the human parasite Blastocystis require mRNA polyadenylation to create functional termination codons. Genome biology and evolution. PMID: 25015079
Lukeš J, Kuchta R, Scholz T, & Pomajbíková K. (2014) (Self-) infections with parasites: re-interpretations for the present. Trends in parasitology. PMID: 25033775
Tomasini N, Lauthier JJ, Ayala FJ, Tibayrenc M, & Diosque P. (2014) How often do they have sex? A comparative analysis of the population structure of seven eukaryotic microbial pathogens. PloS one, 9(7). PMID: 25054834
Sleep disturbance following traumatic brain injury (TBI) is a common clinical challenge.Hypersomnia and insomnia can both been seen in the TBI population.The risk factors related to TBI-related sleep disturbance are not well known. Identification of risk factors can provide insight into clinical assessment and management.Lijun Hou and colleagues recently examined risk factors related to subjective sleep complaints in a series of 98 TBI subjects.The study sample include adults admitted to a ........ Read more »
Hou L, Han X, Sheng P, Tong W, Li Z, Xu D, Yu M, Huang L, Zhao Z, Lu Y.... (2013) Risk factors associated with sleep disturbance following traumatic brain injury: clinical findings and questionnaire based study. PloS one, 8(10). PMID: 24098425
In many countries around the world, codeine is available only on prescription. It’s a weak opioid, but can still cause addiction. Low dose codeine is also available in the UK, over-the-counter (OTC) in pharmacies. It’s sold in combination with paracetamol (co-codamol, e.g. Solpadol), in combination with ibuprofen (e.g. Nurofen Plus), and in combination with dihydrocodeine (co-dydramol, e.g. [...]
The post Over the counter drug addiction appeared first on Recovery Review.
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Cooper, R. (2013) 'I can't be an addict. I am.' Over-the-counter medicine abuse: a qualitative study. BMJ Open, 3(6). DOI: 10.1136/bmjopen-2013-002913
Fasting is defined as either completely abstaining from or minimizing food intake for a defined period time - ranging from about 12 hours to even a few weeks. Calorie restriction, on the other hand, refers to an overall reduction in the daily calorie intake by about 20%-40% without necessarily reducing the meal intake frequency. Although calorie restriction is well-suited for weight loss and thus also reduces the risk of chronic diseases such as diabetes or heart disease, proponents of fasting c........ Read more »
Cheng, C., Adams, G., Perin, L., Wei, M., Zhou, X., Lam, B., Da Sacco, S., Mirisola, M., Quinn, D., Dorff, T.... (2014) Prolonged Fasting Reduces IGF-1/PKA to Promote Hematopoietic-Stem-Cell-Based Regeneration and Reverse Immunosuppression. Cell Stem Cell, 14(6), 810-823. DOI: 10.1016/j.stem.2014.04.014
Cognitive reserve (high educational attainment, high IQ) is known to reduce or delay the risk for Alzheimer's disease.However, the effect of cognitive reserve on recovery from traumatic brain injury (TBI) is less well studied.Two recent research studies support the beneficial effects of cognitive reserve on TBI.Schneider and colleagues examined a series of 769 adult TBI subjects using the TBI Model Systems Database.This cohort was followed during rehabilitation for a period of at least one year......... Read more »
Schneider EB, Sur S, Raymont V, Duckworth J, Kowalski RG, Efron DT, Hui X, Selvarajah S, Hambridge HL, & Stevens RD. (2014) Functional recovery after moderate/severe traumatic brain injury: a role for cognitive reserve?. Neurology, 82(18), 1636-42. PMID: 24759845
Fay TB, Yeates KO, Taylor HG, Bangert B, Dietrich A, Nuss KE, Rusin J, & Wright M. (2010) Cognitive reserve as a moderator of postconcussive symptoms in children with complicated and uncomplicated mild traumatic brain injury. Journal of the International Neuropsychological Society : JINS, 16(1), 94-105. PMID: 19835663
Legal highs in Lothian The UK has the largest market for new psychoactive substances (NSP or “legal highs”) in Europe. Scotland is no stranger to them and, as a seminar in Edinburgh heard last week, the Lothian area is seeing a surge in demand, some worrying trends in injecting and significant new presentations due to problems [...]
The post Legal highs – not for human consumption appeared first on Recovery Review.
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Baumann, M. (2014) Awash in a sea of ‘bath salts’: implications for biomedical research and public health. Addiction. DOI: 10.1111/add.12601
Understanding the specific brain regions vulnerable to traumatic brain injury (TBI) is important for assessment and intervention research.Two areas of active research include studies of brain white matter using diffusion tensor imaging and assessment of regional brain atrophy using magnetic resonance imaging (MRI).Two recent MRI studies have suggested the brain hippocampus may be a region of vulnerability to TBI.A Canadian study by Robin Green and colleagues used brain MRI to examine a cohort of........ Read more »
Green RE, Colella B, Maller JJ, Bayley M, Glazer J, & Mikulis DJ. (2014) Scale and pattern of atrophy in the chronic stages of moderate-severe TBI. Frontiers in human neuroscience, 67. PMID: 24744712
Singh R, Meier TB, Kuplicki R, Savitz J, Mukai I, Cavanagh L, Allen T, Teague TK, Nerio C, Polanski D.... (2014) Relationship of collegiate football experience and concussion with hippocampal volume and cognitive outcomes. JAMA : the journal of the American Medical Association, 311(18), 1883-8. PMID: 24825643
Trauma results in 180,000 deaths per year in the U.S. and disproportionately affects children and young adults. The Centers for Disease Control (CDC) recently published a review highlighting unintentional injury and violence as the leading cause of death in the U.S. for those in the one to 30 year old age group. Additionally, trauma produces significant disability through residual effects such as like that often seen following traumatic brain injury.Trauma centers are hospital-affiliat........ Read more »
Haegerich, T., Dahlberg, L., Simon, T., Baldwin, G., Sleet, D., Greenspan, A., & Degutis, L. (2014) Prevention of injury and violence in the USA. The Lancet, 384(9937), 64-74. DOI: 10.1016/S0140-6736(14)60074-X
Garwe T, Cowan LD, Neas B, Cathey T, Danford BC, & Greenawalt P. (2010) Survival benefit of transfer to tertiary trauma centers for major trauma patients initially presenting to nontertiary trauma centers. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 17(11), 1223-32. PMID: 21175521
Bukur M, Felder SI, Singer MB, Ley EJ, Malinoski DJ, Margulies DR, & Salim A. (2013) Trauma center level impacts survival for cirrhotic trauma patients. The journal of trauma and acute care surgery, 74(4), 1133-7. PMID: 23511156
Prada SI, Salkever D, & Mackenzie EJ. (2014) Level-I trauma centre treatment effects on return to work in teaching hospitals. Injury. PMID: 24630835
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