Continuous Infusions

Source:http://academiclifeinem.blogspot.com/2012/03/paucis-verbis-continuous-infusions.html

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PALS-Medication

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Wellens' syndrome

Source: Wiki


Wellens' syndrome (or sign, or occasionally warning) is an electrocardiographic manifestation of critical proximal left anterior descending(LAD) coronary artery stenosis in patients with unstable angina.

It is characterized by symmetrical, often deep >2mm, T wave inversions in the anterior precordial leads. A less common variant is biphasic T wave inversions in the same leads.

  First described by Hein J. J. Wellens and colleagues in 1982 in a subgroup of patients with unstable angina it does not seem to be rare, appearing in 18% of patients in his original study. A subsequent prospective study identified this syndrome in 14% of patients at presentation and 60% of patients within the first 24 hours. 


The presence of Wellens' syndrome carries significant diagnostic and prognostic value. All patients in the De Zwann's study with characteristic findings had more than 50% stenosis of the left anterior descending artery (mean=85% stenosis) with complete or near-complete occlusion in 59%.


In the original Wellens' study group 75% of those with the typical syndrome manifestations had an anterior myocardial infarction.


Sensitivity and specificity for significant (more or equal to 70%) stenosis of the LAD artery was found to be 69% and 89% respectively with positive predictive value 86%. Wellens' sign has also been seen as a rare presentation of Takotsubo or stress cardiomyopathy.


Diagnostic criteria
 Progressive symmetrical deep T wave inversion in leads V2 and V3
 Slope of inverted T waves generally at 60°-90°
 Little or no cardiac marker elevation  Discrete or no ST segment elevation
 No loss of precordial R waves.
 Pattern abnormal during chest-pain free periods


Further Reading :http://emedicine.medscape.com/article/1512230-overview

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Anti-emetic Drugs

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Datura (Buah kecubung) Toxicity

All Datura plants contain tropane alkaloids such as scopolamine, hyoscyamine, and atropine, primarily in their seeds and flowers. Because of the presence of these substances, Datura has been used for centuries in some cultures as a poison and hallucinogen. There can be a 5:1 toxin variation across plants, and a given plant's toxicity depends on its age, where it is growing, and the local weather conditions. This variation makes Datura exceptionally hazardous as a drug. In traditional cultures, a great deal of experience with and detailed knowledge of Datura was critical in order to minimize harm. Many tragic incidents result from modern recreational users ingesting Datura. For example, in the 1990s and 2000s, the United States media contained stories of adolescents and young adults dying or becoming seriously ill from intentionally ingesting Datura. There are also several reports in the medical literature of deaths from Datura stramonium and Datura ferox intoxication. Children are especially vulnerable to atropine poisoning, and their prognosis is likely to be fatal. In some parts of Europe and India, Datura has been a popular poison for suicide and murder. From 1950–1965, the State Chemical Laboratories in Agra, India investigated 2,778 deaths that were caused by ingesting Datura. The U.S. Centers for Disease Control and Prevention reported accidental poisoning resulting in hospitalization for a family of six who inadvertently ingested Datura used as an ingredient in stew. In some places it is prohibited to buy, sell or cultivate Datura plants. Effects of ingestion Due to the potent combination of anticholinergic substances it contains, Datura intoxication typically produces effects similar to that of an anticholinergic delirium (as contrasted to hallucination): a complete inability to differentiate reality from fantasy; hyperthermia; tachycardia; bizarre, and possibly violent behavior; and severe mydriasis with resultant painful photophobia that can last several days. Pronounced amnesia is another commonly reported effect. No other psychoactive substance has received as many severely negative experience reports as has Datura. The overwhelming majority of those who describe their use of Datura find their experiences extremely unpleasant both mentally and physically and often physically dangerous. Source:http://en.wikipedia.org/wiki/Datura

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Fever without a source (29 days-3 months old)

Source:http://academiclifeinem.blogspot.com/2012/02/paucis-verbis-fever-without-source-29.html

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Gustilo open fracture classification

The most commonly used classification system for Open fractures. Created by Ramon Gustilo and Anderson, then further expanded by Gustilo, Mendoza, and Williams. This system uses the amount of energy, the extent of soft-tissue injury and the extent of contamination for determination of fracture severity. Progression from grade 1 to 3C implies a higher degree of energy involved in the injury, higher soft tissue and bone damage and higher potential for complications. Important to recognize that grade 3C fracture implies vascular injury as well.

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