A 29-year-old man is brought to the emergency center in a drunken stupor. He is accompanied by his wife, who states that he hasn’t been himself at all for the past few months. According to his wife, he was evaluated for depression by his personal physician about 3 months ago and started on an SSRI. He responded quite well to this therapy over the subsequent 2 months. He started feeling so good and so energetic that he stopped taking his medication. He found that he needed less and less sleep, to the point where he is now only sleeping …
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A 62-year-old man is being managed in the intensive care unit following a large anterior wall MI. He has been appropriately managed with oxygen, aspirin, nitrates, and P-adrenergic receptor blockers but has developed recurrent episodes of ventricular tachycardia. During these episodes he remains conscious but feels dizzy, and he becomes diaphoretic and hypotensive. He is given an IV bolus of lidocaine and started on an IV lidocaine infusion. To what class of antiarrhythmic does lidocaine belong? What is lidocaine’s mechanism of action? Answers to case: …
[ Continue Reading... ]Rapid ascension and exposure to altitudes greater than 8,000 feet without appropriate acclimatization is an environmental malady risked by many outdoors enthusiasts. Initiating within 1 to 2 days, this spectrum of symptoms has collectively been termed Altitude Sickness (AS) or Acute Mountain Sickness (AMS). As elevation increases, the partial pressure of oxygen decreases, causing climbers to experience hypoxemia. At 11,500 feet, the oxygen in the air is about 65% of the amount available at sea level, which forces the body to struggle to maintain normal levels of oxygenation. Ventilation may decrease further as one sleeps, potentiating the hypoxemia (Table 1). Table 1: Acclimatization to High Altitude Response Mechanism Time Ventilation …
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