Tamingthesru
Grand Rounds Recap - 10/22/14
Acetaminophen can be one of the most dangerous drugs in overdose, as the toxic dose of acetaminophen is 250 mg/kg
There are 4 stages of acetaminophen overdose:
- Stage 1 from 0-24 hours when labs may be normal but the patient has nonspecific symptoms such as nausea, vomiting, and fatigue
- Stage 2 from 24-72 hours when labs may be normal or be trending upward but the patient is asymptomatic
- Stage 3 from 72-96 hours when significant metabolic derangement can occur such as profound metabolic acidosis, florid liver failure, and AKI.
- Stage 4 takes place only if you are able to get them through the acute illness precipitated in Stage 3 when hopefully recovery takes place, though there is no guarantee of liver recovery
Grand Rounds Recap - 10/15/2014
Prescription Drug and Opiate Epidemic with Dr. Shawn Ryan
The US is the #1 country in the world for opiate prescription drug utilization
- The numbers quoted are likely greatly underestimated due to inconsistent documentation
- Death rate from opiate pain medication (OPM) has quadrupled in the time span of 1999-2010
- Death rate in 2012 was 5.6 per 100,000
- In 2011, 44 people per day died from opiate overdose in the US
- In 2007, unintentional opiate overdose became the leading cause of death in the US for young population
- OH death rate has grown faster than the national rate. At this time 5 people/day die in OH from opiate overdose
Grand Rounds Recap - 10/1/2014
Consultant of the Month Series: Ear Emergencies with Dr. Golub
Auricular hematoma
Blood separates the cartilage from the perichondrium which supplies the blood-flow to the cartilage. This can lead to cartilaginous ischemia, infection, deformation (cauliflower ear). Treatment: I+D: make cuts parallel to natural lines in the helix to reduce visible scarring. Place a bolster to close the new potential space. Bolster stays for 7-10days. Keep on Keflex while bolster in place and f/u with ENT.