Seven out of eight emergency department (ED) visits attributed to adverse events from benzodiazepines involve self-harm or nonmedical use of these drugs, and more than 80% involve concurrent use of alcohol, illicit drugs, or other substances, new research shows.
Although benzodiazepines are typically not problematic in terms of acute overdoses when used alone, patients often don’t take them as prescribed or use them with other substances in a self-harm attempt, author Daniel S. Budnitz, MD, MPH, director of the Medication Safety Program, Centers for Disease Control and Prevention (CDC), told Medscape Medical News.
“Clinicians need to be aware of what other substances patients might be taking when they’re being prescribed a benzodiazepine,” Budnitz added.
The study was published online February 19 in the American Journal of Preventive Medicine.
#2 Remember naloxone, glucose, and thiamine (NGT) Original: Consider or give naloxone, glucose and thiamine The number of patients presenting with opioid intoxication is growing, and the gentle reversal of patients without severe respiratory depression with naloxone is in the art of medicine – consider starting with 0.4mg and titrate to effect.
In contrast to empiric administration of glucose in the altered or ill patient, rapid assessment of glucose level with point-of-care testing is recommended.
Thiamine deficiency may be less prevalent than previously thought in intoxicated patients, but we now know that giving 100mg of IV thiamine can benefit other malnourished patients, including those with calorie-malnourishment from cancer, gastric bypass, hyperemesis gravidarum, and eating disorders. Personally, I use the ‘T’ of ‘NGT’ to remind myself not to miss alcohol withdrawal.
Why does this matter? I hear you thinking we underwrite life insurance, we’re not doctors. So true. But if we think like doctors we will get better at what we do by recognizing the subtleties buried within the medical charts we read. Here’s what my eyes/brain picked up.
The bold in the excerpt above are mine to illustrate how the mind of a mortality risk expert works. In Emergency Department records pay attention to the initial treatments provided which in some cases hints to a serious condition impacting mortality. Naloxone and opioids are obvious. But would you have associated the administration of IV thiamine to malnutrition or alcohol withdrawal? I thought so.
So read and research widely. You’ll always find little jewels to improve your skills and to impress your friends with. Or in my case to make Dr. Lee think his old man knows more than he actually does.
Hospital officials initially reported an outbreak of 44 infections traced back to the apparently impromptu Christmas celebration, but this would be the first fatality associated with the informal Dec. 25 visit. All 44, including the employee who died, had been working in the emergency department that day, according to NBC Bay Area, which also described the outbreak’s first victim as a woman who worked as a registration clerk in the department.
Just another Saturday morning except this day starts the second half of a long four day Thanksgiving holiday break. We have given our thanks for the things we are grateful for. Today I’m asking all who read this post to give thanks for all of our front line healthcare workers for whom there is no break from work. We have many dedicated people who are spending the holiday away from their families while most of us are spending time with our families. These brave souls are putting their own health and safety on the line for the rest of us.
Thanksgiving – 3:00-11:00 PM
Friday Nov. 27 – 1:00-9:00 PM
Saturday Nov. 28 – 1:00-9:00 PM
Sunday Nov. 29 – 6:00 AM-2:00 PM
Is it too hard to wear a mask?
I’m getting better at writing effective click-bait blog post titles.
This article is written by an Emergency Medicine doctor for other Emergency Medicine doctors as a quick primer on recognizing and diagnosing anorexia. While those of us in the life insurance business are not diagnosticians you will definitely benefit from this short ten minute article on the next case you encounter where Momma Bear is applying for $2,000,000 on her skinny 15 year old daughter who can’t seem to gain weight no matter how much the kid eats.
AN is a common, severe psychiatric illness. It is often present with co-morbid psychiatric illnesses. There is a high mortality rate, 5.6% per decade. It is notoriously difficult to treat with psychotherapy and pharmacotherapy.
When should I go to my doctor? The simple answer is when you can’t breathe or can’t hold down fluids. If you are having mild symptoms (fever, body aches, dry cough), stay home, and self-isolate. By going to the doctor, you risk spreading the virus to others, including us. If you go to the ER, we will see you but, if you are only having mild symptoms, you will likely be sent home with no COVID-19 test, no treatment, and a hospital bill.
Lastly, a personal plea. Many people are stuck at home with nothing to do. While alcohol is a disinfectant of sorts, it is not going to treat COVID-19! If you are drinking, have fun, but please wear a helmet and shoulder pads so that when you fall and hit your head, you do not have to come in and see me in the ER. We already see too many alcohol-associated visits in the emergency department. In a related note, drugs will make you feel strange. If you choose to use edibles or try new things because you are idle, please don’t do drugs and come in because you feel weird. I can’t fix that. As I told a patient this week, “You are high. If you don’t like this feeling, then don’t do drugs.”