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case study

Discussion in 'Clinical Rotations' started by Tiffany, Apr 2, 2001.

  1. Tiffany

    Tiffany Member

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    Can any future doctor tell me what 's going on with this man?

    a 55 years old man, suddently stop breathing, the ambulance take him to the emergency room, after putting oxygen, 10 mins later, he start breathing and walking like like normal person again. He has headache sometimes. What's going on with this man?

    Tiff.
     
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  3. jawurheemd

    jawurheemd xx ToXiC xx

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    Your case does sound a bit curious. More detail would be nice, such as further H and P, lab values, and the like. However, when you described your case, I was reminded of GHB intoxication that can lead to profound respiratory depression, but very rapid recovery. The problem with GHB is that it is hard to detect as it is naturally occuring in our bodies as well. I think you would need a lab who can detect abnormal levels -- not too many that do that as of yet. Otherwise, you would have to go around excluding other possibilities: other toxins, medical conditions, psychiatic conditions, etc. Just my 2 cents.

    -James
     
  4. jawurheemd

    jawurheemd xx ToXiC xx

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    A Tale of Novel Intoxication: Seven Cases of gamma-Hydroxybutyric Acid Overdose

    James Li MD*
    Sharon Arnaud Stokes MD
    Anna Woeckener MD*


    --------------------------------------------------------------------------------
    From the Departments of Emergency Medicine* and Medicine, Charity Hospital, New Orleans, LA.
    Received for publication February 17, 1997.
    Revisions received May 16 and July 11, 1997, and February 18, 1998.
    Accepted for publication March 5, 1998.

    --------------------------------------------------------------------------------
    Address for reprints: James Li, MD, Mount Auburn Hospital, Department of Emergency Medicine, 330 Mount Auburn Street, Cambridge, MA 02238, E-mail [email protected]

    Copyright ? 1998 by the American College of Emergency Physicians.

    47/1/90301


    Study Objective: We describe seven patients presenting with combination substance abuse involving gamma-Hydroxybutyric acid (GHB).
    Methods: During a 3-month period, we identified consecutive patients with GHB ingestion confirmed by urine mass spectrometry presenting to a high-volume urban emergency department.
    Results: All patients presented with acute delirium and transient but severe respiratory depression. With supportive care, including intubation and mechanical ventilation in four cases, normal mentation and respiratory function returned within 2 to 6 hours. None of these patients had documented seizures, and none of the four patients who received naloxone had a reversal response. This clinical observation supports previous experimental work in GHB-intoxicated human subjects demonstrating neither epileptiform changes on electroencephalography nor reversal with naloxone. Two findings are remarkable in this series. The first is the observation of a peculiar state of violent aggression present on stimulation of the GHB-intoxicated patient despite near or total apnea. The fact that patients fully recovered from this state may be the result of a previously demonstrated GHB hypoxia-sparing effect. The second is the observation of ECG abnormalities in several cases, including U waves in five patients.
    Conclusion: Emergency physicians should be alerted to this agent, its characteristic effects, and its potential for serious sequelae including respiratory arrest and death.
    [Li J, Stokes SA, Woeckener A: A tale of novel intoxication: Seven cases of gamma-Hydroxybutyric acid overdose. Ann Emerg Med June 1998;31:723-728.]

     
  5. Medulla oblongata ("inna godda davida baby...") lesion?

    I had originally thought methem from poppers, but that's not tx'd with O2.
     
  6. Tiffany

    Tiffany Member

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    Lab test everythings are normal except Blood Pressure a little bit high. His family doctor think he has asthma so he gave him inhaler but he didn't use it because i told him not to.
    castcan is normal...All blood and urine test came out fine....

    Help help help future doctor

    blood pressure just slightly high
    and he's not on any medication. He is very normal man. The only sympton i can tell is suddently breathing and have headache
    sometimes

    Tiff.
     
  7. alshepard

    alshepard Member

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    Why did you tell him not to use the inhaler?
     
  8. sara

    sara Junior Member

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    hi there
    could be CO intoxication !!! was there something evident like exposure to CO ?
    if he had or will have some attacks like this in future, could be a case of mild pulmonary HTN.get echo for pulm pressures.
    one guess is pneumothorax too.


     
  9. Tiffany

    Tiffany Member

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    I told him not to use inhaler because i don't think he need to. You should know the side affect of using inhaler (future doctor, duh!)

    Anyway, pulmornay is not right(pseudo test is negative)
    My question is what does it cause to affect his respiratory system?
    What kind of doctor should i recomment him to?

    Tiff.

     
  10. Tiffany

    Tiffany Member

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    He is a good man. He doesn't drink doesn't take any illegal drug.
     
  11. Tiffany

    Tiffany Member

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    NO PNEUMONIA EITHER!
     
  12. Now, now. There is no need to be petty here. Yes, all inhalers, all drugs have side effects. That doesn't mean that their use is inappropriate in all cases. Find me a drug without any side effects and I will show you a very rich pharmaceutical company.

     
  13. Tiffany

    Tiffany Member

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    Yah, but inhaler doesn't apply in his case why should he use while he doesn't need it.
    Yes, all drugs have side affect and you only use it when you really really have to.

    Iam undergrad student, i don't know any med stuffs here. All i ask just for your help, if you know any specialist doc can treat his case please let me know, no offense here! I just try to help this man.

    Tiff.
     
  14. Pathologist

    Pathologist Senior Member

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    If you are an undegraduate, why are you advising a patient when and when not to use an inhaler?

     
  15. UHS03

    UHS03 Senior Member

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    Let me see if I understand this...your friend goes to a doctor and after being seen in person, the doctor gives your friend an inhaler. You then tell your friend he doesn't need the inhaler and to not use it, even though you admit to having no knowledge of meds...and (suprisingly) your friend listens to you. Now you post on a board to a bunch of pre-meds and med students trying to get the advice you want. What in the world could make you think that a bunch of students on a discussion board who have never seen your friend in person could give better advice than the doctor who personally examined him??

    Tell your friend to use the inhaler as directed and if the problem persists, go see the doctor again. What makes you think that you know better than the doctor what meds your friend should and should not take?? Gimme a break.

    [This message has been edited by UHS03 (edited April 03, 2001).]
     
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  17. jawurheemd

    jawurheemd xx ToXiC xx

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    Well okay -- I'm wondering why the emergency department let this man go without telling him what was wrong. Personally, if I were the physician treating him with the story that you are giving, I wouldn't have sent him home -- after all he did stop breathing. If he stops breathing again and no one is around to save him, he dies. There are some questions that need to be answered:

    one, what was he doing when he stopped breathing? was he sleeping? is this just a case of sleep apnea?

    two, has this ever happened before? if it has, what happened during those occasions?

    three, what relavence is this headache that you are talking about? did you mention in because he gets the headaches whenever he stops breathing? is this a headache that he usually has? what does this headache feel like? is it the worst headache that he's had ever?

    four, did he really stop breathing? or did he just pass out? if he stopped breathing, was he awake and alert, or was he choking on something? did he start breathing rapidly before he stopped breathing?

    basically, we just need a lot more information. we can't actually make a diagnosis online -- we would need to do a complete h&p on him plus other diagnostic tests. right now we're just making some suggestions as to what could be going on, but we can't say anything definitively. the best resource is the doc who's treating this patient.

    -James
     
  18. This would have never happened in California -- The Center of the Universe.

    SEEKING CALIFORNIA MEDICAL TREATMENT

    DR. MEAT EDELL, M.D. [NoCal, baby!], D.O. [hon.]
     
  19. Tiff...

    I think most of us thought we were talking about a hypothetical case here or at the very least a case which HAS an answer.

    It is NOT appropriate for anyone in this forum to be offering medical advice; had we known that was what you were seeking we would have redirected you earlier.

    In addition, I FIND it very strange that your friend was not at least admitted to the hospital if the problem is as you describe. Letting someone with an apneic episode walk away without a diagnosis = malpractice in my book.

    Please STRONGLY encourage your friend to return to his doctor for further explanation of his problem. If this doctor is not forthcoming or there is a communication problem between him and the patient, please find another doctor. Your friend deserves medical advice and information from a real-live doctor and soon.
     
  20. Tiffany

    Tiffany Member

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    Future docs,

    First,i told him not to use inhaler because I Think he doesn't need to. Iam undergrad student doesn't mean iam totally idiot about using any kind of drug. You are doctor and you gave him inhaler telling me that you are lack of knowledge. I do admire docs but some docs are very stuppid that's why so many patients die each year from mistreat or wrong type of medication.

    Second, His family doctor speak the same language as he does, there shouldn't be any miscommunication or misunderstanding. Further, his family doctor send him to radiologist for furture respiratory testing and lab testing as well. Again, everything are normal.

    He suddently stop breathing while he was working. He is a very normal man. The emergency room release him after he start breathing again and told him he has no problem nor even give him advice. Why did they do that, ask the hospital , who know?

    Last, according to his sympton , i assume that his blood is not circulate well which control by brain. I guess i just have to advice him to see neurologist.

    You are future docs and you don't know what to do. I feel sorry for whoever your future patients. I am undergrad but have a little knowledge about drug and how body systems work which help me to eliminate the bad docs and the death.

    Just think hard you will get it people. If everything normal , except headache sometimes and suddently stop breathing, the only thing you can think of is brain. Does brain control everything in the body? what about the cerebrum?

    Don't argue with me people. I just want to make this forum more valuable by bringing some strange case study to discuss. If you don't like ,this is it!

    I can't stand when see all future docs in here talk nonsens.

    Tiff.
    ps: anyway, Neurologist is the best doc for this man to come [​IMG]
     
  21. jawurheemd

    jawurheemd xx ToXiC xx

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    True, there are many neurologic disorders that can lead to profound respiratory depression and arrest including myasthenia gravis, MS, ALS, Guillan-Barre, etc. Usually, however, these disorders however don't resolve on their own with just oxygen. Please give us an update after he visits the neurologist. Also please don't insult me or any of the others on this board -- we have worked hard to get to where we are, and we have learned a lot. It is apparent from your posts that while you are very enthusiastic about medical knowledge and what you know about the medical profession, you still have a lot to learn in a number of areas. I wish you good luck in your endeavors and hope your friend does well.

    Sincerely,
    James
     
  22. alshepard

    alshepard Member

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    I advise that we ignore this thread. It is too reminiscent of the silver_eyess fiasco. Insulting, poor English, ignorant pre-med who somehow knows better than med students/residents/doctors...has she given us her measurements yet?
     
  23. Tiffany

    Tiffany Member

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    First, iam not insulting anyone here.
    Alshepard is very rude. I try to make this forum more interesting. Why did you said iam ignorant, poor-english...blah blah?

    I can learn medical stuffs in any language. I can't write english well doesn't mean iam idiot and only you, future doctor, smart. If you are smart why asked me why did i advise the man not to use inhaler.? Your question telling me that you know nothing. English is my second language.Ofcourse iam not perfect as you are but iam proud of myself because at least i can read and write 2 languages. How about you? Have you ever try to go to another country, learn their language, and sit in the same class, and taking the same tests with them? I DOUBT IT!

    I think you are in the wrong forum alshepard. We are here to learn to share opinion not to insult.

    I can say everything in your body control by your brain and I can even spell cerebrum, Iam better than you [​IMG]

    Don't use language to insult me. you are english native language and can't compare to someone who are not you should go to hell alshepard [​IMG]

    Anyway, I will have to take this man to neurologist and will let whoever interested know what's going on with him. But i think something wrong with his cerebrum, read cerebrum chapper and see how blood follow effect the respiratory system.

    Good luck people
    Tiff
     
  24. UHS03

    UHS03 Senior Member

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    I truly cannot wait to hear what the neurologist has to say about your diagnosis, although you may have to explain your theory in depth just in case the doctor is unable to put 2 and 2 together quite as easily as you can. In fact, if you boggle his mind the way you have boggled mine with your knowledge of human physiology, you are sure to get a great letter of recommendation to medical school!
     
  25. alshepard

    alshepard Member

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    Tiffany, my problem with your posts is not your poor grammar and spelling. If you truly are a non-native English speaker then I am sure you are familiar with your own language difficulties and don't need me to point them out. What put me off, and I'm guessing others as well, is your attitude. You say you are not insulting but that is incorrect. Phrases like "duh", "stupid", "talk nonsense" and stating that you feel sorry for our future patients are, in fact, insulting.

    You obviously have the answer to your question and occasionally give additional hints to us. If you did have an interesting case study why didn't you just say "hey, here's any interesting case for you" and let the discussion ensue? Instead you began it as a hypothetical and then after a few posts turned it into a real patient for whom you were requesting advice. Most of the posters on this site are not physicians and are therefore not qualified to treat patients. I know that I personally would feel quite uncomfortable finding out that I had been unwittingly offering treatment suggestions when I thought it was merely a hypothetical discussion. Thankfully, it seems the case has turned hypothetical again (or at the very least has already been resolved, since as I said, Tiffany already knows the answer.) I don't understand why this couldn't have just been a lively, straight-forward, informative discussion.

    Some of us on this board are a little wary of getting played again. In my previous post I said that it reminded me of another rather nasty, ignorant pre-med who happened to have very poor grammar. That is why your language skills were mentioned at all, only as further comparison to our fiesty and annoying silver-eyess.

    In response to some of your more direct attacks, no I have not yet studied in another country. I leave next month for an albeit brief, intensive language study program in another country to build upon what I began learning in college. My hope is that it will enable me to better communicate with my non-English speaking patients.

    I was not going to respond to this at all but I did not want anything I had written to be used to further prejudice on either side. You see, it is not your language skills or possible ethnicity that irritate me (but if it is easier for you to believe that, then go ahead.)

    As far as me burning in Hell, let's leave that up to God.



    [This message has been edited by alshepard (edited April 05, 2001).]
     
  26. Excellent response Alshepard. I could not have said it better myself.
     
  27. silver_eyess, did you move to silver_springss? [​IMG]
     
  28. Tiffany

    Tiffany Member

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    Who is silver-eyess? Iam Tiffany-girl-and new in this forum.

    Tiff
     
  29. silver_eyess was a formerly frequent poster who had a tendency to ask questions and then argue or disagree with the advice given. She had some of the same characteristics you seem to display - namely audacity to claim that she knew more about medicine than the medical students and physicians posting here. This is why some of the posters here see a similarity.
     
  30. Boomer

    Boomer Supreme Sooner Member

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    THEN WHY IN THE NAME OF ZEUS'S BUTTHOLE DID YOU ADVISE HIM TO STOP USING THE MEDICATION THAT A LICENSED PHYSICIAN PRESCRIBED?????!!! If you truly have no knowledge of "med stuffs" (which, based upon your postings, I believe), then YOU are putting this person in danger much more so than an inhaler....

    Why the hell do I even bother responding....guess I'm not busy enough....back to work.

     
  31. Tiffany

    Tiffany Member

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    GEZZZ, I think a lot of people in here are not real physician or never gone to medical school.

    Some of you are so rude, no maner, no proffessional at all. How could you be a doctor if you don't have any of the above? gezzzzzzzzzzzz.....

    I guess iam in the wrong forum. Your guys can show off as much as you can. Such a waste of time! whocares! Iam out of here.

    the knowledge does count
    The talk doesn't count

    BYE
    TIFF.
     
  32. lilycat

    Moderator Emeritus

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    Tiff, you definitely need to email Rayhana. I think you could find a lot of common ground...
     
  33. UHS03

    UHS03 Senior Member

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    Bye Tiff, Don't let the door hit ya....oh nevermind.
     
  34. Tiffany

    Tiffany Member

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    reading through, i think the only person in here really know what he is talking about is JAWURHEEMD in CT....Thank God! there are at least few real med students in here , the rest are just faking

    Tiff.
     
  35. Tiffany,

    Please refrain from accusing other members here of lying. The members that have answered your questions are physicians (congratulations on graduating Kim!), medical students, or entering medical students. In fact, you might bump into one of them (alshepard) at the University of Maryland Medical Center next time you bring your patient there. [​IMG]

    Stinky, MS IV

    [This message has been edited by Stinky Tofu (edited April 08, 2001).]
     
  36. Tiffany

    Tiffany Member

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    Really? don't scare me stofu [​IMG]))) you scare me to dead dear [​IMG]i think this is reallly\\ fun forum [​IMG])))This is the best forum for entertainment [​IMG])) especially faking physican like Kim is a good characteristic for the show [​IMG]))

    Tiff.
     
  37. caffeinegirl

    Physician

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    Why hello there again "Tiff",
    May I ask what is a "pseudo test"
    And what makes you think that not even having a bachelor's degree is equivalent to an MD and residency training? Me thinks you have been watching too much ER

    caffeinatedly yours
    [​IMG]
     
  38. Tiffany

    Tiffany Member

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    woops...pneumonia test [​IMG] ofcourse, bs can't compare to MD but BS is still better than MD FAKING...how's that sound?hm

    Tiff
     
  39. caffeinegirl

    Physician

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    Why hello again "Tiff"
    So I suppose that the family doctor your "case" went to is a "fake" doctor? And your B.Sc. is better than a licensed physician's experience?
    Things that make you go hmmmm
    caffeinatedly yours
    [​IMG]
     
  40. What if Tiffany=silver_eyess??? God, I've gotta go, my ears are smoking.
     
  41. Neurogirl

    Neurogirl Resident Extraordinaire

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    Tiff,

    First of all, there is no such thing as a pneumonia test. Secondly, if you're
     
  42. Winged Scapula

    Winged Scapula Cougariffic!
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    Thanks...that "fake" diploma hanging on my wall (ok...its still in its envelope waiting to be framed) looks pretty good as does my new LONG (yeah!!!) embroidered lab coat I've been wearing around the house. Hey...its my House Coat! [​IMG]

    Post #2 and going strong!!!


    ------------------
    PGY1
    Penn State University
    Department of Surgery

    [This message has been edited by Kimberli Cox (edited April 10, 2001).]
     
  43. Tiffany

    Tiffany Member

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    You are such an idiot Girl-neurogirl. I think you should change your username to idiotgirl instead of neurogirl. You are abusing medical terms here [​IMG]

    why does a doctor draw blood your into a green test tube (rather than lavender or red)and always have to keep the tube in the ice?

    Idiot..........neurogirl [​IMG] if you don't know , please ask!

    Kim, i don't care who you are..all i know you are not a real physican. IF you want to show up , show it to yourself not to me....

    Tiff<----has a good lafffffffffffffff [​IMG]
    [​IMG]
    [​IMG]
    [​IMG]
     
  44. Allright, this "Tiffany" person has got to be a joke, right??? MEAT, are you responsible?
     
  45. Mango

    Mango Very Senior Member

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    What's this green-top tube nonsense? I thought the best test for pneumonia was chest film? But I could be wrong, I'm just a pretend MS-1.

    Hey Kim, does the embroidery on your new coat say: Kimberly Cox, MD(wink, wink!). Is your stethoscope fake too? Do you even know what one is!!!! [​IMG]
     
  46. Winged Scapula

    Winged Scapula Cougariffic!
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    It sure does. Its beautiful - says
    Kimberli S. Cox, MD
    Department of Surgery

    There's a couple of pockets under the embroidery to put things like Green top tubes for my "pseudo tests"!

    Stethoscope? Heck, I threw that out once I matched. Everyone knows surgeons don't know how to use those things!!

    In case Tiff hasn't had the pleasure, I'll post a piccie here of me at work:

    [​IMG]



    [This message has been edited by Kimberli Cox (edited April 10, 2001).]
     
  47. Mango

    Mango Very Senior Member

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    This is funny as hell! Good One [​IMG]

    And to Tiff: in case you didn't know, it's uncommon in this country to allow strange women who claim to be doctors/med students into an OR to PERFORM SURGERY!

    Seems pretty strict, but that's the law!! [​IMG]

     
  48. Is this a joke??? Of all the pimping, abuse, scut work, and insults, this has gotta be the WORST INSULT EVER !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

    I wish I were Tiffany so I could shut myself up !!!! I might even consider swallowing some fluid from a green bottle labeled Drano. Hopefully, this will be the antidote for my pneumonia (the Tiffany strain). [​IMG] [​IMG]

    Sadly, she must be from the University of Maryland. You have to have a valid e-mail address to get your password. Her e-mail is listed as @umaryland.edu.

    ppdka, tell me you are kidding !!!! Otherwise, MEAT might have to break that bottle of champagne over your head!! [​IMG]

     
  49. Winged Scapula

    Winged Scapula Cougariffic!
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    I know at least 1 moderator she's written to asking for pre-med advice. He seems to believe she is "on the level" as far as being a real person. Hard to imagine that someone would post with their real name and email if they weren't going to be posting mostly positive things (or having already matched feel comfortable going wild, as in my case).

    I can verify that it IS NOT MEAT. Unless he's lying to me again..sorry sad %^$&#&**!! [​IMG]
     
  50. <as Saddam in South Park, BLU> Hey, relax guy. Look over here.

    No, MEAT, I never really thought you were Tiffany. I think it's almost impossible to fake this amount of stupidity. Just thought I might get a rise out of ya. [​IMG]

    Tiffany, I must urgently recommend that you go to the doctor and get some blood drawn. Tell him to use the vial with the fluorescent orange cap. This is the "absolute moron" test. If you test positive (which, judging by your symptoms, you probably will) you must be quarantined immediately.
     
  51. Tiffany

    Tiffany Member

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    hahahaha....good lafffffffffffffff.........NEXT TIME i will take a pix in er show or in the surgery room and post up here ....hahahahha

    FAKING DOC--------->KIM
    Tiff suggest KIM find something better in real life to do rather sit infront of computer all day long [​IMG] how about exercise? exercise is good for KIM's health reather drinking CO2 [​IMG] Hhahahahha

    Anyway people..i have a good laff [​IMG]
     
  52. Allright, at first this was really annoying but know I find it kinda sexy....

    Hey Tiff, you single???
     

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