my first intubation!!!

[amyl]

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Well I got my step one score back today I got a 222....not the 247 i got on the test at the usmle website (i knew that test was bs), more like the 221 I got on the nmbe practice test. I was hoping for better but as long as it is good enough to get into a decent anesthesiology residency I am happy. Hopefully they understand how tough it was to go back at the end of third year and study all that biochem and stuff again. Thanks everyone for all the advice and support.
On another exciting note, i intubated my first patient today...on the first try! i know it makes me a nerd but i was soooo excited. She may turn out to be a super interesting case... 66yo female from nursing home presents with axillary temperature of 106, tachypneic, hypotensive and altered mental status. didn't believe rescue with that 106 so did a rectal temp in the ER.....108!
chest xray clear, amazingly no decubiti but candida, curiously ABG showed mild respiratory alkalosis. waiting on cultures, etc. ER doc kept saying "it may be malignant hyperthermia" but I think she meant neuroleptic malignant syndrome (but i didn't correct her -- her meds included seroquel and zyprexa and no surgery lately -- can anything else cause MH besides sux and inhaled anes?). I wanted to stay and follow the case but i had been on for 30h and my hospital won't let med students stay longer but i will find out what it was tonight.

 

[VentdependenT]

Well I got my step one score back today I got a 222....not the 247 i got on the test at the usmle website (i knew that test was bs), more like the 221 I got on the nmbe practice test. I was hoping for better but as long as it is good enough to get into a decent anesthesiology residency I am happy. Hopefully they understand how tough it was to go back at the end of third year and study all that biochem and stuff again. Thanks everyone for all the advice and support.
On another exciting note, i intubated my first patient today...on the first try! i know it makes me a nerd but i was soooo excited. She may turn out to be a super interesting case... 66yo female from nursing home presents with axillary temperature of 106, tachypneic, hypotensive and altered mental status. didn't believe rescue with that 106 so did a rectal temp in the ER.....108!
chest xray clear, amazingly no decubiti but candida, curiously ABG showed mild respiratory alkalosis. waiting on cultures, etc. ER doc kept saying "it may be malignant hyperthermia" but I think she meant neuroleptic malignant syndrome (but i didn't correct her -- her meds included seroquel and zyprexa and no surgery lately -- can anything else cause MH besides sux and inhaled anes?). I wanted to stay and follow the case but i had been on for 30h and my hospital won't let med students stay longer but i will find out what it was tonight.

Neuroleptic Malignant Syndrome

 

[proclivity]

Well I got my step one score back today I got a 222....not the 247 i got on the test at the usmle website (i knew that test was bs), more like the 221 I got on the nmbe practice test. I was hoping for better but as long as it is good enough to get into a decent anesthesiology residency I am happy. Hopefully they understand how tough it was to go back at the end of third year and study all that biochem and stuff again. Thanks everyone for all the advice and support.
On another exciting note, i intubated my first patient today...on the first try! i know it makes me a nerd but i was soooo excited. She may turn out to be a super interesting case... 66yo female from nursing home presents with axillary temperature of 106, tachypneic, hypotensive and altered mental status. didn't believe rescue with that 106 so did a rectal temp in the ER.....108!
chest xray clear, amazingly no decubiti but candida, curiously ABG showed mild respiratory alkalosis. waiting on cultures, etc. ER doc kept saying "it may be malignant hyperthermia" but I think she meant neuroleptic malignant syndrome (but i didn't correct her -- her meds included seroquel and zyprexa and no surgery lately -- can anything else cause MH besides sux and inhaled anes?). I wanted to stay and follow the case but i had been on for 30h and my hospital won't let med students stay longer but i will find out what it was tonight.

congratulations on your first intubation! sounds like it was fairly emergent as well....your first intubation and it was under considerable duress.......if you get your residency...you'll be at 50 before you know it.

 

[W222]

Well I got my step one score back today I got a 222....not the 247 i got on the test at the usmle website (i knew that test was bs), more like the 221 I got on the nmbe practice test. I was hoping for better but as long as it is good enough to get into a decent anesthesiology residency I am happy. Hopefully they understand how tough it was to go back at the end of third year and study all that biochem and stuff again. Thanks everyone for all the advice and support.
On another exciting note, i intubated my first patient today...on the first try! i know it makes me a nerd but i was soooo excited. She may turn out to be a super interesting case... 66yo female from nursing home presents with axillary temperature of 106, tachypneic, hypotensive and altered mental status. didn't believe rescue with that 106 so did a rectal temp in the ER.....108!
chest xray clear, amazingly no decubiti but candida, curiously ABG showed mild respiratory alkalosis. waiting on cultures, etc. ER doc kept saying "it may be malignant hyperthermia" but I think she meant neuroleptic malignant syndrome (but i didn't correct her -- her meds included seroquel and zyprexa and no surgery lately -- can anything else cause MH besides sux and inhaled anes?). I wanted to stay and follow the case but i had been on for 30h and my hospital won't let med students stay longer but i will find out what it was tonight.

Haldol and other antipsychotics can also cause NMS. I have heard of one M&M case where NMS was due to the patient being given haldol to calm them during an episode of ICU psychosis. Also, you may want to check the nursing log at the outside facility for any additional meds. I know it hasn't been backed up as far as I know but Zofran works on serotonin receptors and pharmacy at our hospital always warns that Zofran cannot be given with SSRIs, of which it appears your patient was on. Your patient may have been having an episode of Serotonin syndrome.

 

[fakin' the funk]

Haldol and other antipsychotics can also cause NMS. I have heard of one M&M case where NMS was due to the patient being given haldol to calm them during an episode of ICU psychosis. Also, you may want to check the nursing log at the outside facility for any additional meds. I know it hasn't been backed up as far as I know but Zofran works on serotonin receptors and pharmacy at our hospital always warns that Zofran cannot be given with SSRIs, of which it appears your patient was on. Your patient may have been having an episode of Serotonin syndrome.

I'm gonna be picky here.

"-setrons" = 5HT3 agonists
olanzapine, quetiapine = partial dopamine antagonists, mixed 5HT1/5HT2 agonists/antagonists, not SSRIs

So...why can't ondansetron be given w/ SSRIs?

 

[W222]

I'm gonna be picky here.

"-setrons" = 5HT3 agonists
olanzapine, quetiapine = partial dopamine antagonists, mixed 5HT1/5HT2 agonists/antagonists, not SSRIs

So...why can't ondansetron be given w/ SSRIs?

The argument is that the pharm between these drugs is not "pure" and some argue Zofran could act to stimulate 5HT3 receptor at a low level and lead to serotonin syndrome. I am only saying its is a theory that has come up with the pharm people when I have tried to order zofran for those on SSRIs. Also, olanzapine has action at 5HT3 receptors.
See here:
http://psy.psychiatryonline.org/cgi/reprint/42/3/258.pdf