Dr. Gustin's Blog

Emergency Room Treatment of Marijuana Psychosis

Marijuana is a commonly used drug.  In some states it is legal.  The following article appeared in the Western Journal of Emergency Medicine, and it describes the correct approach and standard of practice in the treatment of marijuana overdose resulting in psychosis in the emergency department.  The citation is noted at the bottom of the article.

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Surprising and Perplexing Med-Legal Verdicts

A recent article by Dr. Segal in Medscape discusses two defensible cases that resulted in surprising horrific outcomes for the two doctors who were sued.  There is a take home message and lesson to be learned embedded in these two cases.

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Ending Medical Malpractice Litigation

A Sensible Alternative to Our Broken System?

As every physician knows, our tort system is broken. Various solutions have been suggested over the years, only to fade away. But now, a promising new system for patient compensation in cases of medical error is being proposed in two states: Georgia and Florida. It makes sense for doctors and patients alike, and for our healthcare system as a whole.

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Dangers of Atarax (Hydroxyzine, Vistaril)

Physicians should take certain precautions in prescribing the first-generation antihistamine hydroxyzine to minimize the drug’s risk for potentially fatal heart arrhythmias, the European Medicines Agency (EMA) announced recently.

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Long acting opioids and increased risk of overdose

Long-acting opioids were associated with a greater than 2-fold risk for unintentional overdose compared with short-acting formulations, according to a cohort study published online February 16 in JAMA Internal Medicine. Moreover, the risk was more than 5-fold greater in the first 2 weeks of using a long-acting opioid.

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Breaking News: Dozens of Drugs to be Removed from the Market!

A committee of the European Medicines Agency (EMA) has just a few days ago recommended suspending the sale of roughly four dozen generic drugs that are used for conditions including diabetes, depression, and hypertension because they noted that their approvals were based on flawed clinical studies conducted only in India. The US Food and Drug Administration (FDA) has not yet taken action on the issue.  But they are in the process of reviewing this issue now.

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Another Statin Side Effect

Statins are one of the most popular drugs.  They reduce serum lipids implicated in producing cardiac and vascular disease.  Statins have side effects and are well-known, such as liver disease and muscle pain.  Now a new side effect has been discovered.

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Ecstasy Use Increases Dramatically

As Emergency Departments swell while suffering the repercussions of the Affordable Healthcare Act, our nation's youth increase their use of mind-altering drugs, in particular, Ecstasy (Mollys).

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Elevated Glucose in the ER

Over the past few years advancements have been made in the approach to, and management of, elevated blood glucose.  In the emergency room, elevated blood glucose (hyperglycemia) is commonly encountered.  Often times, patients who present with unrelated problems are coincidentally found to have elevated blood glucose.  Many emergency physicians dismiss this finding as a chronic finding and therefore, do not investigate further.  But this is a mistake that often results in an adverse patient outcome, and later a medical-legal inquiry and possibly a medical malpractice lawsuit.

Elevated blood glucose can be a tip-off that there are serious metabolic abnormalites present.  A detailed investigation is warranted in the ER because many of these patients are asymptomatic and will not seek follow-up medical care until they become symptomatic, by which time their condition may be far advanced.  The following review article on the approach to hyperglycemia in the ER is current and represents the standard of care approach to these patients.

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