Dr. Gustin's Blog

Ultrasound Gel Contaminated with Bacteria

Bacteria has a proclivity for finding any medium that can support its growth.  That includes the gel that is used by ultrasonographers to perform routine ultrasounds.  Normally the skin acts as a decent barrier against microbials but not always.  Staphylococcal organisms have a tendency to find their way through the skin barrier and can cause superficial or deep skin infections.  Sterile technique and good habits are necessary to prevent contamination of these biologic media.  The following report details the recently discovered contamination of ultrasound gel:

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Opiate Analgesic Deaths and Medical Malpractice

Opiates are prescribed regularly by physicians in all medical specialities for pain.  Patients frequently request opiates from their physicians when they are in pain.  Recent studies show a trend of increasing prescriptions.  Opiates, when taken in excess, or when they are taken on a regular basis, create addiction, by causing tolerance, that phenomenon where increasing doses of the medication are necessary to ameliorate the pain.  Opiate addiction increases the risk of overdose and death.  Opiate-related overdose and death has increased dramatically over the past few years, and now surpasses deaths from heroin and cocaine combined.  Physicans may be in violation of acceptable standards of practice by excessive prescribing and poor pain management practices.  The following study compares the use and abuse of opiate pain relievers by State.

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Emergency Rooms and New Stimulant Drugs

"Bath salts" are the latest designer drugs sending patients to the emergency department (ED). Unlike traditional bath salts that are added to bath water for a relaxing soak, these drugs, which can be ingested, inhaled, or injected, contain cardiovascular and central nervous system (CNS) stimulants such as 3,4 –methylenedioxypyrovalerone (MDPV) or 4-methylmethcarhinone (mephedrone). The drugs were initially sold over-the-counter under a number of different names. Patients using the drugs present to the ED with signs of acute stimulant overdose.

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Emergency Medicine Malpractice Avoidance

The following is a noteworthy article appearing in the Journal of Emergency Medicine, volume 41, issue 6, 2011.  Emergency physicians who have not had an opportunity to read it will find it helpful to their practice.  Because emergency medicine is a high risk speciality with regards to malpractice litigation, most emergency physicians adjust their practice so as to avoid situations that could lead to a medical malpractice lawsuit.  Moreover, most ER physicians live with a certain sense of unease because of the uncertainty and unpredictability of the emergency room environment, and the perception that it is just a matter of time before some adverse outcome leads to a lawsuit.  Read the article in its entirety.

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Emergency Rooms See Energy Drink Overdoses

With increasing frequency over the past 2 years, emergency departments have witnessed a sharp spike in visits related to energy drinks especially amongst teenagers.  These drinks are high in caffeine, sugar, and other herbal stimulants.  When combined with alcohol or illicit drugs, overdoses occur.  Read the article explaining the sharp increase of cases as well as the problems associated with this particular type of overdose.

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Problems Arising From Poor Patient Communication

Medical malpractice lawsuits frequently arise because of misundertandings, poor communication, and the reactive emotions that naturally follow. When patients become angry, they are apt to escalate the situation, magnify the problems or bad outcomes, and become predisposed to blaming the doctor or the hospital. Much litigation can be avoided if situations are de-escalated early.

There are ways to deal with such encounters in which you work with the angry patient and guide them through their emotions, and the accompanying volatility, to the point where it is possible to have a constructive, or at least manageable discussion with them.

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Can Vitamin Supplements Cause Death?

The following article is from a recent issue of Medscape. Vitamin supplements are ubiquitous and are commonly taking by people who want to be health conscious and maximally healthy. But not all vitamins and minerals are benign. The Medscape summarizes a recent study in the Archives of Internal Medicine. The citation appears at the end of this report. The study has serious public health implications.

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Substance Abuse: New DEA Emergency Ban for Bath Salts

Recently the DEA took emergency action to ban for one year bath salts that are composed of PABS, methylenedioxypyrovalerone, which is structurally and toxicologically related to pyrovalerone and a-pyrrolidinophenone compounds that inhibit norepinephrine-dopamine reuptake and act as central nervous system stimulants.  These salts are deadly, and are sold under the brand names:  Ivory Wave and Vanilla Sky.

Users take it orally, intranasally, intravenously, or rectally and achieve a high that is similar to methamphetamine.  It enhances alertness, increases energy, and is an aphrodisiac.  On the street, it is being called "legal cocaine".  

Doses as low as 3-5 mg will produce an effect.  The average dose ranges from 5 to 20 mg, and the risk for overdose is high because packages contain up to 500 mg.  In fact, it was the increase in overdose, emergency room visits, and death that prompted the DEA to take action.  Orally, absorption is rapid, and the rush (euphoria) that is produced peaks at 1-2 hours after ingestion, and the total effect lasts about 3-4 hours.

The physical effects of PABS include tachycardia, hypertension, arrhythmias, hyperthermia, seizures, stroke, myocardial infarction, and even death. Behavioral and mental effects include panic attacks, anxiety, paranoia, hallucinations, psychosis, aggressive or violent behavior (such as self-mutilation, suicide attempts, and homicidal activity), insomnia, anorexia, and depression.

Emergency treatment consists of benzodiazepams for sedation and IV fluids to prevent hypercatabolic rhabdomyolysis.  Metabolic acidosis, if present, is treated in the usual manner.

Click Here:  to obtain the New England Journal of Medicine article in PDF format

A Vaccine for Substance Abuse?

Can you imagine a vaccine that would eliminate smoking, cocaine, methamphetamine, heroin or opiate use?  Researchers are tantalizingly close to developing a vaccine that would permanently block those receptors that when stimulated by these and other substances of abuse provide the addictive euphoric and mind-altering effects.

Addicts would no longer be able to use and enjoy the effects of the substances they abuse.  The research is being headed by Dr. Janda at Scripps Research Institute.

To read the full NY Times article:  Click Here

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