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Narrative as Rhetoric and the Art of Medicine
Published in James Phelan, Narrative Medicine, 2023
Assessment: 44-year-old male with typical chest pain without syncope. Differential diagnosis includes ischemic heart disease (stable angina); medication side effect; caffeine side effect; acute anxiety episodes; cardiac dysrhythmia.
Positional Traumatic and Restraint Asphyxia
Published in Burkhard Madea, Asphyxiation, Suffocation,and Neck Pressure Deaths, 2020
In conclusion, the mechanism of death may be a fatal cardiac dysrhythmia or respiratory arrest induced by the interaction of several factors resulting in an imbalance of increased oxygen demand and decreased oxygen delivery. Psychiatric or drug-induced stress of agitated delirium coupled with police confrontation generates catecholamine mediated stress (heart). The hyperactivity associated with excited delirium, struggle with the police and ventilatory work to overcome the restraint increases the oxygen delivery demands. Finally, the hog-tied position inhibits chest wall and diaphragmatic movements, thus impairing ventilation in a situation of high oxygen demand [13].
The Long-Term Effects of Beta Receptor Agonist Therapy in Relation to Morbidity and Mortality
Published in Richard Beasley, Neil E. Pearce, The Role of Beta Receptor Agonist Therapy in Asthma Mortality, 2020
Colin S. Wong, Anne E. Tattersfield
Greenberg55 reported the sudden deaths of eight asthmatic patients known to have overused their sympathomimetic inhalers, proposing that the mechanism of death was cardiac rather than respiratory. The only evidence to support this was ventricular tachycardia in the one patient in whom electrocardiographic recordings were available. Most asthma deaths occur outside hospital, and autopsy cannot determine whether or not a cardiac dysrhythmia has contributed to death. There are several anecdotal reports of cardiac dysrhythmias associated with beta agonists56 but despite a close temporal relationship in some instances a coincidental association is always possible.
Myasthenic crisis as an initial presentation of myasthenia gravis in an 81-year-old following endoscopic myotomy for Zenker’s diverticulum
Published in Baylor University Medical Center Proceedings, 2023
Daniel Tran, Lucas Fair, Bryana Baginski, Bola Aladegbami, Steven Leeds, Marc Ward
In patients presenting in myasthenic crisis, airway support is paramount for optimal outcomes. Patients with appropriate mentation and secretion management may be candidates for noninvasive positive pressure ventilation or bilevel positive airway pressure. Intubation can be performed if necessary, and decisions regarding this are similar to those for other critically ill patients. Once a patient with myasthenic crisis is stabilized, further evaluation can be performed to evaluate for triggers. Infectious evaluation may include a chest radiograph, complete blood count, urinalysis, and blood cultures. As metabolic abnormalities can result in crisis, electrolyte levels and thyroid function tests should be checked. Pregnancy can precipitate crisis, and beta-human chorionic gonadotropin levels should be obtained in females of childbearing age. Creatinine kinase levels can be measured to evaluate for other myopathies. Electrocardiography is useful in evaluating a cardiac dysrhythmia or a toxicologic etiology. Arterial or venous blood gases may not be useful for diagnosing crisis, but can help with ventilator management. Plasma exchange and intravenous immunoglobulin are the primary treatments for myasthenic crisis.12 If the trigger is identified, the underlying cause should be treated concurrently.
The association of cannabis use and cardiac dysrhythmias: a systematic review
Published in Clinical Toxicology, 2020
John R. Richards, Eike Blohm, Kara A. Toles, Angela F. Jarman, Dylan F. Ely, Joshua W. Elder
There were 16 Level II clinical studies identified in our review in which heart rate greater than 100 beats per minute and/or cardiac dysrhythmia was noted, and these are discussed in chronological order (Table 1). The first study was published in 1971 by Johnson and Domino [4], in which 25 subjects smoked cannabis and experienced dose-related tachycardia as high as 150 beats per minute that persisted for several minutes. Two subjects were noted to have premature ventricular contractions and T wave changes. This was followed by a study by Beaconsfield et al. [5] in which ten subjects who smoked cannabis were noted to experience tachycardia, with five also having P and T wave changes. The next two studies demonstrated increased heart rate with both smoked cannabis and oral THC administration but no mention of electrocardiogram (ECG) abnormalities [6,7]. The two studies which followed in 1973, however, did include descriptions of ECG irregularities in addition to tachycardia associated with cannabis administration. Kochar and Hosko [8] reported ingestion of oral THC at higher doses resulted in tachycardia in six of seven subjects, T wave changes in two subjects, and ST segment elevation in one subject. In their study of 10 subjects, Roth and co-workers [9] reported overall tachycardia, premature ventricular contractions in four subjects, and sinus arrhythmia in two subjects.
Ultrasound Guidance Enhances the Efficiency of Brachial Plexus Block and Ameliorates the Vascular Injury Compared with Nerve Stimulator Guidance in Hand Surgery Patients
Published in Journal of Investigative Surgery, 2020
Liandi Li, Yanjing Zhao, Ling Guo, Xie Lv, Guanghao Yu
Axillary brachial plexus block may trigger complications such as infection or bleeding as any other procedures, which associate with the disruption of the integrity of the body and skin [29]. In addition, there is a higher risk of complications relevant to bleeding in patients treated with anticoagulant agents [30]. Complications related to axillary brachial plexus block also include local anesthetic toxicity caused by either intravenous or intra-arterial injection [31]. Serious central nervous symptoms such as central nervous system depression, epileptic seizure, and coma may be caused [32]. In addition, local anesthetic toxicity may cause various cardiovascular effects including the impairment of the capacity to pump blood through the circulatory system caused by the decelerate of the heart rate, which might eventually induce circulatory collapse [33]. Cardiac arrest, cardiac dysrhythmia, and death may also occur in many severe cases [34]. Persistent paresis of the phrenic nerve and pneumothorax are also rare but severe complications of axillary brachial plexus block [35]. Based on our study, the production of ROS, NO, and NOS were significantly decreased by ultrasound guidance when compared with nerve stimulation guidance, suggesting that ultrasound guidance causes less vascular damage in patients. Moreover, pro-inflammatory cytokines such as TNF-α and MCP-1 were significantly alleviated by ultrasound guidance. These findings might give a hint that ultrasound guidance is less likely to cause complications than nerve stimulation guidance in patients undergoing axillary brachial plexus block.