Practice Updates


MDCalc App Launches for Android

Joe Habboushe, MD Leave a Comment Practice Updates

EBM is under attack. The Trump administration has signaled it will de-regulate the FDA, lowering the current threshold of safety & efficacy. This may bring us closer to the pharmaceutical disasters of the past: the children of Thalidomide, snake oil salesmen selling heal-all elixirs, Bayer’s invention & marketing of Heroin as a non-addictive cough suppressant, and more. They will argue higher FDA thresholds increase cost, while we know more evidence actually reduces cost – up to $1 Trillion per year1.

And us academics have become lazy. This week a third-year EM resident told me LOC is an absolute indication for a head CT. I pimped him on the Canadian CT Head Rule (CCHR), he seemed confused, looked it up, and then argued “well these tools always miss things so I don’t use them” [many tools do miss a few and yet are still useful, but CCHR essentially does not miss any,
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A Call to Use and Infuse High Dose Insulin! – Hyperinsulinemia Euglycemia Therapy (HIET) for Beta Blocker and Calcium Channel Blocker Toxicity

Jenny Beck-Esmay, MD Leave a Comment Practice Updates Tags: , ,

A 45-year-old male is brought into your resuscitation bay by EMS. He was found down, with empty prescription bottles for metoprolol, amlodipine and verapamil on his person. His heart rate is in the 30s and his blood pressure is 80s/40s. He is unresponsive but has palpable pulses. You intubate the patient, start IV fluids and give glucagon and calcium for the presumed beta-blocker and calcium-channel blocker overdose. You give several rounds of atropine in an attempt to correct the patient’s bradycardia, but nothing seems to be helping your patient. His blood pressure continues to drop and you are concerned you may have a cardiac arrest on your hands. You place a central line and start an infusion of norepinephrine, but see little to no improvement in the patient’s vital signs. What are you going to do?!

Beta-blockers and calcium channel blocker overdoses are associated with significant morbidity and mortality because they cause severe hypotension that is often refractory to traditional therapies.
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