The Cocaine Mule

The Cocaine Mule

This morning, I was contacted by the emergency department. We had a patient who came in with severe agitated delirium to the point that no combination of sedative and anti-psychotic medications could control him and keep him from harming himself or ER staff members. Ultimately, he had to be intubated and placed on continuous IV sedatives. It reminded […]

An Epidemic Of Endocarditis

An Epidemic Of Endocarditis

Last week, I was called about triaging a patient to the intensive care unit. A 38-year-old woman had come to a rural Ohio hospital emergency department with sepsis and chest x-ray changes that looked like septic emboli. She uses intravenous heroin. The opioid epidemic in the U.S. has primarily received a lot of press because […]

Living Longer Or Dying Longer

Living Longer Or Dying Longer

Much of my clinical practice is in the intensive care unit. Currently, health care costs Americans 17.5% of the gross domestic product and ICU costs account for about 4% of health care. Therefore, I practice in a service area that accounts for nearly 1% of the gross domestic product of the United States. Therefore, it […]

2,3-DPG Is A Wonderful Thing

Yesterday, I responded to a code blue in one of the procedural areas of our hospital. The patient had severe hypoxemia due to flash pulmonary edema from combined systolic + diastolic heart failure and then had an IV dye load that tipped him over into pulmonary edema. He had a previous tracheostomy and still had […]

BRAVE New World In the ICU

Glucometers are one of the most common medical devices in use today. They cost about $20 or $30 to buy at the drugstore and every nursing station and doctor’s office has one. Most of the time, they work great and are very accurate to measure the blood glucose level by pricking the skin to obtain a […]