SSRI Withdrawal

Posted 25 January, 2008 - 09:34 by steve

 This is a popular question in many medical exams I thnk. 

SSRI Withdrawal symptoms

SSRIs can cause withdrawal symptoms if you stop taking them suddenly or if your dose is reduced. The most common symptoms are dizziness, feeling sick, headaches, a feeling that the room is spinning, and numb or tingly feelings. Other withdrawal symptoms are sweating, anxiety and problems sleeping.

 

Paroxetine seems more likely than some other SSRIs to cause these problems. In one study, nearly two-thirds of people taking paroxetine had withdrawal symptoms when they stopped taking it.

Sodium Valproate Encephalopathy

Posted 17 January, 2008 - 14:01 by steve

A few cases have been seen. I will post more about it.

Palatal Myoclonus

Posted 17 January, 2008 - 14:00 by steve

In education meeting today, it was talked about Palatal Myoclonus. Patient may complained with some clicking sound from the mouth, which disappear on mouth opening.

When I googled, I found out more about it as follow.

 Palatal Myoclonus

Timothy C. Hain, MD

Please read our disclaimer. Most recent update: 5/14/00.

SIRS

Posted 6 December, 2007 - 15:49 by steve

Systemic Inflammatory Response Syndrome (SIRS) is defined as:

A. Temperature >38oC or < 36oC
B. Heart rate > 90 Beats/min
C. Respiratory rate >20 breaths/min or PaCO2 <32 mmHg
D. WBC count >12,000/mm3 , <4000/mm3 , or >10% immature (bands) form

The Hunt and Hess grades in SAH

Posted 4 December, 2007 - 15:19 by steve

 The Hunt and Hess scale grades SAH :

1. Asymptomatic or minimal headache + slight neck stiffness
2. Moderate or severe headache with neck stiffness, but no neurological deficit other than cranial nerve palsy.
3. Drowsiness with confusion or mild focal neurology
4. Stupor with moderate to severe hemiparesis or mild decerebrate rigidity
5. Deeply comatose with severe decerebrate rigidity.

Severity and mortality increase with grade.

Antibiotics Guidelines

Posted 21 November, 2007 - 14:23 by steve

DO     use antibiotic only when necessary. Antibiotics are drugs, with side-effects. 
DO     seek advice early rather than late in a seriously ill patient.
DO     give the antibiotic parenterally if the patient is seriously septic, unable to take it orally, or vomiting. 
DO     move from iv to oral antibiotic as soon as it is safe to do so (“switch” therapy) because iv lines can become infected e.g. they are a risk of MRSA bacteraemia.  
DO     stop the antibiotic as soon as possible, otherwise you waste money and risk toxicity and superinfection e.g. Clostridium difficile diarrhoea. Generally, antibiotic can safely be stopped when the patient has fully recovered for 48 hours. 
DO     DE-ESCALATE i.e. move to a narrower spectrum antibiotic as soon as the pathogen’s sensitivity is known e.g. pneumococcal pneumonia, patient improving on co-amoxiclav: move to iv benzylpenicilin or oral amoxicillin. 

Echocardiography images

Posted 4 October, 2007 - 13:34 by steve

I am preparing to do an audit about Echocardiography. I came across this webpage. If you're interested in echo images, click here.

The followings are some guidelines from American Heart Association (The clinical application of Echocardiography)

1997 guideline

Updated 2003 guideline

 

 

A patient in CCU

Posted 21 August, 2007 - 09:47 by steve

Last night on-call, a 63 year old lady came in with sudden onset chest pain which started when she went to loo at 3AM. The ambulance crew brought in to CCU directly as her ECG showed left bundle branch block. She was still in pain after 45 min of onset. She was haemodymically stable, but oxygen saturation 93% on 15 L. Air entry was reduced especially on left side. I thought it was due to poor respiratory effort because of pain. According to her she was an ex-smoker for 3-4 years. But husband said she did smoke 20/day until yesterday. He also added his wife had alcohol related cardiomyopathy although she gave me a history of occasional sherry drinker.

What is Single Assessment process?

Posted 17 August, 2007 - 21:27 by steve

My friend mentioned about Single assessment. So I googled. The following is the most approriate info I think

THE SINGLE ASSESSMENT PROCESS (SAP) was introduced in the National Service Framework for Older People (2001), Standard 2: person centred care. This standard aims to ensure that the NHS and social care services treat older people as individuals and enable them to make choices about their own care.

Person centred approaches are ways of commissioning, providing and organising services rooted in listening to what people want, to help them live in their communities as they choose. These approaches work to use resources flexibly, designed around what is important to an individual from their own perspective and work to remove any cultural and organisational barriers. People are not simply placed in pre-existing services and expected to adjust, rather the service strives to adjust to the person.

Addenbrooke's Hospital and me

Posted 11 August, 2007 - 09:21 by steve

Addenbrooke's Hospital

Recently, I had a chance to work for Addenbrooke's hospital in Cambridge. I would like to thank to Dr Carmichael, Dr Morrell and Dr Coggle for their supports.

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