Why Syntopical Reading Matters To Medical Literature The mark of a true subject matter expert is their in-depth knowledge of the literature pertaining to that subject. As these individuals will tell you their expertise is derived from years of reading and re-reading the content, then contemplating and challenging the assumptions and conclusions, and ultimately designing experimental models to test the robustness of the findings. It is important to recognize that the origins of their knowledge [...]

Three Ways To Develop A Health Reading Practice I believe it is a myth that medical professionals read medical literature casually. That is, with no purpose. They do not simply pick up The New England Journal and read cover-to-cover as if it were a novel. This fallacy, perpetrated by academic institutions is not a healthy nor effective way to keep your professional knowledge and skills up to par. So, that begs the question: how does [...]

Three rules for critiquing studies Modern evidence-based medicine fundamentally requires a continuous flow of new evidence. As obvious statements go, it’s still a reflection on our healthcare practice today. But with thousands of new articles published on a monthly basis, the task of simply keeping up on the literature can quickly become overwhelming. But it doesn’t have to. Although not specifically about how to read a scientific paper, “How To Read A Book” can teach [...]

Rodenticides And Other Large Animal Toxins Strychnine/Brucine Effects/MOA Glycine receptor antagonist on spinal cord PNS Clinical Manifestations Conscious seizures, until metabolic demands lead to AMS, multiorgan failure (renal, heart, brain, lung) MGMT/Notes Benzos, cooling, hydration, nondepolarizing NMB, urine alkalinization AC binds 1:1 so 1g/kg x 1 Effective management within first 6 hours is essential Rapid onset vs tetanus (which inhibits glycine release, not competitive antagonism) Professor Touery survived strychnine by also ingesting AC Mole/gopher poison [...]

Carbamates Organophosphates and Riot Agents Organophosphates Agents Dimethyl: azinphos-methyl, demeton-s-methyl, dichlorvos, dimethoate, fenitrothion, malathion, oxydemeton-methyl, parathion-methyl Diethy: Chlorpyrifos, diazinon, disulfoton, ethion, parathion, quinalphos diMethyl More important to give 2-paM Exposure Dermal exposure with the concentrated product or for prolonged periods of time. Volatility contributes to exposure: Dichlorvos > malathion Distributed in fat, liver, kidney, salivary gland => redistribute out, can have prolonged effects. Phosphorothioates (diethyl) may have delayed onset due to activation Clinical Manifestations PNS [...]

Metal Toxicity and Chelators Aluminum (Al) Source/Events Aluminum= Anticholinergic + seizures Foil (chasing dragon) Many medical sources (meds/HD fluids) Dialysis dementia Metalworking/refining “Potroom palsy” (pulm fibrosis similar to pneumoconiosis)  Organ/Toxicity Microcytic hypochromic resistant to iron (before CNS manifestations) Inhibits delta-aminolevulinic acid dehydrogenase leading to accumulation of erythrocyte protoporphyrins Central anticholinergic effect Neuro (acute/chronic) (interacts w ACh pathway in brain, anticholinergic effect) Encephalopathy, myoclonus and seizures - CAN BE DELAYED onset of days to weeks Transported [...]

Laws Acts and Agencies Hazardous Materials Incident Response International hazard classification system (IHCS) = Each hazard is assigned a 4 digit number know as the United Nations, North American or Product ID numbers - Displayed on vehicle placards Class 1 - Explosives Class 2 - Gases Class 3 - Flammable or combustible liquids Class 4 - Flammable solids Class 5 - Oxidizers and organic peroxides Class 6 - Poisonous materials and infectious substances Class 7 [...]

Hazards classification pictograms International hazard classification system (IHCS) Class 1: Explosives Class 2: Gases Class 3: Flammable or combustible liquids Class 4: Flammable solids Class 5: Oxidizers and organic peroxides Class 6: Poisonous materials and infectious substances Class 7: Radioactive substances Class 8: Corrosive materials Class 9: Miscellaneous Each hazard is assigned a 4 digit number known as the United Nations, North American or Product ID numbers - Displayed on vehicle placards NFPA 704- National Fire Protection Association - Fixed placarding Left to [...]

Carbon Monoxide Small increase in CO partial pressure leads to large increase in COHb.  When this occurs hemoglobin and O2 partial pressure may be normal = false normal readings of SpO2 CO also interacts with other small gaseous ligands (free radical nitric oxide). Accumulation of free radical NO leads to: Activation of NMDA Release of NE and AA Endothelial injury Neutrophil activation Lipid peroxidation CO binds to Cytochrome C oxidase => inhibiting ATP synthesis, generation [...]

Botulism and Clostridia Species Review Clostridia species and toxins C. botulinum produces serotypes A through H C. baratti → toxin F C. batyricum → toxin E C. argentinense → toxin G Clostridia species review Types Type A = West of Mississippi (0-7 day incubation) Typer B = East of Mississippi (0-5 day incubation) A/B process meat/vegetables - smells putrified E - ALASKA -> Raw fermented fish/animals (food looks and tastes NORMAL) (incubation 0-2 days) Most [...]