Unfortunately, the passover didn't go as well as I hoped.
I answered the question that I was asked to present, but I was then asked on how LAs actually work and about it's toxicity. So, that is my homework for today - to present tomorrow. I don't really mind actually, at least I will learn something.
I am oncall tomorrow.
Every call is a stress.
Every call is a challenge.
Every pre-call is a depressing day.
Anyway, I heard Ipoh was quite a happening place today.
I have no idea what happened.
I have no idea who is the MB, who is the government.
Our day in the hospital is no different.
Admissions, clerkings, discharges.
Life goes on as usual.
Just the other day, there was a news article about a 6 year old boy who probably died of Paracetamol (PCM) overdose.
Supposedly, the doctor prescribed 2 tablets of PCM to be taken 4 times a day.
I wonder how such a mistake could happen.
A 12 year old would probably generally know that kids take 1 tablet of PCM while adults take 2.
(As a doctor, you calculate the amount based on the child's body weight - 15mg/kg)
They have set up an inquiry for this case for now - let's see what happens next.
Have to study my LA now.
Till later!
Today, I learnt that carbon dioxide in the blood stimulates the respiratory system - the carbon dioxide drive; which means, that the reason we breathe is because of high carbon dioxide level in our blood stream.
However, as we live in a polluted world, by the time we get old, our body is almost resistant to carbon dioxide drive (I don't know why) and we depend on oxygen drive - which means that when there is low level of oxygen in our body, we breathe in more.
When someone has trouble breathing and we give them oxygen, then the oxygen drive does not work (as there is no hypoxia). And so, if we prolong the supplementation of the oxygen, we are basically not helping the patient as we are surpressing their oxygen drive.
(p/s the things that I learnt may not be very accurate, it is just what I understand from what I hear/read.
I answered the question that I was asked to present, but I was then asked on how LAs actually work and about it's toxicity. So, that is my homework for today - to present tomorrow. I don't really mind actually, at least I will learn something.
I am oncall tomorrow.
Every call is a stress.
Every call is a challenge.
Every pre-call is a depressing day.
Anyway, I heard Ipoh was quite a happening place today.
I have no idea what happened.
I have no idea who is the MB, who is the government.
Our day in the hospital is no different.
Admissions, clerkings, discharges.
Life goes on as usual.
Just the other day, there was a news article about a 6 year old boy who probably died of Paracetamol (PCM) overdose.
Supposedly, the doctor prescribed 2 tablets of PCM to be taken 4 times a day.
I wonder how such a mistake could happen.
A 12 year old would probably generally know that kids take 1 tablet of PCM while adults take 2.
(As a doctor, you calculate the amount based on the child's body weight - 15mg/kg)
They have set up an inquiry for this case for now - let's see what happens next.
Have to study my LA now.
Till later!
Today, I learnt that carbon dioxide in the blood stimulates the respiratory system - the carbon dioxide drive; which means, that the reason we breathe is because of high carbon dioxide level in our blood stream.
However, as we live in a polluted world, by the time we get old, our body is almost resistant to carbon dioxide drive (I don't know why) and we depend on oxygen drive - which means that when there is low level of oxygen in our body, we breathe in more.
When someone has trouble breathing and we give them oxygen, then the oxygen drive does not work (as there is no hypoxia). And so, if we prolong the supplementation of the oxygen, we are basically not helping the patient as we are surpressing their oxygen drive.
(p/s the things that I learnt may not be very accurate, it is just what I understand from what I hear/read.
2 comments:
In a small population of patients(1%) there is an IgE mediated hypersensitivity reaction while in the majority of the patients, the adverse reactions of LA occurs when the effects of LA becomes systemic. This occurs when the LA gains entry into a vessel(the injecting needle accidentally penetrates a vessel). Keeping this in mind, the adverse reactions of LA can found by extrapolating this concept. Two main systems that are mainly effected, are the CNS and the CVS. To counter the CNS toxicity, methods/drugs that reduce the cerebral metabolism oxygen consumption(CMRO2) is employed. The CVS toxicity is managed symtomaticly in uncomplicated cases.
In case of bupivacaine cardiac toxicity, Intralipids are used besides the standard resuscitative measures.
Thank you.
Some interesting facts regarding CNS toxicity of LA's.In regards to lidocaine (which inhibits Na+ channels) causing seizures; This is caused at lower concentrations, because a relatively selective depression of inhibitory neurons results in cerebral excitation, which may lead to generalized convulsions.Inhibition of inhibitory neuron = CNS stimulation = seizures. As concentrations increase, a profound depression of brain functions occurs at higher concentrations which may lead to coma, respiratory arrest and death.
Thank you.
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