Fault is supposed to be causative.

Thrombolytic therapy would not have made a difference because it takes more than a few minutes to prepare, and then it takes some time, typically more than 30 minutes, to work, this patient would have checked out pretty much regardless of speed of administration.

When your gene’s and lifestyle are a bad enough combination to have an MI at age 38 not much is going to save the patient. Let’s blame the primary doc for not screening him prior to his first MI.

“Regardless of the merits of the case, why do doctors always have to blame the lifestyle?”

We don’t, but sometimes shit happens and if you walk around it a lot you are more likely to step into it.

In the “The Textbook of Defensive Medicine” which is yet to be published and yet to be written, a patient 20 years old or over with chest pain and shortness of breath has either P.E., Acute M.I., Pnemothorax, Aortic Dissection, Pericarditis with pericardial effusion with tamponade, Pneumomediastinum, superior vena caval syndrome, or Atrial Myxoma and should be approached as such,so that the public or the plaintiff’s attorney or the family will not misconstrue that these diagnoses were not entertained during the first 5 minutes of the encounter. Do not give any medication such as Ativan or a device such as paper sack to suggest a diagnosis of trivial significance.

Was a cardiologist called at anytime during this?

Again, this is retrospective, and I’m a doctor not a sodomite so I don’t practice medicine retrospectively, but if the DOc gave a 38 year old Ativan, had the patient told him he had just used Cocaine? Ativan is the treatment for cocaine chest pain. When I was a resident I had a great attending who used to ask “How much cocaine did the patient use?” whenever I presented him a young person with chest pain. When I said “patient denies cocaine” he would say again, “OK, so how much cocaine did he use?” At my hospital any young person admitted for chest pain is tested for cocaine, even if they deny it. Approximately 25% test positive.

Sorry, I put the * in the wrong place.

“Cocaine differs from other local anesthetics in that it also binds to monoamine transporters and blocks the reuptake of catecholamines into the presynaptic nerve terminals. This results in a high degree of adrenergic activity and widespread toxicity. Alpha-adrenergic stimulation, which is largely due to norepinephrine, induces hypertension, whereas beta-receptor stimulation, which is largely due to epinephrine, commonly results in tachycardia (beta1 effect) and hypotension (beta2 vasodilation). Other factors, such as the generation of CNS-excitatory amino acids (glutamate and aspartate), may play a role in CNS hyperactivity and cardiovascular pathology.
Beta-blockers, in general, are best avoided in the setting of cocaine toxicity because they may result in unopposed alpha effects of cocaine.

“Beta-blockers have been reported to increase the blood pressure, reduce coronary blood flow, reduce left ventricular function, and reduce the cardiac output and tissue perfusion in patients with cocaine toxicity. Furthermore, in animal models of cocaine toxicity, beta-blockers have been associated with an increased risk of seizures and an increased mortality.

“Benzodiazepines have been shown to be effective in the treatment of cocaine-induced hypertension, with or without chest pain or tachycardia.

“When benzodiazepines fail to control hypertension, vasodilators, such as nitroprusside and nitroglycerin, are effective in controlling the blood pressure. If a contraindication to nitrate therapy exists, alpha-blockers, such as phentolamine, which block the vasomotor effect of norepinephrine, may be used.from emedicine.com

-Your friendly neighborhood med student

To the med student: EKG’s can be remarkably unhelpful in Cocaine chest pain. Patients can come in with obvious ST elevation MI’s and if they’ve been using cocaine it can be just vasospasm. That’s why its important to get a tox screen in these patients, since they are known to lie about their cocaine use (this has been studied, it’s not a patient insult)

When you say thrombolytic therapy, are you talking about tPA? As far as I know, tPA is the only thrombolytic thats FDA approved. Or does that include clopidogrel, or the experimental drugs like desmoteplase?

tPA has a freaking huge laundry list of inclusion and exclusion criteria. Its NOT a routine drug to administer and few people, evne if they are having an MI, qualify for it.

If this case is about failure to deliver tPA, there’s no way it should have ever gotten past initial review. Just to go thru the inclusion/exclusion criteria requires more than “several minutes”

I think we all agree that the lawsuit is ludicrous (except the sodomites and their concubines, diora and cathy and sarah w)but the question is how do we protect ourselves from this type of thing until we can save enough money to retire and take care of our families…I think the answer is cardiology should be called immediately and the call documented, and treat chest pain aggressively (beta-blocker, ntg, asa) and document all of it…chest pain should be triaged to the acute area and dealt with immediately…

it would take a few minutes to arrange this, write orders and then you can return to giving lidocaine, amio, ambu-bagging the code and take over from the residents or nurses…

anon 11:07,

“A concubine of the sodomites” Is that what you just called me? I have not posted even one response to this post. I know NOTHING about this topic. I have just been reading it. Are you so angry that I sign my posts that now I must be siding with the Lawyers? I guess you missed my post where I told him he wouldn’t want me in his malpractice lawsuit.

Does it now mean if someone actually owns their work (by signing in) it gives cause to attack? BTW, are you VS?

As one of the alleged “sodomites”, I’m curious – how does one maintain a concubine?

CJD

after taking cocaine on a daily basis for the last month, I’ve used ativan a couple of times to come down in the evenings, is this safe?