Real Deal Medicine

How many things can cause Hoarseness?  Here are some pearls I picked up today.

• Cancer (esophageal/laryngeal) - Lasts longer than a couple weeks.
• GERD (Gastroesophageal Reflux Disease)
• Viral Pharyngitis (about a week)
• Allergies (usually short duration)
• Post Nasal Drip (see above)
• Overuse injury (like yelling or screaming)

When in doubt, try a PPI for GERD and consult Otolaryngology for laryngoscopy to rule out cancer.

How do you abort a migraine headache on a patient in the ER.  Here is one cocktail I encountered that worked well.

• IV Hydration NS Bolus 1000mL IV Over One Hour
• Toradol (Ketorolac) 30 Mg IV
• Decadron (Dexamethasone) 10 Mg IV
• Compazine (Procholperazine) 10 Mg IV Slowly
• Benadryl (Diphenhydramine) 25 Mg IV

Patient’s Headache resolved in 2 hours.

Here is what I learned today about Tension Headaches.

Description

• Usually a constant dull pressure, described like a “rubber Band” around the head or the head being put in a vice.
• Presents Bilaterally, usually around the Parietal area
• Occurs less than 15 days a month
• Typically lasts 4-6 hours

Causes of Tension Headaches

• Stress
• Muscle Spasm in Neck
• Eyestrain
• Caffeine Widthdrawl
• Sleep deprivation
• Hunger (missing a scheduled meal)

Treatment of Tension Headaches

• First Line:  Over the counter analgesics like tylenol, ibuprofen and aspirin.  Taking the aforementioned with caffeine may provide a positive synergistic effect in relieving the headache.
• Second Line:   Amitriptyline, Mirtazapine, or Toradol.
• Can also use Osteopathic Manipulation to the cervical region to relieve cervical tension.
• Biofeedback, sleep, and having the proper prescription glasses can also remedy the problem.

A small handful of things learned today on Type II Diabetes:

• Actos (pioglitazone) is contraindicated in patients with Congestive Heart Failure due to the fact that is promotes Fluid Retention on some patients.
• One of the best remedies for acute events of Hypoglycemia is drinking a glass of milk.  The lactose provides quick energy and the protein/fat content helps keep blood sugars elevated past 30 minutes post ingestion.
• Glucophage (Metformin) is the goto drug for new onset Type II Diabetes patients as it promotes weight loss, regulates blood sugars well and is relatively inexpensive.    One must warn of the diarrhea associated with the initial stages of taking the drug.
• Lantus Insulin is wonderful, it provides for a near steady-state 24 hour coverage for those who need blood sugar control who fail oral therapy.