Medicine Hack

No guidelines have suggested that Angiotensin Converting Enzyme Inhibitors (ACEI) and Angiotensin Receptor Blockers (ARB) can be given together. Yet in practice, well i should say malpractice, many doctors do prescribe both simultaneously. This is not good at all since recent trials have shown that using both together doubles the risk of hyperkalemia and doubles the level of creatinine and risk of developing ESRD within 6 months of bi therapy.

It is a benzodiazepine receptor antagonist. It acts by binding with high affinity to specific sites on the GABA receptor and thus competitively antagonises the binding of the benzodiazepine e.g. diazepam. In a case of overdose, a cumulative dose of 1-5 mg I.V given over 2-10 minutes should respond well. If sedation reappears then additional course can be repeated after 20-30 minutes.

This phenomenon has not been given its due importance. Many of us surely know the term 'White Coat Hypertension'. The latter refers to an increase of up to 20 mm Hg in the systolic blood pressure of the patient if a doctor is taking the B.P measurement. 'White Cap' actually refers to the cap of the nurses. It was compulsory in the 1980s and still worn in many settings. It was seen that when nurses take the B.P then also there was an increase of up to 10 mm Hg of the systolic blood pressure compared to a home setting. Since in our setting it is the nurse who takes the B.P measurement, then the above named term is more appropriate. Also another conclusion from this is that doctors are scarier than nurses. :-)

Various formulas exist to estimate the body surface area, the simplest one being that published by Mosteller in the NEJM in 1987. The formula goes like this. . . The refe rence value for an adult is considered to be 1.73  m². A proteinuria of at least 3.5 g/ day/1.73  m² BSA   is considered diagnostic for nephrotic syndrome. 

The scoring system used is the ABCD score. A - Age : 1 pt for age > 60 yr B - Blood pressure : 1 pt for B.P > 140/90 mmHg C - Clinical features : 1 pt for speech disturbance without weakness,                                  2 pts for unilateral weakness D - Duration of symptoms : 1 pt for 10-59 min,                                           2 pts for > 60 min       Diabetes : 1 pt if present. Low risk : 0-3 pts Moderate risk : 4, 5 pts High risk : 6, 7 pts

A Short History of Medicine 2000 B.C. - "Here, eat this root." 1000 B.C. - "That root is heathen, say this prayer." 1850 A.D. - "That prayer is superstition, drink this potion." 1940 A.D. - "That potion is snake oil, swallow this pill." 1985 A.D. - "That pill is ineffective, take this antibiotic." 2000 A.D. - "That antibiotic is artificial. Here, eat this root."

A doctor must work eighteen hours a day and seven days a week.  If you cannot console yourself to this, get out of the profession. :)