From the monthly archives:

September 2008

The stock market stresses the heart and more

The stock market stresses the heart and more






Can anxiety from the economic meltdown cause a heart attack?



The fact that we are not seeing 1000 heart attacks per day probably means that this economic meltdown is not actually causing heart attacks directly. But are we seeing more anxiety problems and panic attacks? You bet! Any ER doctor will tell you that anxiety is a big component of our work, mostly because people get concerning symptoms with anxiety such as chest pain, trouble breathing, numbness, tingling, palpitations, and the like. It can actually be difficult sorting out which patients are just anxious and which ones have a true medical problem going on, and often times, some tests are in order.

I remember working in Los Angeles after the Northridge earthquake, and many people came in with severe anxiety, trouble sleeping, chest pain, etc. The financial problems going on right now are absolutely causing people stress, and we are seeing them in the ER regularly. I’m always happy when I can tell patients that their symptoms are not due to a major medical problem, but unfortunately it doesn’t do much for their financial woes.  I also feel that stress, in general, can cause long term health problems, if not managed appropriately.



Word has it that the Chinese milk poisoning – containing the stuff called Melamine , used to make plastics and fertilizer, and is making babies sick in China has spread into the USA. Have you seen this in your ER? What signs should a parent look for if they have fed this formula to their baby?


Fortunately, I have not seen or heard of a case of melamine poisoning in any emergency department locally. My understanding is that the melamine was added to milk products in Chinese factories only, apparently to make the milk appear to have more protein. There have been multiple recalls associated with this problem, and many Chinese children have been sickened by it, but no children in the United States. One of the biggest concerns is infant formula that is produced and sold in China. The FDA states that no manufacturer or distributor of infant formula in the US are getting their milk products from Chinese manufacturers, so they should be safe. However, there is concern that some illegal formulas sold at ethnic stores could be contaminated. Obviously these should be avoided. More information can be found here as well.



“How do I know if I’m having a stroke?”


Excellent question, and actually can be difficult to answer.  Sometimes a stroke is obvious—Completely weak on one side of the body, facial droop on one side, trouble talking.  I think most people would recognize these symptoms and act on them.  Often times, however, I have patients with less classic symptoms who think they have had a stroke.  Confusion, weakness, dizziness, headache, all can be part of a stroke, but sorting it out usually requires a trip to the ER.

To simplify this, the American Academy of Neurology has created a

simple stroke diagnostic aid “Give-Me-Five.”

simple stroke diagnostic aid “Give-Me-Five.”

Walk—Is the patient’s balance off?

Talk—Is the speech slurred or face droopy?

Reach—Is one side weak or numb?

See—Is the vision all or partly lost?

Feel—Is there a severe headache?


If the patient appears to have had a stroke, or it is unclear, the best bet is calling 911, and getting checked out in the ER.

Stroke is the 3rd leading cause of death in the US, and also a huge cause of disability.  Preventing stroke is the key, but if a stroke occurs, prompt medical attention can lessen the damaging effects.


Arriving at The ER

Arriving at The ER

“Trauma code, ETA 5 minutes.”  My pulse always goes up a little bit with these radio notifications, but in this particular case it went up more than usual.  The paramedic said it was a train versus pedestrian, no other information given.  I could hear the siren in the background and a definite anxiousness in the paramedics voice.  He didn’t have time to give us vital signs–not good.

I walked to the ambulance bay, opened the doors, and waited.  The ambulance came in fast, the driver wasting no time backing up and throwing the back doors open.

“She had a pulse, and a blood pressure, I’ve got an IV started, but no airway, she was talking to us a few minutes ago,” the paramedic fired off.

We all helped pull the gurney into the resuscitation room, and I took a look.  She was about 30, laying flat on her back, eyes closed, clearly not conscious.  I couldn’t see any sign of trauma on her head, chest, abdomen or extremities, but there was quite a bit of blood coming from somewhere.  It was pooling on the gurney.

I quickly put a plastic tube down her windpipe as the nurses tried to get vital signs, and started CPR.  Her blood pressure was completely gone, no pulses at all.  She had died.  We rolled her on her side to examine her back, and found the problem.  The back of her hips, pelvis and lower back were simply gone, somehow torn away from her body when she was hit by the train.  What remained of her blood volume poured out of the wound, and onto the gurney and floor.

Later, we found out from a roomate that it was probably suicide, and that she had been fighting depression.  She had stopped taking her medication.  No one came to the hospital.  No family, no friends.

I picked up the next patient’s chart and moved on.  It was a 20 year old man with an ingrown toenail.  He let me know he was very irritated to have been waiting for me.


Your ER Doc – coming in October 2008!