Your ER Doc » trouble breathing

Botulism – Infants and Honey

Your ER Doc — Wed, 19 Nov 2008 18:23:34 +0000

A colleague recently saw a newborn child brought in with trouble breathing. He seemed to be trying to cry, but no noise was coming out of his mouth. He was very “floppy”- just no muscular tone at all. Because he couldn’t breath well, he needed to be put on a ventilator to keep his oxygen up. All the tests in the ER came back normal, so there was no explanation for the child behaving this way. He didn’t seem to have any serious infection such as pneumonia, or sepsis. The brain scan was normal. It turned out that the child was from out of the country, and the parents had given him some honey that may have been contaminated.

Laboratory tests showed this child had infant botulism, which resulted in paralysis, to the point where he couldn’t breath on his own. He had to be kept on a mechanical ventilator and admitted to intensive care, until the infection could be treated fully, but he did well, and gradually regained his strength.

About the use of an Epi-pen – mightier than the sword?

yourerdoc — Mon, 20 Oct 2008 17:31:39 +0000

My child has been diagnosed with severe allergic reactions to a number of foods including peanuts. We were told that we must keep something called an “Epi-Pen” on hand at all times in case she has a sudden reaction. What does this device do exactly and will it “cure” the reaction or just buy us some time to get her to medical attention like an emergency room?

Epi-pens are commonly prescribed to patients with a history of serious allergic reactions known as anaphylaxis. With anaphylaxis, patients may have trouble breathing, swelling, rash, dizziness, and it can get rapidly worse, and in some cases be fatal. These reactions usually occur after a patient is exposed to something they are allergic to, such as a bee sting, certain foods such as peanuts, or latex. ER doctors often prescribe the “Epi-pen” after seeing patients with anaphylaxis, because it is a very effective way to reduce these symptoms and allow patients time to get in to see a doctor or come to the emergency room.

The Epi-pen is given by the patient to themsevles, as a shot, and it releases a medicine called epinephrine. This decreases the allergic reaction, but beware, epinephrine does not “cure” it. The allergic reaction can come back after the epinephrine wears off. Therefore, it is important to seek medical care immediately with any serious allergic reaction, even if you have used an Epi-pen.

Allergy doctors prescribe quite a few Epi-pens, because they have been shown to reduce the chance of death from anaphylaxis, and it’s important to have these readily available, especially when immediate medical attention may be difficult to obtain. Anyone with a history of serious allergic reactions should see their primary physician as well, and consider follow up with an allergy specialist.

Financial Meltdown

Your ER Doc — Wed, 01 Oct 2008 03:29:53 +0000

The stock market stresses the heart and more

Q:

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.