AM Report Pearls: Cheyne-Stokes Breathing & Fun Fish Poisoning Review!

AM Report Pearls: Cheyne-Stokes Breathing

  • Pathophysiology: Delay b/w changes in ventilation & detection of PaCO2àcyclical pattern
    • But why delay? Long time frm lung to brain, hypoxia, hypercapnia, increased ventilator drive by CNS
  • Who gets it? CHF, Neuro dz (Strokes, CVAs, Parkinson’s disease), normal sleep, acidemia, premature babies, altitude, hypoxic brain injury
  • How to dx? Sleep study or can just see on the RR monitor!
  • How to tx? Treat the underlying cause…but CPAP/O2 may help attenuate but does not affect survival (see this NEJM article: http://www.nejm.org/doi/full/10.1056/NEJMoa051001)

AM Report Pearls: Fun Fish Poisoning Review!

  • Attached is a super fun article on a review of all seafood-acquired toxidromes/poisonings
  • Viral causes:
    • Hepatitis A virus – contaminated clams & oysters
    • Norwalk virus – ask about cruise ships & shellfish consumption
  • Bacterial causes:
    • Vibrio cholera – especially in endemic areas & there have been outbreaks related to crabs & oysters
    • Vibrio vulnificus – contaminated oysters
    • Clostridium botulinum – can be seen after fish egg ingestion
  • Parasitic causes:
    • Giardia lamblia – watery diarrhea associated with freshwater exposure
    • Diphyllobothriasis/fish tapewarm
  • Ciguatera poisoning
    • Most common reported fish-borne illness worldwide! Can have neuromuscular symptoms!
  • Scombroid poisoning
    • Also common and mistaken for fish “allergy” with flushing, headaches, dizziness and GI sx
  • Miscellaneous: Tetrodotoxication (puffer fish toxicity), neurotoxic shellfish poisoning, & paralytic shellfish poisoning!
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