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!