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RE: EMS Challenge (2) Hint #1

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If it's an actual lithium OD, I have. My patient was in cardiac arrest, though.

Sodium bicarb brought back ROSC, probably because of the chemistry of it binding

at the electron level with the positive lithium ions.

Wes Ogilvie

Sent from my iPad

> yes, Wesley, I am jerking your chain again....I'm sure that you have seen

> this condition before.

>

> ck

>

>

> In a message dated 6/13/2010 19:35:48 Central Daylight Time,

> krin135@... writes:

>

> I'm waiting for Wes to chime back in. I jerked his chain pretty hard

> earlier, so I'm betting that he's been doing some research. I'd wait at

> least

> another half hour.

>

> I'm also waiting for someone to ask the obvious question, about how

> closely

> you and I are working together...some of them know how devious I can be...

>

> ck

>

> In a message dated 6/13/2010 19:33:09 Central Daylight Time,

> _amwoods8644@..._ (mailto:amwoods8644@...) writes:

>

> Think it's time for another hint?

>

> Alyssa Woods, FF/NREMT-B

>

> On Jun 13, 2010, at 6:57 PM, _krin135@..._ (mailto:krin135@...)

> wrote:

>

> > chuckle...then you are missing something.

> >

> > Even without inside knowledge, I can reasonably predict that while the

> > lithium levels may be elevated to a toxic (a common side effect of the

> > medication and dehydration), the Tums didn't cause her acute problem.

> >

> > and if you were to persist in treating the patient *just* for lithium

> > toxicity, you will miss a life threatening complication that is

> > staring you in

> > the face.

> >

> >

> >

> > ck

> >

> >

> > In a message dated 6/13/2010 18:50:08 Central Daylight Time,

> > _rob.davis@..._ (mailto:rob.davis@...)

> writes:

> >

> > On Sunday, June 13, 2010 18:18, __krin135@..._

> (mailto:_krin135@...) _

> (mailto:_krin135@..._ (mailto:krin135@...)

> > )

> > said:

> >

> > > OH? and what was your diagnosis?

> >

> > Too early to spoil the whole shebang yet. But someone should have

> > told her

> > to lay off the Tums while taking Li.

> >

> > Rob

> >

> >

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Guest guest

If it's an actual lithium OD, I have. My patient was in cardiac arrest, though.

Sodium bicarb brought back ROSC, probably because of the chemistry of it binding

at the electron level with the positive lithium ions.

Wes Ogilvie

Sent from my iPad

> yes, Wesley, I am jerking your chain again....I'm sure that you have seen

> this condition before.

>

> ck

>

>

> In a message dated 6/13/2010 19:35:48 Central Daylight Time,

> krin135@... writes:

>

> I'm waiting for Wes to chime back in. I jerked his chain pretty hard

> earlier, so I'm betting that he's been doing some research. I'd wait at

> least

> another half hour.

>

> I'm also waiting for someone to ask the obvious question, about how

> closely

> you and I are working together...some of them know how devious I can be...

>

> ck

>

> In a message dated 6/13/2010 19:33:09 Central Daylight Time,

> _amwoods8644@..._ (mailto:amwoods8644@...) writes:

>

> Think it's time for another hint?

>

> Alyssa Woods, FF/NREMT-B

>

> On Jun 13, 2010, at 6:57 PM, _krin135@..._ (mailto:krin135@...)

> wrote:

>

> > chuckle...then you are missing something.

> >

> > Even without inside knowledge, I can reasonably predict that while the

> > lithium levels may be elevated to a toxic (a common side effect of the

> > medication and dehydration), the Tums didn't cause her acute problem.

> >

> > and if you were to persist in treating the patient *just* for lithium

> > toxicity, you will miss a life threatening complication that is

> > staring you in

> > the face.

> >

> >

> >

> > ck

> >

> >

> > In a message dated 6/13/2010 18:50:08 Central Daylight Time,

> > _rob.davis@..._ (mailto:rob.davis@...)

> writes:

> >

> > On Sunday, June 13, 2010 18:18, __krin135@..._

> (mailto:_krin135@...) _

> (mailto:_krin135@..._ (mailto:krin135@...)

> > )

> > said:

> >

> > > OH? and what was your diagnosis?

> >

> > Too early to spoil the whole shebang yet. But someone should have

> > told her

> > to lay off the Tums while taking Li.

> >

> > Rob

> >

> >

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Guest guest

Yes to both.

Would you like a complete history?

Alyssa Woods, FF/NREMT-B

> Alyssa,

> Does this patient have a history of alcohol abuse or malnutrition?

>

> Sent from my iPhone,

> McGee, EMT-P, EMT-T

>

> On Jun 13, 2010, at 7:32 PM, Alyssa Woods amwoods8644@...>

> wrote:

>

> Think it's time for another hint?

>

> Alyssa Woods, FF/NREMT-B

>

>

>

> chuckle...then you are missing something.

>

> Even without inside knowledge, I can reasonably predict that while the

> lithium levels may be elevated to a toxic (a common side effect of the

> medication and dehydration), the Tums didn't cause her acute problem.

>

> and if you were to persist in treating the patient *just* for lithium

> toxicity, you will miss a life threatening complication that is

> staring you in

> the face.

>

>

>

> ck

>

> In a message dated 6/13/2010 18:50:08 Central Daylight Time,

> rob.davis@... writes:

>

> On Sunday, June 13, 2010 18:18, _krin135@..._ (mailto:krin135@...

> )

> said:

>

> OH? and what was your diagnosis?

>

> Too early to spoil the whole shebang yet. But someone should have

> told her

> to lay off the Tums while taking Li.

>

> Rob

>

>

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Guest guest

Yes to both.

Would you like a complete history?

Alyssa Woods, FF/NREMT-B

> Alyssa,

> Does this patient have a history of alcohol abuse or malnutrition?

>

> Sent from my iPhone,

> McGee, EMT-P, EMT-T

>

> On Jun 13, 2010, at 7:32 PM, Alyssa Woods amwoods8644@...>

> wrote:

>

> Think it's time for another hint?

>

> Alyssa Woods, FF/NREMT-B

>

>

>

> chuckle...then you are missing something.

>

> Even without inside knowledge, I can reasonably predict that while the

> lithium levels may be elevated to a toxic (a common side effect of the

> medication and dehydration), the Tums didn't cause her acute problem.

>

> and if you were to persist in treating the patient *just* for lithium

> toxicity, you will miss a life threatening complication that is

> staring you in

> the face.

>

>

>

> ck

>

> In a message dated 6/13/2010 18:50:08 Central Daylight Time,

> rob.davis@... writes:

>

> On Sunday, June 13, 2010 18:18, _krin135@..._ (mailto:krin135@...

> )

> said:

>

> OH? and what was your diagnosis?

>

> Too early to spoil the whole shebang yet. But someone should have

> told her

> to lay off the Tums while taking Li.

>

> Rob

>

>

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Guest guest

Yes to both.

Would you like a complete history?

Alyssa Woods, FF/NREMT-B

> Alyssa,

> Does this patient have a history of alcohol abuse or malnutrition?

>

> Sent from my iPhone,

> McGee, EMT-P, EMT-T

>

> On Jun 13, 2010, at 7:32 PM, Alyssa Woods amwoods8644@...>

> wrote:

>

> Think it's time for another hint?

>

> Alyssa Woods, FF/NREMT-B

>

>

>

> chuckle...then you are missing something.

>

> Even without inside knowledge, I can reasonably predict that while the

> lithium levels may be elevated to a toxic (a common side effect of the

> medication and dehydration), the Tums didn't cause her acute problem.

>

> and if you were to persist in treating the patient *just* for lithium

> toxicity, you will miss a life threatening complication that is

> staring you in

> the face.

>

>

>

> ck

>

> In a message dated 6/13/2010 18:50:08 Central Daylight Time,

> rob.davis@... writes:

>

> On Sunday, June 13, 2010 18:18, _krin135@..._ (mailto:krin135@...

> )

> said:

>

> OH? and what was your diagnosis?

>

> Too early to spoil the whole shebang yet. But someone should have

> told her

> to lay off the Tums while taking Li.

>

> Rob

>

>

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Guest guest

And for the record, I figured you were conspiring with Alyssa, Doc. Y'all are

danged close to being a racketeer influenced corrupt organization. ;-)

Wes

Sent from my iPad

> I'm waiting for Wes to chime back in. I jerked his chain pretty hard

> earlier, so I'm betting that he's been doing some research. I'd wait at least

> another half hour.

>

> I'm also waiting for someone to ask the obvious question, about how closely

> you and I are working together...some of them know how devious I can be...

>

> ck

>

>

> In a message dated 6/13/2010 19:33:09 Central Daylight Time,

> amwoods8644@... writes:

>

> Think it's time for another hint?

>

> Alyssa Woods, FF/NREMT-B

>

>

>

> > chuckle...then you are missing something.

> >

> > Even without inside knowledge, I can reasonably predict that while the

> > lithium levels may be elevated to a toxic (a common side effect of the

> > medication and dehydration), the Tums didn't cause her acute problem.

> >

> > and if you were to persist in treating the patient *just* for lithium

> > toxicity, you will miss a life threatening complication that is

> > staring you in

> > the face.

> >

> >

> >

> > ck

> >

> >

> > In a message dated 6/13/2010 18:50:08 Central Daylight Time,

> > rob.davis@... writes:

> >

> > On Sunday, June 13, 2010 18:18, _krin135@..._

> (mailto:krin135@...

> > )

> > said:

> >

> > > OH? and what was your diagnosis?

> >

> > Too early to spoil the whole shebang yet. But someone should have

> > told her

> > to lay off the Tums while taking Li.

> >

> > Rob

> >

> >

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Guest guest

And for the record, I figured you were conspiring with Alyssa, Doc. Y'all are

danged close to being a racketeer influenced corrupt organization. ;-)

Wes

Sent from my iPad

> I'm waiting for Wes to chime back in. I jerked his chain pretty hard

> earlier, so I'm betting that he's been doing some research. I'd wait at least

> another half hour.

>

> I'm also waiting for someone to ask the obvious question, about how closely

> you and I are working together...some of them know how devious I can be...

>

> ck

>

>

> In a message dated 6/13/2010 19:33:09 Central Daylight Time,

> amwoods8644@... writes:

>

> Think it's time for another hint?

>

> Alyssa Woods, FF/NREMT-B

>

>

>

> > chuckle...then you are missing something.

> >

> > Even without inside knowledge, I can reasonably predict that while the

> > lithium levels may be elevated to a toxic (a common side effect of the

> > medication and dehydration), the Tums didn't cause her acute problem.

> >

> > and if you were to persist in treating the patient *just* for lithium

> > toxicity, you will miss a life threatening complication that is

> > staring you in

> > the face.

> >

> >

> >

> > ck

> >

> >

> > In a message dated 6/13/2010 18:50:08 Central Daylight Time,

> > rob.davis@... writes:

> >

> > On Sunday, June 13, 2010 18:18, _krin135@..._

> (mailto:krin135@...

> > )

> > said:

> >

> > > OH? and what was your diagnosis?

> >

> > Too early to spoil the whole shebang yet. But someone should have

> > told her

> > to lay off the Tums while taking Li.

> >

> > Rob

> >

> >

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Guest guest

And for the record, I figured you were conspiring with Alyssa, Doc. Y'all are

danged close to being a racketeer influenced corrupt organization. ;-)

Wes

Sent from my iPad

> I'm waiting for Wes to chime back in. I jerked his chain pretty hard

> earlier, so I'm betting that he's been doing some research. I'd wait at least

> another half hour.

>

> I'm also waiting for someone to ask the obvious question, about how closely

> you and I are working together...some of them know how devious I can be...

>

> ck

>

>

> In a message dated 6/13/2010 19:33:09 Central Daylight Time,

> amwoods8644@... writes:

>

> Think it's time for another hint?

>

> Alyssa Woods, FF/NREMT-B

>

>

>

> > chuckle...then you are missing something.

> >

> > Even without inside knowledge, I can reasonably predict that while the

> > lithium levels may be elevated to a toxic (a common side effect of the

> > medication and dehydration), the Tums didn't cause her acute problem.

> >

> > and if you were to persist in treating the patient *just* for lithium

> > toxicity, you will miss a life threatening complication that is

> > staring you in

> > the face.

> >

> >

> >

> > ck

> >

> >

> > In a message dated 6/13/2010 18:50:08 Central Daylight Time,

> > rob.davis@... writes:

> >

> > On Sunday, June 13, 2010 18:18, _krin135@..._

> (mailto:krin135@...

> > )

> > said:

> >

> > > OH? and what was your diagnosis?

> >

> > Too early to spoil the whole shebang yet. But someone should have

> > told her

> > to lay off the Tums while taking Li.

> >

> > Rob

> >

> >

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Guest guest

If he doesn't, I do...including an explanation for the very medically precocious

17 year old!

Wes

Sent from my iPad

> Yes to both.

>

> Would you like a complete history?

>

> Alyssa Woods, FF/NREMT-B

>

>

>

>> Alyssa,

>> Does this patient have a history of alcohol abuse or malnutrition?

>>

>> Sent from my iPhone,

>> McGee, EMT-P, EMT-T

>>

>> On Jun 13, 2010, at 7:32 PM, Alyssa Woods amwoods8644@...>

>> wrote:

>>

>> Think it's time for another hint?

>>

>> Alyssa Woods, FF/NREMT-B

>>

>>

>>

>> chuckle...then you are missing something.

>>

>> Even without inside knowledge, I can reasonably predict that while the

>> lithium levels may be elevated to a toxic (a common side effect of the

>> medication and dehydration), the Tums didn't cause her acute problem.

>>

>> and if you were to persist in treating the patient *just* for lithium

>> toxicity, you will miss a life threatening complication that is

>> staring you in

>> the face.

>>

>>

>>

>> ck

>>

>> In a message dated 6/13/2010 18:50:08 Central Daylight Time,

>> rob.davis@... writes:

>>

>> On Sunday, June 13, 2010 18:18, _krin135@..._ (mailto:krin135@...

>> )

>> said:

>>

>> OH? and what was your diagnosis?

>>

>> Too early to spoil the whole shebang yet. But someone should have

>> told her

>> to lay off the Tums while taking Li.

>>

>> Rob

>>

>>

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Guest guest

If he doesn't, I do...including an explanation for the very medically precocious

17 year old!

Wes

Sent from my iPad

> Yes to both.

>

> Would you like a complete history?

>

> Alyssa Woods, FF/NREMT-B

>

>

>

>> Alyssa,

>> Does this patient have a history of alcohol abuse or malnutrition?

>>

>> Sent from my iPhone,

>> McGee, EMT-P, EMT-T

>>

>> On Jun 13, 2010, at 7:32 PM, Alyssa Woods amwoods8644@...>

>> wrote:

>>

>> Think it's time for another hint?

>>

>> Alyssa Woods, FF/NREMT-B

>>

>>

>>

>> chuckle...then you are missing something.

>>

>> Even without inside knowledge, I can reasonably predict that while the

>> lithium levels may be elevated to a toxic (a common side effect of the

>> medication and dehydration), the Tums didn't cause her acute problem.

>>

>> and if you were to persist in treating the patient *just* for lithium

>> toxicity, you will miss a life threatening complication that is

>> staring you in

>> the face.

>>

>>

>>

>> ck

>>

>> In a message dated 6/13/2010 18:50:08 Central Daylight Time,

>> rob.davis@... writes:

>>

>> On Sunday, June 13, 2010 18:18, _krin135@..._ (mailto:krin135@...

>> )

>> said:

>>

>> OH? and what was your diagnosis?

>>

>> Too early to spoil the whole shebang yet. But someone should have

>> told her

>> to lay off the Tums while taking Li.

>>

>> Rob

>>

>>

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Guest guest

If he doesn't, I do...including an explanation for the very medically precocious

17 year old!

Wes

Sent from my iPad

> Yes to both.

>

> Would you like a complete history?

>

> Alyssa Woods, FF/NREMT-B

>

>

>

>> Alyssa,

>> Does this patient have a history of alcohol abuse or malnutrition?

>>

>> Sent from my iPhone,

>> McGee, EMT-P, EMT-T

>>

>> On Jun 13, 2010, at 7:32 PM, Alyssa Woods amwoods8644@...>

>> wrote:

>>

>> Think it's time for another hint?

>>

>> Alyssa Woods, FF/NREMT-B

>>

>>

>>

>> chuckle...then you are missing something.

>>

>> Even without inside knowledge, I can reasonably predict that while the

>> lithium levels may be elevated to a toxic (a common side effect of the

>> medication and dehydration), the Tums didn't cause her acute problem.

>>

>> and if you were to persist in treating the patient *just* for lithium

>> toxicity, you will miss a life threatening complication that is

>> staring you in

>> the face.

>>

>>

>>

>> ck

>>

>> In a message dated 6/13/2010 18:50:08 Central Daylight Time,

>> rob.davis@... writes:

>>

>> On Sunday, June 13, 2010 18:18, _krin135@..._ (mailto:krin135@...

>> )

>> said:

>>

>> OH? and what was your diagnosis?

>>

>> Too early to spoil the whole shebang yet. But someone should have

>> told her

>> to lay off the Tums while taking Li.

>>

>> Rob

>>

>>

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Guest guest

Delerium tremens?

Wes

Sent from my iPad

> nope...the problem is something more common than lithium toxicity.

>

> ck

>

>

> In a message dated 6/13/2010 19:48:42 Central Daylight Time,

> ExLngHrn@... writes:

>

> If it's an actual lithium OD, I have. My patient was in cardiac arrest,

> though. Sodium bicarb brought back ROSC, probably because of the chemistry of

> it binding at the electron level with the positive lithium ions.

>

> Wes Ogilvie

>

> Sent from my iPad

>

> On Jun 13, 2010, at 19:38, _krin135@..._ (mailto:krin135@...)

> wrote:

>

> > yes, Wesley, I am jerking your chain again....I'm sure that you have

> seen

> > this condition before.

> >

> > ck

> >

> >

> > In a message dated 6/13/2010 19:35:48 Central Daylight Time,

> > _krin135@..._ (mailto:krin135@...) writes:

> >

> > I'm waiting for Wes to chime back in. I jerked his chain pretty hard

> > earlier, so I'm betting that he's been doing some research. I'd wait at

> > least

> > another half hour.

> >

> > I'm also waiting for someone to ask the obvious question, about how

> > closely

> > you and I are working together...some of them know how devious I can

> be...

> >

> > ck

> >

> > In a message dated 6/13/2010 19:33:09 Central Daylight Time,

> > __amwoods8644@..._ (mailto:_amwoods8644@...) _

> (mailto:_amwoods8644@..._ (mailto:amwoods8644@...) ) writes:

> >

> > Think it's time for another hint?

> >

> > Alyssa Woods, FF/NREMT-B

> >

> > On Jun 13, 2010, at 6:57 PM, __krin135@..._ (mailto:_krin135@...)

> _ (mailto:_krin135@..._ (mailto:krin135@...) )

> > wrote:

> >

> > > chuckle...then you are missing something.

> > >

> > > Even without inside knowledge, I can reasonably predict that while the

> > > lithium levels may be elevated to a toxic (a common side effect of the

> > > medication and dehydration), the Tums didn't cause her acute problem.

> > >

> > > and if you were to persist in treating the patient *just* for lithium

> > > toxicity, you will miss a life threatening complication that is

> > > staring you in

> > > the face.

> > >

> > >

> > >

> > > ck

> > >

> > >

> > > In a message dated 6/13/2010 18:50:08 Central Daylight Time,

> > > __rob.davis@..._ (mailto:_rob.davis@...)

> _ (mailto:_rob.davis@..._

> (mailto:rob.davis@...) )

> > writes:

> > >

> > > On Sunday, June 13, 2010 18:18, ___krin135@..._

> (mailto:__krin135@...) _

> > (mailto:__krin135@..._ (mailto:_krin135@...) ) _

> > (mailto:__krin135@..._ (mailto:_krin135@...) _

> (mailto:_krin135@..._ (mailto:krin135@...) )

> > > )

> > > said:

> > >

> > > > OH? and what was your diagnosis?

> > >

> > > Too early to spoil the whole shebang yet. But someone should have

> > > told her

> > > to lay off the Tums while taking Li.

> > >

> > > Rob

> > >

> > >

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Guest guest

Delerium tremens?

Wes

Sent from my iPad

> nope...the problem is something more common than lithium toxicity.

>

> ck

>

>

> In a message dated 6/13/2010 19:48:42 Central Daylight Time,

> ExLngHrn@... writes:

>

> If it's an actual lithium OD, I have. My patient was in cardiac arrest,

> though. Sodium bicarb brought back ROSC, probably because of the chemistry of

> it binding at the electron level with the positive lithium ions.

>

> Wes Ogilvie

>

> Sent from my iPad

>

> On Jun 13, 2010, at 19:38, _krin135@..._ (mailto:krin135@...)

> wrote:

>

> > yes, Wesley, I am jerking your chain again....I'm sure that you have

> seen

> > this condition before.

> >

> > ck

> >

> >

> > In a message dated 6/13/2010 19:35:48 Central Daylight Time,

> > _krin135@..._ (mailto:krin135@...) writes:

> >

> > I'm waiting for Wes to chime back in. I jerked his chain pretty hard

> > earlier, so I'm betting that he's been doing some research. I'd wait at

> > least

> > another half hour.

> >

> > I'm also waiting for someone to ask the obvious question, about how

> > closely

> > you and I are working together...some of them know how devious I can

> be...

> >

> > ck

> >

> > In a message dated 6/13/2010 19:33:09 Central Daylight Time,

> > __amwoods8644@..._ (mailto:_amwoods8644@...) _

> (mailto:_amwoods8644@..._ (mailto:amwoods8644@...) ) writes:

> >

> > Think it's time for another hint?

> >

> > Alyssa Woods, FF/NREMT-B

> >

> > On Jun 13, 2010, at 6:57 PM, __krin135@..._ (mailto:_krin135@...)

> _ (mailto:_krin135@..._ (mailto:krin135@...) )

> > wrote:

> >

> > > chuckle...then you are missing something.

> > >

> > > Even without inside knowledge, I can reasonably predict that while the

> > > lithium levels may be elevated to a toxic (a common side effect of the

> > > medication and dehydration), the Tums didn't cause her acute problem.

> > >

> > > and if you were to persist in treating the patient *just* for lithium

> > > toxicity, you will miss a life threatening complication that is

> > > staring you in

> > > the face.

> > >

> > >

> > >

> > > ck

> > >

> > >

> > > In a message dated 6/13/2010 18:50:08 Central Daylight Time,

> > > __rob.davis@..._ (mailto:_rob.davis@...)

> _ (mailto:_rob.davis@..._

> (mailto:rob.davis@...) )

> > writes:

> > >

> > > On Sunday, June 13, 2010 18:18, ___krin135@..._

> (mailto:__krin135@...) _

> > (mailto:__krin135@..._ (mailto:_krin135@...) ) _

> > (mailto:__krin135@..._ (mailto:_krin135@...) _

> (mailto:_krin135@..._ (mailto:krin135@...) )

> > > )

> > > said:

> > >

> > > > OH? and what was your diagnosis?

> > >

> > > Too early to spoil the whole shebang yet. But someone should have

> > > told her

> > > to lay off the Tums while taking Li.

> > >

> > > Rob

> > >

> > >

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Guest guest

Delerium tremens?

Wes

Sent from my iPad

> nope...the problem is something more common than lithium toxicity.

>

> ck

>

>

> In a message dated 6/13/2010 19:48:42 Central Daylight Time,

> ExLngHrn@... writes:

>

> If it's an actual lithium OD, I have. My patient was in cardiac arrest,

> though. Sodium bicarb brought back ROSC, probably because of the chemistry of

> it binding at the electron level with the positive lithium ions.

>

> Wes Ogilvie

>

> Sent from my iPad

>

> On Jun 13, 2010, at 19:38, _krin135@..._ (mailto:krin135@...)

> wrote:

>

> > yes, Wesley, I am jerking your chain again....I'm sure that you have

> seen

> > this condition before.

> >

> > ck

> >

> >

> > In a message dated 6/13/2010 19:35:48 Central Daylight Time,

> > _krin135@..._ (mailto:krin135@...) writes:

> >

> > I'm waiting for Wes to chime back in. I jerked his chain pretty hard

> > earlier, so I'm betting that he's been doing some research. I'd wait at

> > least

> > another half hour.

> >

> > I'm also waiting for someone to ask the obvious question, about how

> > closely

> > you and I are working together...some of them know how devious I can

> be...

> >

> > ck

> >

> > In a message dated 6/13/2010 19:33:09 Central Daylight Time,

> > __amwoods8644@..._ (mailto:_amwoods8644@...) _

> (mailto:_amwoods8644@..._ (mailto:amwoods8644@...) ) writes:

> >

> > Think it's time for another hint?

> >

> > Alyssa Woods, FF/NREMT-B

> >

> > On Jun 13, 2010, at 6:57 PM, __krin135@..._ (mailto:_krin135@...)

> _ (mailto:_krin135@..._ (mailto:krin135@...) )

> > wrote:

> >

> > > chuckle...then you are missing something.

> > >

> > > Even without inside knowledge, I can reasonably predict that while the

> > > lithium levels may be elevated to a toxic (a common side effect of the

> > > medication and dehydration), the Tums didn't cause her acute problem.

> > >

> > > and if you were to persist in treating the patient *just* for lithium

> > > toxicity, you will miss a life threatening complication that is

> > > staring you in

> > > the face.

> > >

> > >

> > >

> > > ck

> > >

> > >

> > > In a message dated 6/13/2010 18:50:08 Central Daylight Time,

> > > __rob.davis@..._ (mailto:_rob.davis@...)

> _ (mailto:_rob.davis@..._

> (mailto:rob.davis@...) )

> > writes:

> > >

> > > On Sunday, June 13, 2010 18:18, ___krin135@..._

> (mailto:__krin135@...) _

> > (mailto:__krin135@..._ (mailto:_krin135@...) ) _

> > (mailto:__krin135@..._ (mailto:_krin135@...) _

> (mailto:_krin135@..._ (mailto:krin135@...) )

> > > )

> > > said:

> > >

> > > > OH? and what was your diagnosis?

> > >

> > > Too early to spoil the whole shebang yet. But someone should have

> > > told her

> > > to lay off the Tums while taking Li.

> > >

> > > Rob

> > >

> > >

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I would as well

Sent from my iPhone,

McGee, EMT-P, EMT-T

If he doesn't, I do...including an explanation for the very medically precocious

17 year old!

Wes

Sent from my iPad

> Yes to both.

>

> Would you like a complete history?

>

> Alyssa Woods, FF/NREMT-B

>

>

>

>> Alyssa,

>> Does this patient have a history of alcohol abuse or malnutrition?

>>

>> Sent from my iPhone,

>> McGee, EMT-P, EMT-T

>>

>> On Jun 13, 2010, at 7:32 PM, Alyssa Woods amwoods8644@...>

>> wrote:

>>

>> Think it's time for another hint?

>>

>> Alyssa Woods, FF/NREMT-B

>>

>>

>>

>> chuckle...then you are missing something.

>>

>> Even without inside knowledge, I can reasonably predict that while the

>> lithium levels may be elevated to a toxic (a common side effect of the

>> medication and dehydration), the Tums didn't cause her acute problem.

>>

>> and if you were to persist in treating the patient *just* for lithium

>> toxicity, you will miss a life threatening complication that is

>> staring you in

>> the face.

>>

>>

>>

>> ck

>>

>> In a message dated 6/13/2010 18:50:08 Central Daylight Time,

>> rob.davis@... writes:

>>

>> On Sunday, June 13, 2010 18:18, _krin135@..._ (mailto:krin135@...

>> )

>> said:

>>

>> OH? and what was your diagnosis?

>>

>> Too early to spoil the whole shebang yet. But someone should have

>> told her

>> to lay off the Tums while taking Li.

>>

>> Rob

>>

>>

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Guest guest

I would as well

Sent from my iPhone,

McGee, EMT-P, EMT-T

If he doesn't, I do...including an explanation for the very medically precocious

17 year old!

Wes

Sent from my iPad

> Yes to both.

>

> Would you like a complete history?

>

> Alyssa Woods, FF/NREMT-B

>

>

>

>> Alyssa,

>> Does this patient have a history of alcohol abuse or malnutrition?

>>

>> Sent from my iPhone,

>> McGee, EMT-P, EMT-T

>>

>> On Jun 13, 2010, at 7:32 PM, Alyssa Woods amwoods8644@...>

>> wrote:

>>

>> Think it's time for another hint?

>>

>> Alyssa Woods, FF/NREMT-B

>>

>>

>>

>> chuckle...then you are missing something.

>>

>> Even without inside knowledge, I can reasonably predict that while the

>> lithium levels may be elevated to a toxic (a common side effect of the

>> medication and dehydration), the Tums didn't cause her acute problem.

>>

>> and if you were to persist in treating the patient *just* for lithium

>> toxicity, you will miss a life threatening complication that is

>> staring you in

>> the face.

>>

>>

>>

>> ck

>>

>> In a message dated 6/13/2010 18:50:08 Central Daylight Time,

>> rob.davis@... writes:

>>

>> On Sunday, June 13, 2010 18:18, _krin135@..._ (mailto:krin135@...

>> )

>> said:

>>

>> OH? and what was your diagnosis?

>>

>> Too early to spoil the whole shebang yet. But someone should have

>> told her

>> to lay off the Tums while taking Li.

>>

>> Rob

>>

>>

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Guest guest

On Sunday, June 13, 2010 18:57, krin135@... said:

> Even without inside knowledge, I can reasonably predict that while the

> lithium levels may be elevated to a toxic (a common side effect of the

> medication and dehydration), the Tums didn't cause her acute problem.

Now who is guessing incorrectly? ;)

I was thinking more along the lines of the hypermagnesaemia and increased PTH

secondary to the interaction between antacids and Li. The sx match up, and it

is a problem I have heard of before.

Rob

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Full History:

Bipolar, OCD, ADD, PTSD, Autism, Chronic Headaches, Asthma, an unknown

respiratory ailment, acid reflux, IBS, and unknown GI issue,

Allergies, Osteoporosis, Anemia, High BP, High Cholesterol, 3

Miscarriages, 1 surgery to remove an IUD, 1 C-Section, Menopause,

cea, Psoriasis, Back Problems, and an Arrythmia.

And I've already explained the precocious 17 year old - her pet hobby

happened to be neurology, with a specific focus on psychopharmacology.

> If he doesn't, I do...including an explanation for the very

> medically precocious 17 year old!

>

> Wes

>

> Sent from my iPad

>

>

>

> > Yes to both.

> >

> > Would you like a complete history?

> >

> > Alyssa Woods, FF/NREMT-B

> >

> >

> >

> >> Alyssa,

> >> Does this patient have a history of alcohol abuse or malnutrition?

> >>

> >> Sent from my iPhone,

> >> McGee, EMT-P, EMT-T

> >>

> >> On Jun 13, 2010, at 7:32 PM, Alyssa Woods amwoods8644@...>

> >> wrote:

> >>

> >> Think it's time for another hint?

> >>

> >> Alyssa Woods, FF/NREMT-B

> >>

> >>

> >>

> >> chuckle...then you are missing something.

> >>

> >> Even without inside knowledge, I can reasonably predict that

> while the

> >> lithium levels may be elevated to a toxic (a common side effect

> of the

> >> medication and dehydration), the Tums didn't cause her acute

> problem.

> >>

> >> and if you were to persist in treating the patient *just* for

> lithium

> >> toxicity, you will miss a life threatening complication that is

> >> staring you in

> >> the face.

> >>

> >>

> >>

> >> ck

> >>

> >> In a message dated 6/13/2010 18:50:08 Central Daylight Time,

> >> rob.davis@... writes:

> >>

> >> On Sunday, June 13, 2010 18:18, _krin135@..._ (mailto:krin135@...

> >> )

> >> said:

> >>

> >> OH? and what was your diagnosis?

> >>

> >> Too early to spoil the whole shebang yet. But someone should have

> >> told her

> >> to lay off the Tums while taking Li.

> >>

> >> Rob

> >>

> >>

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Chuck Ktin devious? Nah.

Louis N. Molino, Sr. CET

FF/NREMT/FSI/EMSI

Typed by my fingers on my iPhone.

Please excuse any typos.

(Cell)

LNMolino@...

> I'm waiting for Wes to chime back in. I jerked his chain pretty hard

> earlier, so I'm betting that he's been doing some research. I'd wait

> at least

> another half hour.

>

> I'm also waiting for someone to ask the obvious question, about how

> closely

> you and I are working together...some of them know how devious I can

> be...

>

> ck

>

>

> In a message dated 6/13/2010 19:33:09 Central Daylight Time,

> amwoods8644@... writes:

>

> Think it's time for another hint?

>

> Alyssa Woods, FF/NREMT-B

>

>

>

> > chuckle...then you are missing something.

> >

> > Even without inside knowledge, I can reasonably predict that while

> the

> > lithium levels may be elevated to a toxic (a common side effect of

> the

> > medication and dehydration), the Tums didn't cause her acute

> problem.

> >

> > and if you were to persist in treating the patient *just* for

> lithium

> > toxicity, you will miss a life threatening complication that is

> > staring you in

> > the face.

> >

> >

> >

> > ck

> >

> >

> > In a message dated 6/13/2010 18:50:08 Central Daylight Time,

> > rob.davis@... writes:

> >

> > On Sunday, June 13, 2010 18:18, _krin135@..._

> (mailto:krin135@...

> > )

> > said:

> >

> > > OH? and what was your diagnosis?

> >

> > Too early to spoil the whole shebang yet. But someone should have

> > told her

> > to lay off the Tums while taking Li.

> >

> > Rob

> >

> >

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And it goes to Wes!

Congratulations!

Alyssa Woods, FF/NREMT-B

> Delerium tremens?

>

> Wes

>

> Sent from my iPad

>

>

>

> > nope...the problem is something more common than lithium toxicity.

> >

> > ck

> >

> >

> > In a message dated 6/13/2010 19:48:42 Central Daylight Time,

> > ExLngHrn@... writes:

> >

> > If it's an actual lithium OD, I have. My patient was in cardiac

> arrest,

> > though. Sodium bicarb brought back ROSC, probably because of the

> chemistry of

> > it binding at the electron level with the positive lithium ions.

> >

> > Wes Ogilvie

> >

> > Sent from my iPad

> >

> > On Jun 13, 2010, at 19:38, _krin135@..._

> (mailto:krin135@...)

> > wrote:

> >

> > > yes, Wesley, I am jerking your chain again....I'm sure that you

> have

> > seen

> > > this condition before.

> > >

> > > ck

> > >

> > >

> > > In a message dated 6/13/2010 19:35:48 Central Daylight Time,

> > > _krin135@..._ (mailto:krin135@...) writes:

> > >

> > > I'm waiting for Wes to chime back in. I jerked his chain pretty

> hard

> > > earlier, so I'm betting that he's been doing some research. I'd

> wait at

> > > least

> > > another half hour.

> > >

> > > I'm also waiting for someone to ask the obvious question, about

> how

> > > closely

> > > you and I are working together...some of them know how devious I

> can

> > be...

> > >

> > > ck

> > >

> > > In a message dated 6/13/2010 19:33:09 Central Daylight Time,

> > > __amwoods8644@..._ (mailto:_amwoods8644@...) _

> > (mailto:_amwoods8644@..._ (mailto:amwoods8644@...) )

> writes:

> > >

> > > Think it's time for another hint?

> > >

> > > Alyssa Woods, FF/NREMT-B

> > >

> > > On Jun 13, 2010, at 6:57 PM, __krin135@..._ (mailto:_krin135@...

> )

> > _ (mailto:_krin135@..._ (mailto:krin135@...) )

> > > wrote:

> > >

> > > > chuckle...then you are missing something.

> > > >

> > > > Even without inside knowledge, I can reasonably predict that

> while the

> > > > lithium levels may be elevated to a toxic (a common side

> effect of the

> > > > medication and dehydration), the Tums didn't cause her acute

> problem.

> > > >

> > > > and if you were to persist in treating the patient *just* for

> lithium

> > > > toxicity, you will miss a life threatening complication that is

> > > > staring you in

> > > > the face.

> > > >

> > > >

> > > >

> > > > ck

> > > >

> > > >

> > > > In a message dated 6/13/2010 18:50:08 Central Daylight Time,

> > > > __rob.davis@..._ (mailto:_rob.davis@...

> )

> > _ (mailto:_rob.davis@..._

> > (mailto:rob.davis@...) )

> > > writes:

> > > >

> > > > On Sunday, June 13, 2010 18:18, ___krin135@..._

> > (mailto:__krin135@...) _

> > > (mailto:__krin135@..._ (mailto:_krin135@...) ) _

> > > (mailto:__krin135@..._ (mailto:_krin135@...) _

> > (mailto:_krin135@..._ (mailto:krin135@...) )

> > > > )

> > > > said:

> > > >

> > > > > OH? and what was your diagnosis?

> > > >

> > > > Too early to spoil the whole shebang yet. But someone should

> have

> > > > told her

> > > > to lay off the Tums while taking Li.

> > > >

> > > > Rob

> > > >

> > > >

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I had specified Sinus Tach, btw.

Alyssa Woods, FF/NREMT-B

> And if we're talking about some electrolyte imbalances, I'd like to

> see

> 12-lead....

>

> -Wes

>

>

> In a message dated 6/13/2010 7:57:46 P.M. Central Daylight Time,

> rob.davis@... writes:

>

> On Sunday, June 13, 2010 18:57, _krin135@..._ (mailto:krin135@...

> )

> said:

>

> > Even without inside knowledge, I can reasonably predict that while

> the

> > lithium levels may be elevated to a toxic (a common side effect of

> the

> > medication and dehydration), the Tums didn't cause her acute

> problem.

>

> Now who is guessing incorrectly? ;)

>

> I was thinking more along the lines of the hypermagnesaemia and

> increased

> PTH secondary to the interaction between antacids and Li. The sx

> match up,

> and it is a problem I have heard of before.

>

> Rob

>

>

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No way no vowel on end of name.

Louis N. Molino, Sr. CET

FF/NREMT/FSI/EMSI

Typed by my fingers on my iPhone.

Please excuse any typos.

(Cell)

LNMolino@...

> And for the record, I figured you were conspiring with Alyssa, Doc.

> Y'all are danged close to being a racketeer influenced corrupt

> organization. ;-)

>

> Wes

>

> Sent from my iPad

>

>

>

> > I'm waiting for Wes to chime back in. I jerked his chain pretty hard

> > earlier, so I'm betting that he's been doing some research. I'd

> wait at least

> > another half hour.

> >

> > I'm also waiting for someone to ask the obvious question, about

> how closely

> > you and I are working together...some of them know how devious I

> can be...

> >

> > ck

> >

> >

> > In a message dated 6/13/2010 19:33:09 Central Daylight Time,

> > amwoods8644@... writes:

> >

> > Think it's time for another hint?

> >

> > Alyssa Woods, FF/NREMT-B

> >

> >

> >

> > > chuckle...then you are missing something.

> > >

> > > Even without inside knowledge, I can reasonably predict that

> while the

> > > lithium levels may be elevated to a toxic (a common side effect

> of the

> > > medication and dehydration), the Tums didn't cause her acute

> problem.

> > >

> > > and if you were to persist in treating the patient *just* for

> lithium

> > > toxicity, you will miss a life threatening complication that is

> > > staring you in

> > > the face.

> > >

> > >

> > >

> > > ck

> > >

> > >

> > > In a message dated 6/13/2010 18:50:08 Central Daylight Time,

> > > rob.davis@... writes:

> > >

> > > On Sunday, June 13, 2010 18:18, _krin135@..._

> > (mailto:krin135@...

> > > )

> > > said:

> > >

> > > > OH? and what was your diagnosis?

> > >

> > > Too early to spoil the whole shebang yet. But someone should have

> > > told her

> > > to lay off the Tums while taking Li.

> > >

> > > Rob

> > >

> > >

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On Sunday, June 13, 2010 20:02, krin135@... said:

> Tums are calcium carbonate, and thus much less likely to be associated

> with HYPERmagnesemia, even with an increased PTH.

Well, I was still wrong, but for the record, I intended to write hypercalcaemia.

Note to self: don't post while smelling dinner cooking!

Rob

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Thank you!

And... I could've sworn I said this already, but can't find it on

here, SO...

In real life, the pt was taken to the ER a total of five times. The

diagnoses were: heat exhaustion, vertigo, lithium toxicity, and Alice

in Wonderland Syndrome. Finally, she was diagnosed with DT's. (And,

for the record, the DT diagnosis was only reached after she got a DUI

- her breathalizer was .29.)

I figured if it took five trips to the ER and a DUI for the docs to

get it, it had to be a bit of a tough one.

And the great thing is that some of the diagnoses were correct - she

DID have heat exhaustion. And her lithium levels were 1.5 times the

lethal level. But in the end, it was the detoxing that was causing the

emergent situation.

Alyssa Woods, FF/NREMT-B

> Thanks! This was a good one! Lots of rabbit trails to mislead you.

> Lord knows you had me chasing tons of zebras!

>

>

> In a message dated 6/13/2010 8:03:46 P.M. Central Daylight Time,

> amwoods8644@... writes:

>

> And it goes to Wes!

>

> Congratulations!

>

> Alyssa Woods, FF/NREMT-B

>

>

>

> > Delerium tremens?

> >

> > Wes

> >

> > Sent from my iPad

> >

> >

> >

> > > nope...the problem is something more common than lithium toxicity.

> > >

> > > ck

> > >

> > >

> > > In a message dated 6/13/2010 19:48:42 Central Daylight Time,

> > > ExLngHrn@... writes:

> > >

> > > If it's an actual lithium OD, I have. My patient was in cardiac

> > arrest,

> > > though. Sodium bicarb brought back ROSC, probably because of the

> > chemistry of

> > > it binding at the electron level with the positive lithium ions.

> > >

> > > Wes Ogilvie

> > >

> > > Sent from my iPad

> > >

> > > On Jun 13, 2010, at 19:38, _krin135@..._

> > (mailto:krin135@...)

> > > wrote:

> > >

> > > > yes, Wesley, I am jerking your chain again....I'm sure that you

> > have

> > > seen

> > > > this condition before.

> > > >

> > > > ck

> > > >

> > > >

> > > > In a message dated 6/13/2010 19:35:48 Central Daylight Time,

> > > > _krin135@..._ (mailto:krin135@...) writes:

> > > >

> > > > I'm waiting for Wes to chime back in. I jerked his chain pretty

> > hard

> > > > earlier, so I'm betting that he's been doing some research. I'd

> > wait at

> > > > least

> > > > another half hour.

> > > >

> > > > I'm also waiting for someone to ask the obvious question, about

> > how

> > > > closely

> > > > you and I are working together...some of them know how devious I

> > can

> > > be...

> > > >

> > > > ck

> > > >

> > > > In a message dated 6/13/2010 19:33:09 Central Daylight Time,

> > > > __amwoods8644@..._ (mailto:_amwoods8644@...) _

> > > (mailto:_amwoods8644@..._ (mailto:amwoods8644@...) )

> > writes:

> > > >

> > > > Think it's time for another hint?

> > > >

> > > > Alyssa Woods, FF/NREMT-B

> > > >

> > > > On Jun 13, 2010, at 6:57 PM, __krin135@..._

> (mailto:_krin135@...

> > )

> > > _ (mailto:_krin135@..._ (mailto:krin135@...) )

> > > > wrote:

> > > >

> > > > > chuckle...then you are missing something.

> > > > >

> > > > > Even without inside knowledge, I can reasonably predict that

> > while the

> > > > > lithium levels may be elevated to a toxic (a common side

> > effect of the

> > > > > medication and dehydration), the Tums didn't cause her acute

> > problem.

> > > > >

> > > > > and if you were to persist in treating the patient *just* for

> > lithium

> > > > > toxicity, you will miss a life threatening complication that

> is

> > > > > staring you in

> > > > > the face.

> > > > >

> > > > >

> > > > >

> > > > > ck

> > > > >

> > > > >

> > > > > In a message dated 6/13/2010 18:50:08 Central Daylight Time,

> > > > > __rob.davis@..._

> (mailto:_rob.davis@...

> > )

> > > _ (mailto:_rob.davis@..._

> > > (mailto:rob.davis@...) )

> > > > writes:

> > > > >

> > > > > On Sunday, June 13, 2010 18:18, ___krin135@..._

> > > (mailto:__krin135@...) _

> > > > (mailto:__krin135@..._ (mailto:_krin135@...) ) _

> > > > (mailto:__krin135@..._ (mailto:_krin135@...) _

> > > (mailto:_krin135@..._ (mailto:krin135@...) )

> > > > > )

> > > > > said:

> > > > >

> > > > > > OH? and what was your diagnosis?

> > > > >

> > > > > Too early to spoil the whole shebang yet. But someone should

> > have

> > > > > told her

> > > > > to lay off the Tums while taking Li.

> > > > >

> > > > > Rob

> > > > >

> > > > >

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It has been brought to my attention that the treatment was not noted.

Wes, I'm sure you know this, so, take it away...

Alyssa Woods, FF/NREMT-B

> How far was the ED?

>

> With the time you guys spent on this Val DeFrance in Alaska would have

> been back in service for an hour by now ;)

>

> Louis N. Molino, Sr., CET

> FF/NREMT-B/FSI/EMSI

> Freelance Consultant/Trainer/Author/Journalist/Fire Protection

> Consultant

>

> LNMolino@...

>

> (Cell Phone)

>

> " A Texan with a Jersey Attitude "

>

> " Great minds discuss ideas; Average minds discuss events; Small minds

> discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 -

> 1962)

>

> In a message dated 6/13/2010 8:03:41 P.M. Central Daylight Time,

> amwoods8644@... writes:

>

> And it goes to Wes!

>

> Congratulations!

>

> Alyssa Woods, FF/NREMT-B

>

>

>

> > Delerium tremens?

> >

> > Wes

> >

> > Sent from my iPad

> >

> >

> >

> > > nope...the problem is something more common than lithium toxicity.

> > >

> > > ck

> > >

> > >

> > > In a message dated 6/13/2010 19:48:42 Central Daylight Time,

> > > ExLngHrn@... writes:

> > >

> > > If it's an actual lithium OD, I have. My patient was in cardiac

> > arrest,

> > > though. Sodium bicarb brought back ROSC, probably because of the

> > chemistry of

> > > it binding at the electron level with the positive lithium ions.

> > >

> > > Wes Ogilvie

> > >

> > > Sent from my iPad

> > >

> > > On Jun 13, 2010, at 19:38, _krin135@..._

> > (mailto:krin135@...)

> > > wrote:

> > >

> > > > yes, Wesley, I am jerking your chain again....I'm sure that you

> > have

> > > seen

> > > > this condition before.

> > > >

> > > > ck

> > > >

> > > >

> > > > In a message dated 6/13/2010 19:35:48 Central Daylight Time,

> > > > _krin135@..._ (mailto:krin135@...) writes:

> > > >

> > > > I'm waiting for Wes to chime back in. I jerked his chain pretty

> > hard

> > > > earlier, so I'm betting that he's been doing some research. I'd

> > wait at

> > > > least

> > > > another half hour.

> > > >

> > > > I'm also waiting for someone to ask the obvious question, about

> > how

> > > > closely

> > > > you and I are working together...some of them know how devious I

> > can

> > > be...

> > > >

> > > > ck

> > > >

> > > > In a message dated 6/13/2010 19:33:09 Central Daylight Time,

> > > > __amwoods8644@..._ (mailto:_amwoods8644@...) _

> > > (mailto:_amwoods8644@..._ (mailto:amwoods8644@...) )

> > writes:

> > > >

> > > > Think it's time for another hint?

> > > >

> > > > Alyssa Woods, FF/NREMT-B

> > > >

> > > > On Jun 13, 2010, at 6:57 PM, __krin135@..._

> (mailto:_krin135@...

> > )

> > > _ (mailto:_krin135@..._ (mailto:krin135@...) )

> > > > wrote:

> > > >

> > > > > chuckle...then you are missing something.

> > > > >

> > > > > Even without inside knowledge, I can reasonably predict that

> > while the

> > > > > lithium levels may be elevated to a toxic (a common side

> > effect of the

> > > > > medication and dehydration), the Tums didn't cause her acute

> > problem.

> > > > >

> > > > > and if you were to persist in treating the patient *just* for

> > lithium

> > > > > toxicity, you will miss a life threatening complication that

> is

> > > > > staring you in

> > > > > the face.

> > > > >

> > > > >

> > > > >

> > > > > ck

> > > > >

> > > > >

> > > > > In a message dated 6/13/2010 18:50:08 Central Daylight Time,

> > > > > __rob.davis@..._

> (mailto:_rob.davis@...

> > )

> > > _ (mailto:_rob.davis@..._

> > > (mailto:rob.davis@...) )

> > > > writes:

> > > > >

> > > > > On Sunday, June 13, 2010 18:18, ___krin135@..._

> > > (mailto:__krin135@...) _

> > > > (mailto:__krin135@..._ (mailto:_krin135@...) ) _

> > > > (mailto:__krin135@..._ (mailto:_krin135@...) _

> > > (mailto:_krin135@..._ (mailto:krin135@...) )

> > > > > )

> > > > > said:

> > > > >

> > > > > > OH? and what was your diagnosis?

> > > > >

> > > > > Too early to spoil the whole shebang yet. But someone should

> > have

> > > > > told her

> > > > > to lay off the Tums while taking Li.

> > > > >

> > > > > Rob

> > > > >

> > > > >

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