RE: EMS Challenge (2) Hint #1

June 13, 2010

They still did it faster than the doctors in the ER! It took a total

of nearly five months for her to be properly diagnosed. Ironically,

her saving grace was her inability to control her alcoholism.

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

> > > > >

June 13, 2010

They still did it faster than the doctors in the ER! It took a total

of nearly five months for her to be properly diagnosed. Ironically,

her saving grace was her inability to control her alcoholism.

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

> > > > >

June 13, 2010

Congratulations again! Though even in this short amount of time I've

been in this group, I can tell I should expect as much from you, Wes.

Alyssa Woods, FF/NREMT-B

> Typically with benzodiazepines or in extreme cases, low doses of

> antipsychotics.

>

> -Wes Ogilvie

>

> In a message dated 6/13/2010 8:37:02 P.M. Central Daylight Time,

> amwoods8644@... writes:

>

> 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

> > > > > >

June 13, 2010

Nice job Wes, and great case Alyssa.

Sent from my iPhone,

McGee, EMT-P, EMT-T

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

June 13, 2010

If I remember correctly, barbiturates are second-line treatment.

> if benzos are contra indicated for some reason, what other two drugs

> are

> still available for assistance in detoxing the DTs?

>

> and why is the detox of sedative drugs used long term (including,

> but not

> limited to alcohol and benzos) so much more dangerous than the detox

> of

> folks who have been on cocaine or methamphetamine?

>

> ck

>

> In a message dated 6/13/2010 20:39:18 Central Daylight Time,

> ExLngHrn@... writes:

>

> Typically with benzodiazepines or in extreme cases, low doses of

> antipsychotics.

>

> -Wes Ogilvie

>

> In a message dated 6/13/2010 8:37:02 P.M. Central Daylight Time,

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

>

> 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

>

> On Jun 13, 2010, at 8:33 PM, _lnmolino@..._ (mailto:lnmolino@...

> )

> wrote:

>

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

> >

> > And it goes to Wes!

> >

> > Congratulations!

> >

> > Alyssa Woods, FF/NREMT-B

> >

> > > Delerium tremens?

> > >

> > > Wes

> > >

> > > Sent from my iPad

> > >

> > > On Jun 13, 2010, at 19:49, _krin135@..._ (mailto:krin135@...

> )

> wrote:

> > >

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

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

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

> > > > (mailto:__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@...)

> > > )

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

> > > )

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

> > > > > (mailto:___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

> > > > > >

June 13, 2010

If I remember correctly, barbiturates are second-line treatment.

> if benzos are contra indicated for some reason, what other two drugs

> are

> still available for assistance in detoxing the DTs?

>

> and why is the detox of sedative drugs used long term (including,

> but not

> limited to alcohol and benzos) so much more dangerous than the detox

> of

> folks who have been on cocaine or methamphetamine?

>

> ck

>

> In a message dated 6/13/2010 20:39:18 Central Daylight Time,

> ExLngHrn@... writes:

>

> Typically with benzodiazepines or in extreme cases, low doses of

> antipsychotics.

>

> -Wes Ogilvie

>

> In a message dated 6/13/2010 8:37:02 P.M. Central Daylight Time,

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

>

> 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

>

> On Jun 13, 2010, at 8:33 PM, _lnmolino@..._ (mailto:lnmolino@...

> )

> wrote:

>

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

> >

> > And it goes to Wes!

> >

> > Congratulations!

> >

> > Alyssa Woods, FF/NREMT-B

> >

> > > Delerium tremens?

> > >

> > > Wes

> > >

> > > Sent from my iPad

> > >

> > > On Jun 13, 2010, at 19:49, _krin135@..._ (mailto:krin135@...

> )

> wrote:

> > >

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

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

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

> > > > (mailto:__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@...)

> > > )

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

> > > )

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

> > > > > (mailto:___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

> > > > > >

June 13, 2010

Thank you.

Alyssa Woods, FF/NREMT-B

> Nice job Wes, and great case Alyssa.

>

> Sent from my iPhone,

> McGee, EMT-P, EMT-T

>

> On Jun 13, 2010, at 8:14 PM, Alyssa Woods amwoods8644@...>

> wrote:

>

> 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

>

June 13, 2010

Propofol?

Alyssa Woods, FF/NREMT-B

> if benzos are contra indicated for some reason, what other two drugs

> are

> still available for assistance in detoxing the DTs?

>

> and why is the detox of sedative drugs used long term (including,

> but not

> limited to alcohol and benzos) so much more dangerous than the detox

> of

> folks who have been on cocaine or methamphetamine?

>

> ck

>

> In a message dated 6/13/2010 20:39:18 Central Daylight Time,

> ExLngHrn@... writes:

>

> Typically with benzodiazepines or in extreme cases, low doses of

> antipsychotics.

>

> -Wes Ogilvie

>

> In a message dated 6/13/2010 8:37:02 P.M. Central Daylight Time,

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

>

> 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

>

> On Jun 13, 2010, at 8:33 PM, _lnmolino@..._ (mailto:lnmolino@...

> )

> wrote:

>

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

> >

> > And it goes to Wes!

> >

> > Congratulations!

> >

> > Alyssa Woods, FF/NREMT-B

> >

> > > Delerium tremens?

> > >

> > > Wes

> > >

> > > Sent from my iPad

> > >

> > > On Jun 13, 2010, at 19:49, _krin135@..._ (mailto:krin135@...

> )

> wrote:

> > >

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

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

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

> > > > (mailto:__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@...)

> > > )

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

> > > )

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

> > > > > (mailto:___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

> > > > > >

June 13, 2010

I dug up a prize for Wes, and decided that everyone should have one, so here you

all go.

http://www.shoppersvineyard.com/store/pc/DELIRIUM-TREMENS-ALE-750ML-BOTTLE-1p813\

7.htm?utm_source=Vinquire&utm_medium=WineFeed&utm_content=Delirium+Tremens+Ale+7\

50Ml+Bottle&utm_campaign=base&v_traceback=c0611_2224_f0612_0000

Sent from my iPhone,

McGee, EMT-P, EMT-T

Propofol?

Alyssa Woods, FF/NREMT-B

if benzos are contra indicated for some reason, what other two drugs

are

still available for assistance in detoxing the DTs?

and why is the detox of sedative drugs used long term (including,

but not

limited to alcohol and benzos) so much more dangerous than the detox

of

folks who have been on cocaine or methamphetamine?

ck

In a message dated 6/13/2010 20:39:18 Central Daylight Time,

ExLngHrn@... writes:

Typically with benzodiazepines or in extreme cases, low doses of

antipsychotics.

-Wes Ogilvie

In a message dated 6/13/2010 8:37:02 P.M. Central Daylight Time,

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

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

On Jun 13, 2010, at 8:33 PM, _lnmolino@..._ (mailto:lnmolino@...

)

wrote:

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

And it goes to Wes!

Congratulations!

Alyssa Woods, FF/NREMT-B

Delerium tremens?

Wes

Sent from my iPad

On Jun 13, 2010, at 19:49, _krin135@..._ (mailto:krin135@...

)

wrote:

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@..._ (mailto: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@...) _

(mailto:_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@...) _

(mailto:_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@...) ) _

(mailto:__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@...)

)

_ (mailto:__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@...)

)

_ (mailto:__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@...) ) ) _

(mailto:___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

June 13, 2010

I dug up a prize for Wes, and decided that everyone should have one, so here you

all go.

http://www.shoppersvineyard.com/store/pc/DELIRIUM-TREMENS-ALE-750ML-BOTTLE-1p813\

7.htm?utm_source=Vinquire&utm_medium=WineFeed&utm_content=Delirium+Tremens+Ale+7\

50Ml+Bottle&utm_campaign=base&v_traceback=c0611_2224_f0612_0000

Sent from my iPhone,

McGee, EMT-P, EMT-T

Propofol?

Alyssa Woods, FF/NREMT-B

if benzos are contra indicated for some reason, what other two drugs

are

still available for assistance in detoxing the DTs?

and why is the detox of sedative drugs used long term (including,

but not

limited to alcohol and benzos) so much more dangerous than the detox

of

folks who have been on cocaine or methamphetamine?

ck

In a message dated 6/13/2010 20:39:18 Central Daylight Time,

ExLngHrn@... writes:

Typically with benzodiazepines or in extreme cases, low doses of

antipsychotics.

-Wes Ogilvie

In a message dated 6/13/2010 8:37:02 P.M. Central Daylight Time,

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

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

On Jun 13, 2010, at 8:33 PM, _lnmolino@..._ (mailto:lnmolino@...

)

wrote:

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

And it goes to Wes!

Congratulations!

Alyssa Woods, FF/NREMT-B

Delerium tremens?

Wes

Sent from my iPad

On Jun 13, 2010, at 19:49, _krin135@..._ (mailto:krin135@...

)

wrote:

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@..._ (mailto: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@...) _

(mailto:_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@...) _

(mailto:_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@...) ) _

(mailto:__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@...)

)

_ (mailto:__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@...)

)

_ (mailto:__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@...) ) ) _

(mailto:___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

June 13, 2010

Ha! I love that show! It's not about the situation being life

threatening. It's about flying through the framework of medicine;

searching medical literature and texts, and trying to find the fastest

way to get to the diagnosis.

Alyssa Woods, FF/NREMT-B

> Alyssa watch the TV show Mystery Diagnosis which my CIV no medical

> training

> GF watches. Drives me nuts as I think most of the stuff is over

> dramatized

> as most situations are non life threats but then again I've had my

> share

> of drama in my personal medical life

>

> 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 8:42:49 P.M. Central Daylight Time,

> amwoods8644@... writes:

>

> They still did it faster than the doctors in the ER! It took a total

> of nearly five months for her to be properly diagnosed. Ironically,

> her saving grace was her inability to control her alcoholism.

>

> 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

> > > > > >

June 13, 2010

Ha! Hey, though! Couldn't you give me a prize I could legally collect?!

Alyssa Woods, FF/NREMT-B

> I dug up a prize for Wes, and decided that everyone should have one,

> so here you all go.

>

http://www.shoppersvineyard.com/store/pc/DELIRIUM-TREMENS-ALE-750ML-BOTTLE-1p813\

7.htm?utm_source=Vinquire&utm_medium=WineFeed&utm_content=Delirium+Tremens+Ale+7\

50Ml+Bottle&utm_campaign=base&v_traceback=c0611_2224_f0612_0000

>

> Sent from my iPhone,

> McGee, EMT-P, EMT-T

>

> On Jun 13, 2010, at 9:21 PM, Alyssa Woods amwoods8644@...>

> wrote:

>

> Propofol?

>

> Alyssa Woods, FF/NREMT-B

>

> if benzos are contra indicated for some reason, what other two drugs

> are

> still available for assistance in detoxing the DTs?

>

> and why is the detox of sedative drugs used long term (including,

> but not

> limited to alcohol and benzos) so much more dangerous than the detox

> of

> folks who have been on cocaine or methamphetamine?

>

> ck

>

> In a message dated 6/13/2010 20:39:18 Central Daylight Time,

> ExLngHrn@... writes:

>

> Typically with benzodiazepines or in extreme cases, low doses of

> antipsychotics.

>

> -Wes Ogilvie

>

> In a message dated 6/13/2010 8:37:02 P.M. Central Daylight Time,

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

>

> 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

>

> On Jun 13, 2010, at 8:33 PM, _lnmolino@..._ (mailto:lnmolino@...

> )

> wrote:

>

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

>

> And it goes to Wes!

>

> Congratulations!

>

> Alyssa Woods, FF/NREMT-B

>

> Delerium tremens?

>

> Wes

>

> Sent from my iPad

>

> On Jun 13, 2010, at 19:49, _krin135@..._ (mailto:krin135@...

> )

> wrote:

>

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

> (mailto:_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@...) _

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

> (mailto:__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@...)

> )

> _ (mailto:__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@...)

> )

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

> (mailto:___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

>

June 13, 2010

I honestly don't know. I am highly curious, though. Please, enlighten

me.

Alyssa Woods, FF/NREMT-B

> yep.

>

> paraldehyde can also be used for detox, but because of problems with

> plastics, is rarely available these days. I remember the little blue

> bottles on

> the med carts when I first started back in the 1970s.

>

> and the sedative detox problem?

>

> ck

>

> In a message dated 6/13/2010 21:22:08 Central Daylight Time,

> amwoods8644@... writes:

>

> Propofol?

>

> Alyssa Woods, FF/NREMT-B

>

> > if benzos are contra indicated for some reason, what other two drugs

> > are

> > still available for assistance in detoxing the DTs?

> >

> > and why is the detox of sedative drugs used long term (including,

> > but not

> > limited to alcohol and benzos) so much more dangerous than the detox

> > of

> > folks who have been on cocaine or methamphetamine?

> >

> > ck

> >

> > In a message dated 6/13/2010 20:39:18 Central Daylight Time,

> > ExLngHrn@... writes:

> >

> > Typically with benzodiazepines or in extreme cases, low doses of

> > antipsychotics.

> >

> > -Wes Ogilvie

> >

> > In a message dated 6/13/2010 8:37:02 P.M. Central Daylight Time,

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

> >

> > 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

> >

> > On Jun 13, 2010, at 8:33 PM, _lnmolino@..._ (mailto:lnmolino@...

> > )

> > wrote:

> >

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

> > >

> > > And it goes to Wes!

> > >

> > > Congratulations!

> > >

> > > Alyssa Woods, FF/NREMT-B

> > >

> > > > Delerium tremens?

> > > >

> > > > Wes

> > > >

> > > > Sent from my iPad

> > > >

> > > > On Jun 13, 2010, at 19:49, _krin135@..._ (mailto:krin135@...

> > )

> > wrote:

> > > >

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

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

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

> > > > > (mailto:__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@...)

> > > > )

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

> > > > )

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

> > > > > > (mailto:___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

> > > > > > >

June 13, 2010

Is it because of the changes to the neurotransmitters, including

gamma-aminobutyric acid (GABA)

and glutamate?

Â

McGee, EMT-P, EMT-T

Â

> > > > >

> > > > > > 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@...)

> > > )

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

> > > > > (mailto:___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

> > > > > >

June 13, 2010

Yes, but how is a seizure any more dangerous than a drop in BP and HR

from a generalized lack of the norepinephrine/epinephrine reuptake

inhibitor that the body is used to getting from the stimulant drug?

In the end, the body will release prolactin in response to the

seizure, and the BP and HR will drop, but more importantly, the

respiratory rate will drop to a possible dangerous level, and hypoxia

will ensue.

However, hypothetically speaking, could that hypoxia not also occur

with the drop in BP/HR from the lack of a stimulant?

And what about the dopaminergic effects?

Withdrawal from any addictive substance should cause a generalized

drop in dopamine levels, causing a decrease in heart rate, which

should make withdrawal from CNS depressants (which cause an elevation

in CNS activity) easier, and withdrawal from CNS stimulants more

difficult.

A theory compliments of a friend (Ivan , EMT-P): depressants

usually have a longer half-life, and require a longer detox time.

Alyssa Woods, FF/NREMT-B

> Is it because of the changes to the neurotransmitters, including

> gamma-aminobutyric acid (GABA)

> and glutamate?

>

> McGee, EMT-P, EMT-T

>

> > > > > >

> > > > > > > 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@...)

> > > > )

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

> > > > > > (mailto:___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

> > > > > > >

June 13, 2010

Sorry but I've worked in medicine in some way a long time. Very kittle

real drama like on these shows. I do like shows like Trauma Life in

the ER etc. The reality there us hard to fake. People even die unlike

say the vast majority of Rescur 9-1-1.

Louis N. Molino, Sr. CET

FF/NREMT/FSI/EMSI

Typed by my fingers on my iPhone.

Please excuse any typos.

(Cell)

LNMolino@...

> Ha! I love that show! It's not about the situation being life

> threatening. It's about flying through the framework of medicine;

> searching medical literature and texts, and trying to find the fastest

> way to get to the diagnosis.

>

> Alyssa Woods, FF/NREMT-B

>

>> Alyssa watch the TV show Mystery Diagnosis which my CIV no medical

>> training

>> GF watches. Drives me nuts as I think most of the stuff is over

>> dramatized

>> as most situations are non life threats but then again I've had my

>> share

>> of drama in my personal medical life

>>

>> 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 8:42:49 P.M. Central Daylight Time,

>> amwoods8644@... writes:

>>

>> They still did it faster than the doctors in the ER! It took a total

>> of nearly five months for her to be properly diagnosed. Ironically,

>> her saving grace was her inability to control her alcoholism.

>>

>> 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

>>>>>>>

June 13, 2010

I was simply trying to say is that I like to completely ignore the

drama and focus on the mystery part of it. Because I like the Mystery

Diagnosis Game. (As I think we can all see! lol)

Alyssa Woods, FF/NREMT-B

> Sorry but I've worked in medicine in some way a long time. Very kittle

> real drama like on these shows. I do like shows like Trauma Life in

> the ER etc. The reality there us hard to fake. People even die unlike

> say the vast majority of Rescur 9-1-1.

>

> Louis N. Molino, Sr. CET

> FF/NREMT/FSI/EMSI

> Typed by my fingers on my iPhone.

> Please excuse any typos.

> (Cell)

> LNMolino@...

>

> > Ha! I love that show! It's not about the situation being life

> > threatening. It's about flying through the framework of medicine;

> > searching medical literature and texts, and trying to find the

> fastest

> > way to get to the diagnosis.

> >

> > Alyssa Woods, FF/NREMT-B

> >

> >> Alyssa watch the TV show Mystery Diagnosis which my CIV no medical

> >> training

> >> GF watches. Drives me nuts as I think most of the stuff is over

> >> dramatized

> >> as most situations are non life threats but then again I've had my

> >> share

> >> of drama in my personal medical life

> >>

> >> 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 8:42:49 P.M. Central Daylight Time,

> >> amwoods8644@... writes:

> >>

> >> They still did it faster than the doctors in the ER! It took a

> total

> >> of nearly five months for her to be properly diagnosed. Ironically,

> >> her saving grace was her inability to control her alcoholism.

> >>

> >> 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

> >>>>>>>

June 13, 2010

To each his/her own some people read romance novels I can't stand them

bit I still like Wes and Gene.

Louis N. Molino, Sr. CET

FF/NREMT/FSI/EMSI

Typed by my fingers on my iPhone.

Please excuse any typos.

(Cell)

LNMolino@...

> I was simply trying to say is that I like to completely ignore the

> drama and focus on the mystery part of it. Because I like the Mystery

> Diagnosis Game. (As I think we can all see! lol)

>

> Alyssa Woods, FF/NREMT-B

>

>> Sorry but I've worked in medicine in some way a long time. Very

>> kittle

>> real drama like on these shows. I do like shows like Trauma Life in

>> the ER etc. The reality there us hard to fake. People even die unlike

>> say the vast majority of Rescur 9-1-1.

>>

>> Louis N. Molino, Sr. CET

>> FF/NREMT/FSI/EMSI

>> Typed by my fingers on my iPhone.

>> Please excuse any typos.

>> (Cell)

>> LNMolino@...

>>

>> On Jun 13, 2010, at 21:30, Alyssa Woods amwoods8644@...>

>> wrote:

>>

>>> Ha! I love that show! It's not about the situation being life

>>> threatening. It's about flying through the framework of medicine;

>>> searching medical literature and texts, and trying to find the

>> fastest

>>> way to get to the diagnosis.

>>>

>>> Alyssa Woods, FF/NREMT-B

>>>

>>>> Alyssa watch the TV show Mystery Diagnosis which my CIV no medical

>>>> training

>>>> GF watches. Drives me nuts as I think most of the stuff is over

>>>> dramatized

>>>> as most situations are non life threats but then again I've had my

>>>> share

>>>> of drama in my personal medical life

>>>>

>>>> 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 8:42:49 P.M. Central Daylight Time,

>>>> amwoods8644@... writes:

>>>>

>>>> They still did it faster than the doctors in the ER! It took a

>> total

>>>> of nearly five months for her to be properly diagnosed. Ironically,

>>>> her saving grace was her inability to control her alcoholism.

>>>>

>>>> 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

>>>>>>>>>

June 14, 2010

Hey - keep these Challenges goin'. I'm giving them to my paramedic students.

It's always good to get another perspective to teach problem solving.....

-MH

________________________________

From: texasems-l [texasems-l ] On Behalf Of

krin135@... [krin135@...]

Sent: Sunday, June 13, 2010 10:48 PM

To: texasems-l

Subject: Re: EMS Challenge (2) Hint #1

it does include those changes, but more significantly, it's the problem

with the brain trying to compensate for the depression (with increased

internal stimulation levels) vs the brain trying to recover from external

stimulation.

the problem being that the unrestrained internal 'up' leads to the various

problems with DTs, which can be life threatening if not treated.

to the best of my knowledge (covering 35 years of working with various

detox programs), no one has died from a pure opioid or stimulant detox, but a

fair number still die each year from improperly managed sedative detox.

To add insult to injury, the three different classes (ethanol, benzos, and

barbs) of primary sedatives are often mixed and matched by the patient, and

while alcohol and barbs will detox benzos, and benzos and barbs will detox

alcohol, you have to be very careful with barbs, as alcohol will help, but

benzos don't always work.

Since Propofol (in short supply right now for technical reasons) is an

alcohol...

Additionally, alcohol and nicotine are the two most commonly abused self

medications, complicating many other psychological problems.

ck

In a message dated 6/13/2010 21:55:51 Central Daylight Time,

summedic@... writes:

Is it because of the changes to the neurotransmitters, including

gamma-aminobutyric acid (GABA)

and glutamate?

McGee, EMT-P, EMT-T

> > > > >

> > > > > > 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@...)

) _

> >

(mailto:___rob.davis@...

_

(mailto:__rob.davis@...)

_

>

(mailto:__rob.davis@..._

(mailto:_rob.davis@...) )

> > > )

> > > > _

(mailto:___rob.davis@...

_

(mailto:__rob.davis@...)

_

>

(mailto:__rob.davis@..._

(mailto:_rob.davis@...) )

_

> > > >

(mailto:__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@...) ) ) _

> > > > > (mailto:____krin135@..._

(mailto:___krin135@...) _

(mailto:___krin135@..._

(mailto:__krin135@...) ) _

> (mailto:___krin135@..._

(mailto:__krin135@...) _

(mailto:__krin135@..._

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

> > > > > (mailto:____krin135@..._

(mailto:___krin135@...) _

(mailto:___krin135@..._

(mailto:__krin135@...) ) _

> (mailto:___krin135@..._

(mailto:__krin135@...) _

(mailto:__krin135@..._

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

> > > > (mailto:___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

> > > > > >

June 14, 2010

Ok I got one it is not as involved as alyssa's but may be something you see

pretty often in this case I am actually the person this is loosely based on.

dispatched to a 30 y/o male for weakness upon arrival pt. Is sitting in a chair

in his living he room he say he is having a funny feeling in his chest and he

feels very weak what else you wanna know

-Chris

Sorry for the spelling and punctuation this was typed on tge tiny keyboard on my

iPhone

> Hey - keep these Challenges goin'. I'm giving them to my paramedic students.

It's always good to get another perspective to teach problem solving.....

>

> -MH

> ________________________________

> From: texasems-l [texasems-l ] On Behalf Of

krin135@... [krin135@...]

> Sent: Sunday, June 13, 2010 10:48 PM

> To: texasems-l

> Subject: Re: EMS Challenge (2) Hint #1

>

> it does include those changes, but more significantly, it's the problem

> with the brain trying to compensate for the depression (with increased

> internal stimulation levels) vs the brain trying to recover from external

> stimulation.

>

> the problem being that the unrestrained internal 'up' leads to the various

> problems with DTs, which can be life threatening if not treated.

>

> to the best of my knowledge (covering 35 years of working with various

> detox programs), no one has died from a pure opioid or stimulant detox, but a

> fair number still die each year from improperly managed sedative detox.

>

> To add insult to injury, the three different classes (ethanol, benzos, and

> barbs) of primary sedatives are often mixed and matched by the patient, and

> while alcohol and barbs will detox benzos, and benzos and barbs will detox

> alcohol, you have to be very careful with barbs, as alcohol will help, but

> benzos don't always work.

>

> Since Propofol (in short supply right now for technical reasons) is an

> alcohol...

>

> Additionally, alcohol and nicotine are the two most commonly abused self

> medications, complicating many other psychological problems.

>

> ck

>

> In a message dated 6/13/2010 21:55:51 Central Daylight Time,

> summedic@... writes:

>

> Is it because of the changes to the neurotransmitters, including

> gamma-aminobutyric acid (GABA)

> and glutamate?

>

> McGee, EMT-P, EMT-T

>

>>>>>>

>>>>>>> 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@...)

) _

>>>

(mailto:___rob.davis@...

_

>

(mailto:__rob.davis@...)

_

>>

(mailto:__rob.davis@..._

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

)

>>>> )

>>>>> _

(mailto:___rob.davis@...

_

>

(mailto:__rob.davis@...)

_

>>

(mailto:__rob.davis@..._

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

) _

>>>>>

(mailto:__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@...) ) ) _

>>>>>> (mailto:____krin135@..._

(mailto:___krin135@...) _

> (mailto:___krin135@..._

(mailto:__krin135@...) ) _

>> (mailto:___krin135@..._

(mailto:__krin135@...) _

> (mailto:__krin135@..._

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

>>>>>> (mailto:____krin135@..._

(mailto:___krin135@...) _

> (mailto:___krin135@..._

(mailto:__krin135@...) ) _

>> (mailto:___krin135@..._

(mailto:__krin135@...) _

> (mailto:__krin135@..._

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

>>>>> (mailto:___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

>>>>>>>

June 14, 2010

Ok I got one it is not as involved as alyssa's but may be something you see

pretty often in this case I am actually the person this is loosely based on.

dispatched to a 30 y/o male for weakness upon arrival pt. Is sitting in a chair

in his living he room he say he is having a funny feeling in his chest and he

feels very weak what else you wanna know

-Chris

Sorry for the spelling and punctuation this was typed on tge tiny keyboard on my

iPhone

> Hey - keep these Challenges goin'. I'm giving them to my paramedic students.

It's always good to get another perspective to teach problem solving.....

>

> -MH

> ________________________________

> From: texasems-l [texasems-l ] On Behalf Of

krin135@... [krin135@...]

> Sent: Sunday, June 13, 2010 10:48 PM

> To: texasems-l

> Subject: Re: EMS Challenge (2) Hint #1

>

> it does include those changes, but more significantly, it's the problem

> with the brain trying to compensate for the depression (with increased

> internal stimulation levels) vs the brain trying to recover from external

> stimulation.

>

> the problem being that the unrestrained internal 'up' leads to the various

> problems with DTs, which can be life threatening if not treated.

>

> to the best of my knowledge (covering 35 years of working with various

> detox programs), no one has died from a pure opioid or stimulant detox, but a

> fair number still die each year from improperly managed sedative detox.

>

> To add insult to injury, the three different classes (ethanol, benzos, and

> barbs) of primary sedatives are often mixed and matched by the patient, and

> while alcohol and barbs will detox benzos, and benzos and barbs will detox

> alcohol, you have to be very careful with barbs, as alcohol will help, but

> benzos don't always work.

>

> Since Propofol (in short supply right now for technical reasons) is an

> alcohol...

>

> Additionally, alcohol and nicotine are the two most commonly abused self

> medications, complicating many other psychological problems.

>

> ck

>

> In a message dated 6/13/2010 21:55:51 Central Daylight Time,

> summedic@... writes:

>

> Is it because of the changes to the neurotransmitters, including

> gamma-aminobutyric acid (GABA)

> and glutamate?

>

> McGee, EMT-P, EMT-T

>

>>>>>>

>>>>>>> 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@...)

) _

>>>

(mailto:___rob.davis@...

_

>

(mailto:__rob.davis@...)

_

>>

(mailto:__rob.davis@..._

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

)

>>>> )

>>>>> _

(mailto:___rob.davis@...

_

>

(mailto:__rob.davis@...)

_

>>

(mailto:__rob.davis@..._

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

) _

>>>>>

(mailto:__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@...) ) ) _

>>>>>> (mailto:____krin135@..._

(mailto:___krin135@...) _

> (mailto:___krin135@..._

(mailto:__krin135@...) ) _

>> (mailto:___krin135@..._

(mailto:__krin135@...) _

> (mailto:__krin135@..._

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

>>>>>> (mailto:____krin135@..._

(mailto:___krin135@...) _

> (mailto:___krin135@..._

(mailto:__krin135@...) ) _

>> (mailto:___krin135@..._

(mailto:__krin135@...) _

> (mailto:__krin135@..._

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

>>>>> (mailto:___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

>>>>>>>

June 14, 2010

Ok I got one it is not as involved as alyssa's but may be something you see

pretty often in this case I am actually the person this is loosely based on.

dispatched to a 30 y/o male for weakness upon arrival pt. Is sitting in a chair

in his living he room he say he is having a funny feeling in his chest and he

feels very weak what else you wanna know

-Chris

Sorry for the spelling and punctuation this was typed on tge tiny keyboard on my

iPhone

> Hey - keep these Challenges goin'. I'm giving them to my paramedic students.

It's always good to get another perspective to teach problem solving.....

>

> -MH

> ________________________________

> From: texasems-l [texasems-l ] On Behalf Of

krin135@... [krin135@...]

> Sent: Sunday, June 13, 2010 10:48 PM

> To: texasems-l

> Subject: Re: EMS Challenge (2) Hint #1

>

> it does include those changes, but more significantly, it's the problem

> with the brain trying to compensate for the depression (with increased

> internal stimulation levels) vs the brain trying to recover from external

> stimulation.

>

> the problem being that the unrestrained internal 'up' leads to the various

> problems with DTs, which can be life threatening if not treated.

>

> to the best of my knowledge (covering 35 years of working with various

> detox programs), no one has died from a pure opioid or stimulant detox, but a

> fair number still die each year from improperly managed sedative detox.

>

> To add insult to injury, the three different classes (ethanol, benzos, and

> barbs) of primary sedatives are often mixed and matched by the patient, and

> while alcohol and barbs will detox benzos, and benzos and barbs will detox

> alcohol, you have to be very careful with barbs, as alcohol will help, but

> benzos don't always work.

>

> Since Propofol (in short supply right now for technical reasons) is an

> alcohol...

>

> Additionally, alcohol and nicotine are the two most commonly abused self

> medications, complicating many other psychological problems.

>

> ck

>

> In a message dated 6/13/2010 21:55:51 Central Daylight Time,

> summedic@... writes:

>

> Is it because of the changes to the neurotransmitters, including

> gamma-aminobutyric acid (GABA)

> and glutamate?

>

> McGee, EMT-P, EMT-T

>

>>>>>>

>>>>>>> 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@...)

) _

>>>

(mailto:___rob.davis@...

_

>

(mailto:__rob.davis@...)

_

>>

(mailto:__rob.davis@..._

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

)

>>>> )

>>>>> _

(mailto:___rob.davis@...

_

>

(mailto:__rob.davis@...)

_

>>

(mailto:__rob.davis@..._

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

) _

>>>>>

(mailto:__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@...) ) ) _

>>>>>> (mailto:____krin135@..._

(mailto:___krin135@...) _

> (mailto:___krin135@..._

(mailto:__krin135@...) ) _

>> (mailto:___krin135@..._

(mailto:__krin135@...) _

> (mailto:__krin135@..._

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

>>>>>> (mailto:____krin135@..._

(mailto:___krin135@...) _

> (mailto:___krin135@..._

(mailto:__krin135@...) ) _

>> (mailto:___krin135@..._

(mailto:__krin135@...) _

> (mailto:__krin135@..._

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

>>>>> (mailto:___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

>>>>>>>

June 14, 2010

On Sunday, June 13, 2010 21:28, " McGee " summedic@...> said:

> I dug up a prize for Wes, and decided that everyone should have one, so here

you

> all go.

>

http://www.shoppersvineyard.com/store/pc/DELIRIUM-TREMENS-ALE-750ML-BOTTLE-1p813\

7.htm?utm_source=Vinquire&utm_medium=WineFeed&utm_content=Delirium+Tremens+Ale+7\

50Ml+Bottle&utm_campaign=base&v_traceback=c0611_2224_f0612_0000

And it's Kosher! Bonus!

June 14, 2010

On Sunday, June 13, 2010 21:28, " McGee " summedic@...> said:

> I dug up a prize for Wes, and decided that everyone should have one, so here

you

> all go.

>

http://www.shoppersvineyard.com/store/pc/DELIRIUM-TREMENS-ALE-750ML-BOTTLE-1p813\

7.htm?utm_source=Vinquire&utm_medium=WineFeed&utm_content=Delirium+Tremens+Ale+7\

50Ml+Bottle&utm_campaign=base&v_traceback=c0611_2224_f0612_0000

And it's Kosher! Bonus!

Sign In

RE: EMS Challenge (2) Hint #1

Recommended Posts

Guest guest

Link to comment

Share on other sites

Popular Days

Popular Days

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Guest guest

Link to comment

Share on other sites

Join the conversation

Activity