Not Just Golfing in the Sun

When someone says they are going on a business trip, most of us would think that they are going to some wonderful place for round or two of golf and beer. While I don’t contest that this is a part of many meetings, there is much more that goes on behind the scenes. Recently I had the opportunity to attend the American Heart Association’s Resuscitation Science Symposium. This two-day conference was geared specifically towards advancing resuscitation and included everything from working on cells to full blown clinical trials. And let me tell you…it wasn’t just golfing in the sun. So I thought I would share what else goes on at these conferences.

The Networking…

Conferences are a great place to network. Not only are people for the most part friendly, everyone shares a common interest. And it is through networking and collaboration that research advances. It is great if someone has a new analytical approach, but it does nothing for patients (and the research process for that matter) if there is nobody around to implement it. Networking is also a great opportunity to bounce ideas off others. Each person brings a unique perspective to a problem…and a unique solution. Based on their experiences, training and expertise, two people will have totally different approaches to the same problem. Also, as someone just starting out in the field, I found it super helpful to build connections with other research groups whom I might consider working with in the future. And, I have the most to gain from veteran researchers. So far I have had very few opportunities like this, so I would recommend making the most of them.

The Science…

This may seem redundant, as they are scientific conferences, but the meeting is really about the science. Everyone has his or her own area of interest and expertise that they dedicate their time towards. However, ones area is just a sliver in the grand scheme of things. Just to show you, there were over 250 abstracts presented, each unique in its own way. There were abstracts on everything on the resuscitation spectrum. From incidence of cardiac arrests and trauma to bystander CPR to outcomes, from small animal model studies to randomized control trials involving thousands of patients. There was presentations on which drugs or devices are better, or how to best measure performance. And you can’t forget all the product marketing trying you to use their defibrillator or their antirhythmic either. All of which goes to show that there is fascinating work being conducted around the world, which given time will change practice and improve outcomes.

And Then Everything Else…

I would be foolish if I didn’t mention the other part of conferences. While the networking and the science are great…there are other parts that are equally important. Events like these are a great opportunity foster relationships with coworkers, whether strengthen existing ones or build new ones all together. While there is little free time in the schedule, you can always make something work. Either sneak away for an hour or two of bargain shopping or out for a night on the town. Or maybe even a round of golf and beers if the weather is right. Regardless there is always time to take in what the host city has to offer.

Overall scientific conferences can be a great mix between work and play. But it is all up to you what you want to get out of them. If you want to go shop, socialize and golf during the whole conferences that great. But if you want to spend the whole time at the convention center that is fine too. You get out of it what you put in. Personally, I found that mixing the science with a small vacation worked best. I make valuable connections with international researchers and listened to some fascinating presentations…but I also got a little me time and did some of the fun stuff as well. So if you ever get the opportunity to take part in a conference / business meeting etc…go for it!

Jason Buick is a researcher at Rescu, the resuscitation science program at St. Michael’s Hospital and is completing his Masters degree in Health Research at the University of Toronto.  His research interests focus around prehospital care, specifically bystander CPR and out-of-hospital cardiac arrests.

Welcome to Part 2 of the TOXIDROMES article (Part 1 can be found here).

To recap last month’s article; A drug overdose is the ingestion or application of a substance that is above and beyond the recommended or generally used amount.  Not all overdoes are fatal, and they can happen to anyone; first time or veteran drug users, purposefully or accidental, adult or child.

Understanding the common causes, basic pathophysiology and the signs and symptoms for the major TOXIDROMES is of huge benefit all levels of healthcare providers.  In the last article we covered the anticholinergic, cholinergic and sympathomimetic toxidromes.  The 2^nd part of the article will focus on Opiates, Sedative/Hypnotics and Hallucinogens.

Opiates

The Opiate toxidrome is one of the most common pre-hospital care providers will run into.  Opiates are CNS depressants, and most of the common signs and symptoms of an opiate overdose are due to this nervous system depression.  Common signs and symptoms in the Opiate toxidrome are; nausea and vomiting, dry mouth, drowsiness and miosis (pinpoint pupils) (note: an exception to this hallmark sign is Demerol, which does not cause miosis and is still classified as an opioid).  More sever overdoses can cause bradycardia, hypotension, apnea, hallucinations, delirium, loss of consciousness, seizure, coma and death.

Natural opiates are derived from the opium poppy plant, but semi-synthetic and synthetically produced opioids have existed for the most of the 20^th century.  Common opiates are morphine, heroin, codeine, Demerol, and Fentanyl.  The treatment for severe opiate overdose carried by most ALS services in Ontario is Naloxone (Narcan), which is a competitive opioid antagonist .

Sedative / Hypnotics

Also known as tranquilizers, drugs in this toxidrome act on the nervous system to produce sedation or dissociation without any specific analgesic effects (unlike opioids).  Many of the drugs in this toxidrome cause high rates of physiological or psychological dependence, and as such are commonly abused.  Signs and Symptoms of this toxidrome include; decreased LOA, delusions, ataxia, nystagmus, slurred speech and apnea (being the most serious potential complication).

There are a wide variety of substances that cause the effects of this toxidrome including; barbiturates (eg. Phenobarbital), benzodiazepines (eg. Valium, Ativan etc.), GHB, and alcohol.

Hallucinogenic

Substances in this toxidrome cause a variety of visual, tactile and auditory sensations.  Delusions, hallucinations, disorientation and panic are all potential side effects of drugs that fall into this category.  More severe complications can include hypertension, tachycardia, tachypnea, and seizures.

Common street drugs such as LSD, mushrooms, PCP, cocaine and amphetamines can all be classified under the hallucinogenic toxidrome.  Unlike many Hollywood depictions in which individuals under the influence of hallucinogens experience a complete disconnect from reality and full-scale auditory, visual and tactile hallucinations, it is important to note that many of the substances that fall into this category have less dramatic and dissociative effects.  Treatment for individuals in this toxidrome generally is limited to supportive care, allowing the substance to naturally run it’s course while protecting the patient from doing themselves or others harm.

The above toxidromes (and those covered in Part 1) are only a brief overview.  Given the myriad of substances that can have both positive and negative effects on the human body, understanding and being able to classify symptoms into the various toxidromes gives health care providers and framework on which to begin treatment of a patient.  Often, with severe overdoses, we do not have the luxury of waiting for a toxicology screen before beginning treatment.  Pre-hospital care providers often have a unique opportunity to observe patients in the setting where the overdose took place, so detailed (and safe) scene surveys are extremely important in any suspect drug / substance overdose.  Using these toxidromes, and the information found on scene, first responders and paramedics can initiate the appropriate care, and provide life saving information immediately to hospital staff.

My thanks once again to Blair Bigham for the use of his “Drugs for CERTs” presentation.

Epidural and Subdural Hematomas: Dangerous Blood Clots on the Brain
Gary E Cordingley, MD, PhD

To read the rest of this article click on the link below:
http://www.cordingleyneurology.com/epiduralsubdural.html