Podcast #203: Wine, Milk and… Vaccines!?

Author: Dave Rosenberg M.D.

Educational Pearls:

  • Louis Pasteur developed the technique that is now known as pasteurization. It was first used in the wine-producing regions of France, and eventually in dairy products like milk.
  • Pasteur also investigated infectious disease. During one experiment, Pasteur’s lab assistant accidentally infected chickens with a weakened form of cholera. When none of the chickens died, Pasteur re-infected them with a stronger strain. This time, none of the chickens became sick because they had been inoculated against the disease. This experiment paved the way for modern vaccination.

References: Smith KA. Louis Pasteur, the Father of Immunology? Frontiers in Immunology. 2012;3:68. doi:10.3389/fimmu.2012.00068.

 

Podcast #138: Bromide Toxicity – 1966

bromo-seltzer-bottleRun Time: 3 minutes

Author: Christopher Holmes M.D.

Educational Pearls:

  • In the chapter on altered mentation in a 1966 pamphlet on handling emergency medical situations, the number one suspicion of altered mental status was toxic substance ingestion.
  • The key suspects for toxic ingestion at that time were benzodiazepines and bromide toxicity. They specifically state in the pamphlet that opiods are rarely a cause for altered mentation.
  • Bromide was commonly used in the 18th and 19th century as a headache remedy and sedative. Until the 1970s, bromo-seltzer was used for headaches before being withdrawn from the market. Bromide is currently used to treat epilepsy in dogs and in Germany.
  • Reportedly, bromide was given to the British soldiers of WW I and people with epilepsy during Victorian times to decrease their sexual drive. Epilepsy was believed to be caused by masturbation, during the Victorian age, and therefore decreasing sexual drive decreased seizure activity.
  • The half-life of bromide is 12.5 days, so chronic use leads to bromism. 5-7% of psych admissions were due to bromism caused by the chronic use of bromide. The maximum daily recommended dose of bromide is 0.5 to 1 gram per day to avoid toxicity. In the 1960s, typical doses were between 3-5 grams per day.
  • Symptoms include somnolence, psychosis, seizures, delirium, headache, fatigue, ataxia, memory loss, restlessness, irritability, and hallucinations.
  • The treatment is a fluid flush and salt load the patient.

Link to Podcast: http://medicalminute.madewithopinion.com/bromide-toxicity-1966/

References:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2385720/pdf/ulstermedj00100-0055.pdf

Podcast #136:  James Lind

0bfceb3e-9d23-4b08-9827-435445eea9dbRun Time: 3 minutes

Author: Dylan Luyten M.D.

Educational Pearls:

  • Scurvy is a terrible disease caused by vitamin C deficiency. Causes failure of collagen synthesis and breakdown of connective tissue, and ultimately, death.
  • British sailors were called “Limeys” because of the practice of taking limes to prevent scurvy.
  • James Lind is notable in the history of medicine because he conducted the first clinical trial in 1747 and proved that citrus fruit cure scurvy.
  • Interestingly, he did not understand how vitamin C actually cured scurvy. The concept of “vitamins” did not exist at the time, and he and the rest of the medical profession at the time thought that scurvy was a result of poor hygiene and food “putrifaction”, and that the citrus had an antiseptic function. Just goes to show that you don’t have to understand how something works to know, and prove, it works!

Link to Podcast: http://medicalminute.madewithopinion.com/james-lind/

References: http://www.jameslindlibrary.org/articles/who-was-james-lind-and-what-exactly-did-he-achieve/

Podcast #125:  Old School CPR – 1966

wpbpd-1960sRun Time: 5 minutes

Author: Christopher Holmes M.D.

Educational Pearls:

  • The New England Journal of Medicine produced a pamphlet in 1966 about the management of emergencies.
  • Cardiac arrest treatment algorithm at that time consisted of a precordial thump, then artificial ventilation via mouth to mouth (as intubation wastes too much time), and then initiating compressions.
  • The first line was to give epinephrine…by a cardiac needle directly into the cardiac muscle tissue every 3-5 minutes (Pulp Fiction style)! The next step was to perform a venous cut-down, instead of getting an IV. Then the standard of care was to give one amp of sodium bicarbonate every eight minutes!
  • They also administered a medication called metaraminol (an alpha-agonist), 60 mg of levophed, and solu-cortef for each cardiac arrest.
  • For the treatment of ventricular fibrillation, intracardiac epinephrine and calcium chloride would be given first and foremost. For defibrillation, the patient had a paste applied to their chest and were given 450 volts AC (which is 4 times the power of your home plug). For continued management, the patient was given procainamide, sodium bicarbonate, and made hypothermic.

Link to Podcast: http://medicalminute.madewithopinion.com/old-school-cpr/

References:  For Subscribers: http://www.nejm.org/doi/pdf/10.1056/NEJM196607072750107

Podcast #120: The State of Sepsis in 1966

sepsisRun Time: 6 minutes

Author:  Christopher Holmes M.D.

Educational Pearls:

  • In 1966, sepsis was believed to be comprised of bacteremia, endotoxins and exotoxins, and disruption of capillary blood flow.
  • Risk factors were women who underwent “non-sterile abortions” (A common occurance before Row vs Wade in 1973) and being an “old” man over 40 y/o.
  • For work up, the standard practice was measuring the Central Venous Pressure (CVP) with a manometer by inserting a polyvinyl catheter via surgical cutdown in the basilic vein and using a tape measure to roughly gauge the distance of the column of water to the heart.
  • If CVP was low, blood and plasma were given along with isoproterenol (a beta-agonist) and digoxin (to increase contractility). If this failed, then phenoxybenzamine (an alpha-antagonist) was used to dilate the capillaries. At this point, norepinephrine was not used for treatment.
  • The antibiotics of the day were kanamycin, streptomycin, and chloramphenicol. These treatments were almost always used along with 60 million units of penicillin, the “go-to” antibiotic. Interestingly, every million units of penicillin has 1 milliequivalent of potassium, which is counter-intuitive to give to patients in possible renal failure from sepsis.
  • Steroids and permissible hypotension were in vogue as well, and pressors were supposed to be given only if a blood pressure was not palpable.

Link to Podcast: http://medicalminute.madewithopinion.com/state-of-sepsis-1966/

References:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4403600/

Podcast #38: Diphtheria and March 18th

Run Time: 5 minutes

648x364_diphtheriaAuthor: Dr. David Rosenberg

Educational Pearls:

  • There are two cases of diphtheria per year in the United States due to our ubiquitously provided vaccinations.
  • Diphtheria presents with a grey, leather-like appearance in the back of the throat as well as a “seal-bark” cough. This is caused by a relatively weak bacteria called Corynebacterium diphtheriae, which is dangerous because of the toxin it produces.
  • An anti-toxin can be given to combat the toxin produced by Corynebacterium diphtheria. This anti-toxin serum is held at the CDC in Georgia currently.
  • On March 18th, the Iditarod is run in Alaska to commemorate a sled dog team, led by Balto, that ran from Nome to Anchorage and back to provide children in Nome with the diphtheria anti-toxin serum.

Link to Podcast: http://medicalminute.madewithopinion.com/diphtheria-and-march-18th/

References: http://www.cdc.gov/diphtheria/about/causes-transmission.html

Podcast #3: Alexis St. Martin

Run Time: 3 minutes220px-st_martin_alexis

Author: Dr. Christopher Holmes

Educational Pearls:

  • Shot with musket to upper abdomen in 1822 on Mackinac Island – survived standard of care of blood letting and cathartics – was left with a fistula from his stomach to his abdominal wall.
  • Alexis St. Martin was illiterate and signed a contract with Dr. William Beaumont, who then performed unethical experiments on the patient – William Beaumont was hailed as a great physician for his discoveries through his unethical experiments on Alexis St. Martin.

Link to Podcast:  http://medicalminute.madewithopinion.com/alexis-st-martin/

References:  http://www.ncbi.nlm.nih.gov/books/NBK459/