Tuesday, 30 July 2013
Monday, 29 July 2013
Sunday, 21 July 2013
MISCONCEPTIONS ABOUT HYPERTENSION
Dr Himanshu Gul Mirani
Emergency Physician and Centre Head
UCC,
Kalkaji
1. Hypertension can’t be asymptomatic
Hypertension is a silent killer. It’s very
much possible to have high BP and yet be asymptomatic. Symptoms like headache/
nausea/ vomiting/ chest pain/ shortness of breath –may not be present at the
very outset of disease.
It’s not a rule that BP is high only when
you can feel it!
Usually such patients present to ER upon
decompensating into “Hypertensive Crisis”.
2. Anti-hypertensive medicines need to be
discontinued once normal values are recorded
Your normal values may well be because of
the anti-hypertensive medicines itself. So don’t discontinue them without a
proper physician consult.
Sudden discontinuation of these medicines
without medical supervision can predispose the patient to “rebound
hypertension” and precipitate “Hypertensive Crisis”.
3. It’s OK to miss my doses of medicines –
anyways I take them every day, so some drug holiday is allowed
Non drug compliance itself is thought to
cause about 89000 pre mature deaths in USA per annum. These deaths are simply
preventable by practicing drug regime adherence.
So don’t skip your doses. It would only
undo the good.
4. It’s been quite some time since I saw my
doctor & I am continuing with my prescription which is ages old
It’s very much advisable to have a diligent
follow up with your GP, although you may be having a good control of BP with
your current medicines. Anti-hypertensive medicines have their own side-effects
which need to be monitored, eg patients on ACE Inhibitors need Kidney Function
Tests regularly at the commencement of therapy and continuation of therapy. Diuretics
predispose a person to dyselctrolytemia. Maybe the cough for which you are
gulping OTC cough syrups is a side effect of ACE inhibitor drug.
So do keep visiting your GP as advised by
him/her.
Also maybe after implementing positive
therapeutic lifestyle interventions you may need drug dose reduction!
5. I left exercising as it increases BP
Exercising to the best of one’s capability
and capacity is advisable to even heart failure patients. It has been
established that regular permissible exercise and weight management can only
have positive impact on one’s health.
In fact for every 10kg weight loss SBP may
fall between 5-20 mmHg and if one does regular exercise for about 30-45 mins –
on most days of a week, preferable 5 out of 7; this itself can bring a fall in
SBP of 4-9 mmHg. Sedentary life style is one of the leading risk factor
predisposing to hypertension.
6. High BP affects only oldies
The disease has epidemically plagued the
Gen Y and Gen Z and is no longer limited to the Baby Boomers. There is enough
evidence to testify that the young are fast getting engulfed by hypertension.
High stress levels, lack of physical
activity, tobacco and alcohol addiction, excess salts in packaged and processed
foods, fast foods – all contribute immensely to increase the disease load.
7. Medicines are ineffective in old patients
and they can’t hit their “goal BP”
With the multiple drugs in the
armamentarium of your physician – the drugs are very much capable to help you attain
your target level of BP. These drugs act by varied mechanisms to help an
individual attain the desired control of BP.
Target BP is determined based on one’s
other co-morbid conditions - more the co-morbidities like diabetes and chronic
kidney disease – the more stringent the control of BP.
8. Medicines are the only way to control BP
Non pharmacologic methods to control BP
have a very well established role in today’s BP management methodology. They
have variable effects depending upon individuals. The following are the
suggested measures:
·
Decrease sodium (salt) intake
·
Regular exercise on most days of a week
·
Weight reduction
·
Moderation of alcohol consumption
·
Quit smoking
·
Follow DASH diet
For any feedback/ suggestions/ query regarding this article;
contact the author on himanshu.mirani@urgentcare.co.in
Call us Toll Free at 1800 208 1188
Or SMS UCC to 52424 to know more about UCC
Hospitals and Hospitals in Delhi.
Tuesday, 2 July 2013
Common Household poisonings in children- A Preventable Condition
Dr Bharat Choudhary
Consultant, Pediatric
Emergency Medicine, UCC
Parents often think that home is safest place for children.
But there are so many things in the house for daily use which could be
dangerous to children. Inherent tendency
of infants and toddlers to direct the things from hand to mouth increase the
possibility of the same. Over a year in USA, poison center receive 3.6 million
calls of such incident, means every eight second one call, so this is quite
clear that it is not uncommon. For parent information, describing about few
such common household poisons, their effects and methods of prevention.
Common Household
poisons-
With increasing number of different chemicals used in home,
list of possible household poisons are also increasing. As said by Paracelsus
(Father of toxicology) that – ‘’All
things are poison, and nothing is without poison; only the dose permits
something not to be poisonous.’’ There is long list of chemicals used on day
today basis which can be dangerous for children if taken in significant amount.
For example-Pharmaceuticals (pain killers, antiepiletics, antidiabetics,
vitamins, iron preparations), hydrocarbons (kerosene, petrol, thinner),
cleansers, pesticides, rat killers, cosmetics , plants and much more.
The great majority of such poisonings have no or limited
clinical effects. Many of such children require only observation but a few
poisons can kill after ingestion of very small amounts. Unintentional poisoning
can be much more serious following ingestion of kerosene, caustic agents,
herbal remedies, insecticides or herbicides. Management of symptomatic patients
involves supportive care, if available the administration of antidotes, and the
removal of the offending drug from the body.
Common poisonings,
their effect and initial management
|
S.NO
|
Poison
|
System affected
|
Line of Treatment
|
|
|
|
|
|
|
|
1
|
Pain killer ( paracetamol)
|
liver and biliary system – liver failure
|
Gastric lavage, N acetyl cystiene
|
|
|
|
|
|
|
|
2
|
Kerosene
|
Chemical pneumonitis with acute respiratory distress
syndrome
|
Observation , chest x-ray and monitoring
|
|
|
|
|
|
|
|
3
|
After shave, perfumes, alcohols
|
CNS and respiratory depression , hypoglycemia
|
Observation, glucose monitoring, IVF
|
|
|
|
|
|
|
|
4
|
Bleach
|
Esophageal injury , acidosis
|
IVF, observation
|
|
|
|
|
|
|
|
5
|
Detergents
|
Esophageal injuries, chemical pneumonitis
|
Observation
|
|
|
|
|
|
|
|
6
|
Nail paint remover
|
Mucosal injuries, respiratory depression , CNS depression
|
observation
|
|
|
|
|
|
|
|
7
|
Rat Killer
|
Coagulation system
|
Vit K , observation, coagulation study
|
|
|
|
|
|
|
|
8
|
Camphor
|
CNS irritant , seizures
|
Gastric lavage, antiepileptics, observation
|
|
|
|
|
|
|
|
9
|
Pesticides (Organophosphorous)
|
Vomiting, diarrhea, seizures
|
Gastric Lavage, PAM, hospital admission
|
|
|
|
|
|
|
|
10
|
Iron Preparations
|
Hepatic Dysfunction, renal dysfunction
|
Gastric lavage, Observation, Deferoximine
|
|
|
|
|
|
|
Who is at most risk?
Usually toddlers 1-3 years are more prone for such accidents because they are they are extremely
curious and active they tend to put everything in their mouths their taste buds and sense of smell aren’t
developed to warn them that a substance is dangerous because it tastes or
smells awful.
How does it happen?
It happens mostly when this chemical is in use and children
started playing around them unattended. When they are not properly placed after
their use and also when they are not disposed well.
What to do?
If you suspect your child has eaten something which is not
to be eaten then
- Don’t wait
for your child to be more sick
- Don’t
panic, remain calm.
- Nearest
Urgent Care Hospital - 1800–208-1188 ( Toll Free)
- Call
National Poisoning center (AIIMS Poison cell)
26593677, 26589391, 26583282
Trained professionals
will answer your queries, and help to determine the seriousness of a poisoning,
and give specific advice on how to deal with the incident. While talking to
these centers please be ready to answer common questions like -
- The age and weight of the child, since toxicity usually is based on these factors
- When the child was exposed
- How much the child ate, drank, or spilled
- The child’s general health status
- Whether the child has any signs or symptoms
- What actions have already been taken
- Keep the container near you and read out the content ( either exact brand name, or active ingredient)
- This information is very vital in assisting you and providing proper medical advice.
Don’t DO’s for
parents
- If any child accidently taken some household poison and swallowed, the most common mistake parent does is putting fingers in the mouth and try to extract it or make the child vomit. This is very dangerous practice; it does more harm than benefit. This will may lead to pushing the solid object more deeper may be in respiratory tract or if vomiting happens that may increase the chance of aspiration and further complications ,and if fingers goes more deeper it can injure oral mucosa also. So attempt to remove the poison should only be done if it is solid and not deep into oral cavity and can be easily removed by fingers.
- Do not give anything by mouth unless advised
How to prevent such Mishappening?
Prevention of such incident can be done by proper storage,
use and disposal of these harmful chemicals. Even after taking all the precaution
such incidents do happen, so parents should know basic first aid and how to
access the poison center. (write to info@urgentcare.co.in if you want to learn
first aid )
Following are the basic steps to avoid such incident-
Store toxic products
out of reach of children
Medications, Pesticides, house cleansers and other toxic
substances should be kept in shelves
at least six feet and above.
Keep products in
their original containers
Do not keep medications, chemicals, house cleansers,
pesticides in food or beverage container or vice versa. This commonly happen at
home, that after medicine or chemical got over they use empty container for storing other substances or liquids which
other person or children does not know and leads to unintentional poisoning.
Keep labels on
containers
Label all the containers with name of the product they
contain presently and remove the old labels if you are using the container for
storing other substance then it was containing originally.
Never combine
products
Do not mix household cleansers together because certain
combinations can be explosive or can produce toxic fumes.
- Never give medication to children meant for adult.
- Be aware of all kind of medication used in home
- Never refer medication as candy or taste like candy to children
- Always put medications away immediately after use, out of reach and sight, preferably locked away.
- Ensure the cap’s child resistant closure is working correctly after each use.
- Use wax block rat baits, preferably those enclosed in plastic bait stations.
- Don’t leave brushes to soak in mineral turpentine. Clean them immediately or keep them out of sight and reach of children until you can clean them properly.
- Educate your children about the potential harm of common household substances
So to summarize, unintentional household poisonings are
common but preventable and if taken appropriate steps timely serious and long
term complications can avoided.
For more blogs and write ups like this visit www.urgentcare.co.in
Pacemaker Malfunctions
DR HIMANSHU GUL MIRANI
With increasing number of patients walking home with a
pacemaker for their cardiac care, it has become quite a common scenario to
encounter a bizarre ECG strip with a symptomatic patient and maybe a
malfunctioning pacemaker! It’s extremely vital to sense a pacemaker malfunction
so as to coordinate with the cardiology team and the manufacturer for further
evaluation and management.
In this article I have tried to highlight some very common
pacemaker malfunction phenomena and the possible patient presentation to the ER
along with a simplified scheme to approach such patients and concluded it with
some handy tips for the patients on pacemakers.
Common errors and their causes:-
1. Self tampering
Called as Twiddler’s Syndrome, it’s due to fiddling of the
device by the patient themselves. These patients need more counseling to
understand the implications of such acts.
2. Runaway
Rare, but seen in case of low battery nearing replacement,
especially in patients who have irregular follow up. Low battery causes low
amplitude pulses and inadequate stimulus. There is non-physiological erratic
heart stimulation with rate up to 2000 bpm!
It needs deactivation of the pacemaker using a magnetic
field but definitive treatment is replacement of the battery.
3. Endless loop
tachycardia
It s caused due to retrograde conduction of ventricular
impulse into the atria leading to a vicious endless loop producing pacemaker
mediated tachycardia. This high heart rate may induce ischemic changes in the
heart muscle. Magnetic inhibition is warranted to terminate the tachycardia.
4. Sensing issues
Under-sensing may occur when the pacemaker would not detect
the inherent cardiac activity and hence fire asynchronously. It may occur due
to lead dislodgement or insulation breach or programming error.
Over-sensing would occur when some non-cardiac activity is
detected as cardiac electrical impulses leading to malfunction. Over-sensing
stimuli may be from muscle activity of diaphragm or pectoralis or from external
sources like MRI.
5. Failure to capture
When the pacemaker stimuli are not followed by atrial or
ventricular depolarization, it’s referred to as failure of capture by the
pacemaker. It can be due to numerous causes like circuit failure,
dyselectrolytemia, infarction or fibrosis under the pacemaker tip etc.
Such patients need temporary pacing till the definitive
management is done by correcting the device setting or treating the pathology
like electrolyte imbalances.
6. Pacemaker syndrome
Seen in ventricular pacing, where due to asynchrony, atria
may contract when the ventricles are in systole from pacemaker impulse. Hence
the atria contract against closed AV valves, leading to worsening of patient
symptoms rather than improvement.
Such patients need Dual Chamber Pacemakers rather than just
ventricular stimulation.
Patient
presentation:-
·
Worsening of symptoms.
·
Chest pain.
·
Engorged neck veins.
·
Shortness of breath.
·
Palpitations.
·
Manipulation marks over the site of pacemaker
insertion indicating tampering.
·
Dizzy feeling.
·
Lightheadedness.
·
Racy pulse.
How an ER physician
should proceed:-
·
Take the vitals.
·
Give supplemental oxygen.
·
Give a fluid challenge for low BP, may need
inotropic support.
·
Get a 12 lead ECG.
·
Send blood samples for electrolytes, ABG –
correct any imbalances.
·
Send cardiac enzymes to detect any fresh insult
to the heart.
·
Send drug levels of medicines which the patient
is on and which can alter the conduction (eg – flecainide).
·
External pacing may be needed.
·
Do a chest x-ray as a lot of clues like lead
dislodgement/ lead fracture etc can be noted on the x-ray. Ask for an over
penetrated film. A CT-Scan is more conclusive.
·
Ask for regularity of follow up with the
cardiologist and the last check date, note the model type and pacemaker code
and get in touch with the cardiologist and electro-physiologist for a possible
recalibration or battery change.
·
Magnet application – it helps to convert the
pacemaker to asynchronous mode and thus detect low battery or failure to
capture.
·
Always keep cardiologist, CTVS surgeon and
electro-physiologist in the decision making loop.
Tips for patients:-
·
In case patients sense any of the symptoms as
enlisted above – they must seek medical help immediately at the nearest centre.
·
Be regular in follow up – it would ensure proper
care of the pacemaker and it’s various components like leads, generator,
battery etc. Malfunction of any component can lead to device failure.
·
Always carry with you a laminated card
mentioning the pacemaker type, model, manufacturer’s name and contact, treating
doctor’s name and contact number, list of current medications, any known
allergies & names and contacts of people to be informed case of emergency.
·
Don’t manipulate/ fiddle with the pacemaker.
·
In case external hindrance to pacemaker function
is expected as in case of MRI – inform the doctor/ attendant about it.
·
The manufactures give a list of possible
conditions which interfere with the pacemaker – avoid these conditions always.
For more blogs and write ups like this visit www.urgentcare.co.in
Wednesday, 19 June 2013
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Monday, 1 April 2013
“Health Bytes” on Holi
Dr Vanita Mittal
Emergency Physician
Medical Director –
Delhi
मुठ्ठी में भरकर
रंग चले हैं,
आज सारे गालों
पर कैनवस धरे
हैं, कोई गुलाब
है, कोई सहेली,इंतज़ार में है,
कोई युवती अकेली,
सतरंगी हिलोर में बहकते
चले हैं, तन
कहकहों से भीगते
चले हैं, वहाँ
मेरे अपने, कितने
रंगों में रसें
हैं, हाँ हम
गुलाली बादलों के प्यासे
हैं,
मेरे दोस्तों, हम भी
बनावेंगे टोली, मेरे संग
आओ, मनावेंगे होली
|- डॉ. विवेक शर्मा
The colors & flavors of Holi are in the air again.
Children are on the roads with water filled pichkaris and balloons splashing
every passerby with colors of the season. A festival which is a favorite
amongst kids and youth also brings lines of worry on parent’s faces. Are the colors
used safe? Will they harm my child’s skin? What about slips, trips and falls
during the Holi excitement? Every year a large number of people visit Emergency
rooms for some or the other festivity related health problems during Holi time.
Most common problems are allergic reactions to colors, asthmatic attacks, skin
and eye problems, injuries due to slips & falls, road traffic accidents due
to drunken driving, Bhaang intoxication, gastro – intestinal problems due to
water or food borne infections. Urgent Care believes prevention is better than
cure and thus we bring you some “Health Bytes” on Holi to help prevent these
problems and tips on what to do in case any thing does happen.
Prepare yourself for
playing holi –
• Choose clothes which cover most of
your body parts
• Apply a thick layer of petroleum
jelly or oil over your skin before going out to play. This helps to protect the
skin from the damage caused by harsh chemicals and also helps the color to come
off quickly.
• Apply oil to your hair also as it
helps contradict the dyeing nature of certain holi colors and protects them
from damage. If possible, cover your hair with a cap or a hat in order to
protect them.
• Do not wear contact lenses when
you are playing with colors. This is because color can come between your eye
and lens, resulting in infection and in some cases, eye damage. Glasses can
help protect your eyes from color.
• Coat your finger nails and toes
with paint so that they remain protected.
• Get natural, herbal and
skin-friendly products as too much of harsh chemicals used in the holi colours
can be a major cause of itching. You can prepare colors at home from natural
products like flowers, henna etc
While playing Holi -
• Respect other person’s
independence on Holi. Do not force anyone to play with colors if they do not
wish to do so.
• Do not rub colors too vigorously
on anyone’s face – it can lead to skin damage.
• Be careful and avoid eyes and
mouth when applying color. Keep your eyes and mouth tightly shut when someone
is applying color on you.
• Avoid running on wet floors as one
can slip and get injured.
• Do not use mud, grease, eggs or
gutter water on Holi.
• Do not drink and drive. If you
plan to have alcohol, ensure somebody else is driving.
• It is a traditional practice to
consume Bhang on Holi. When consumed in large quantities Bhang can lead to
effects like increased blood pressure and heart rate, psychosis. Never consume
it on an empty stomach and do not mix it with alcohol
What to do in case of
a problem?
• If you face any kind of trouble as
soon as the colour comes into contact with your skin, wash the colour off
immediately with water and apply a soothing calamine lotion. If the problem
persists immediately seek medical help.
• Itching, redness, swelling,
breathing difficulty are signs of a significant allergic reaction. Immediately
report to nearest medical facility. You may need an injectable medication for
your allergy. Urgent Care Centres are open 24×7 in your neighborhood.
• If you slip and fall check for
injuries. In case of swelling, pain, inability to move a limb, apply an Ice
pack locally and report to the nearest medical facility. You may have a
fracture or soft tissue injury.
• If color goes into your eyes, wash
with plenty of water immediately. If problem persists seek medical help.
• If someone falls from height or
meets with a road traffic accident immediately call ambulance from nearest
source. Call 1800 208 1188 if you are near an Urgent Care Centre, one of the Best Hospitals in Delhi. Moving such a
victim yourself can aggravate spinal injuries.
• If you are a known asthmatic or
suffer from severe dust allergy, it is advisable not to venture out to play
Holi with colors, especially the dry variety. Keep you inhaler with you in case
you go out. If you have an asthmatic attack immediately use your inhaler. If
not relieved immediately report to nearest medical facility. Urgent care
centres are equipped to deal with all asthmatic emergencies.
• If someone has consumed large
quantity of Bhang and is complaining of palpitations, severe headache or is
having uncontrollable abnormal behavior, seek medical attention. Urgent care
centre in your neighborhood can help evaluate and manage Bhaang intoxication
Holi celebrates the arrival of spring, good harvest & is
a time of enjoying spring’s abundant colors and saying farewell to winter. So
don’t stay away from colors, just be color smart….play safe!! In case of any
health problem Urgent Care is just round the corner to take care….at all times.
We are the first response centre – aapke liye!!
Have a fun filled, healthy and safe Holi!!
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