A 🧵 on STORMS in medicine.
First a question ❓️
PRAZOSIN is helpful in management of which among the following conditions❓️
💥Electrical storm
💥Cytokine storm
💥Thunderstorm Asthma
💥Thyroid storm
💥Parathyroid storm
💥Dystonic storm
💥Autonomic storm
#MedTwitter #MedEd
First a question ❓️
PRAZOSIN is helpful in management of which among the following conditions❓️
💥Electrical storm
💥Cytokine storm
💥Thunderstorm Asthma
💥Thyroid storm
💥Parathyroid storm
💥Dystonic storm
💥Autonomic storm
#MedTwitter #MedEd
Brief overview of these emergency conditions.
One of these conditions warrants activation of disaster management protocol 🚑 ⛈️
Which one is that❓️
Read on👇
One of these conditions warrants activation of disaster management protocol 🚑 ⛈️
Which one is that❓️
Read on👇
⚡️𝗘𝗹𝗲𝗰𝘁𝗿𝗶𝗰𝗮𝗹 𝘀𝘁𝗼𝗿𝗺 or 𝗩𝗧 𝘀𝘁𝗼𝗿𝗺
refers to the occurrence of three or more episodes of Ventricular Tachycardia or Ventricular Fibrillation within 24 h requiring intervention for termination.
refers to the occurrence of three or more episodes of Ventricular Tachycardia or Ventricular Fibrillation within 24 h requiring intervention for termination.
Patients of VT storm should be adequately sedated to ⬇️ anxiety and provide pain relief.
Recurrent VT/VF is treated using standard ACLS guidelines.
Rx includes the use of medications such as beta blockers, amiodarone and lidocaine with correction of any metabolic abnormalities
Recurrent VT/VF is treated using standard ACLS guidelines.
Rx includes the use of medications such as beta blockers, amiodarone and lidocaine with correction of any metabolic abnormalities
In addition to this global strategy of stabilizing the heart rhythm, reducing sympathetic drive & relieving any triggering mechanisms for the management of electrical storm, there are some specific therapies to be considered for patients with unique electrophysiologic substrate.
🎡 𝗖𝘆𝘁𝗼𝗸𝗶𝗻𝗲 𝘀𝘁𝗼𝗿𝗺 is a life-threatening systemic inflammatory syndrome involving ⬆️ levels of circulating cytokines resulting from immune-cell hyperactivation that can be triggered by various therapies, pathogens, cancers, autoimmune conditions & monogenic disorders.
Various triggers are identified in cytokine storm and each has distinguishing and overlapping features.
🦋 Thyrotoxic crisis or 𝘁𝗵𝘆𝗿𝗼𝗶𝗱 𝘀𝘁𝗼𝗿𝗺 presents as a life-threatening exacerbation of hyperthyroidism accompanied by fever, delirium, seizures, coma, vomiting, diarrhea and jaundice.
The mortality rate due to cardiac failure, arrhythmia or hyperthermia is ~ 30%.
The mortality rate due to cardiac failure, arrhythmia or hyperthermia is ~ 30%.
🔳Parathyroid crisis also known as 𝗣𝗮𝗿𝗮𝘁𝗵𝘆𝗿𝗼𝗶𝗱 𝘀𝘁𝗼𝗿𝗺 is a rare and serious complication of primary hyperparathyroidism.
Primary hyperparathyroidism (PHPT) is a disease characterized by hypercalcemia attributable to autonomous overproduction of PTН.
Primary hyperparathyroidism (PHPT) is a disease characterized by hypercalcemia attributable to autonomous overproduction of PTН.
The rest of the cases of PHPT are due to multiple gland hyperplasia affecting all parathyroid glands in about 10%, double adenomas in 4%, and parathyroid carcinoma in 1%.
Management of HYPERCALCEMIA👇
Management of HYPERCALCEMIA👇
Surgical removal of a solitary parathyroid tumor or subtotal resection of all pathologic parathyroid tissue in patients with hyperparathyroidism results in normalization of parathyroid hormone secretion, normalization of serum calcium levels, and a durable cure.
🔳𝗗𝘆𝘀𝘁𝗼𝗻𝗶𝗰 𝘀𝘁𝗼𝗿𝗺 is a rare but potentially fatal condition that can occur in response to a stress situation such as a surgical procedure or a systemic infection in patients with preexisting dystonia.
⛈️𝗧𝗵𝘂𝗻𝗱𝗲𝗿𝘀𝘁𝗼𝗿𝗺 𝗮𝘀𝘁𝗵𝗺𝗮 occurs due to airway hyperresponsiveness to pollens dispersed during a thunderstorm
Victims are usually individuals with allergy and previously known asthmatics.
Victims are usually individuals with allergy and previously known asthmatics.
💥𝗔𝘂𝘁𝗼𝗻𝗼𝗺𝗶𝗰 𝘀𝘁𝗼𝗿𝗺 is an acute state of sustained sympathetic surge that results in variable combinations of alterations in BP and heart rate, body temperature respiration, and sweating
Causes of autonomic storm include brain & spinal cord injury toxins & drugs, autonomic neuropathy, and chemodectomas (e.g. pheochromocytoma).
Brain injury is the most common cause of autonomic storm.
Brain injury is the most common cause of autonomic storm.
Now a story of the doctor 🩺 who calmed the storm.
While practicing in rural Maharashtra 🇮🇳 in the 1980s he was deeply concerned by the absence of a concrete management plan for scorpion bite🦂 which had a case fatality rate of disturbing ~40%.
While practicing in rural Maharashtra 🇮🇳 in the 1980s he was deeply concerned by the absence of a concrete management plan for scorpion bite🦂 which had a case fatality rate of disturbing ~40%.
Provoked by this he embarked on a decade long self-funded research into this problem with a methodology based of grassroot medical care, compassion, and astute observation skills.
Scorpion venom delays the inactivation of sodium channels mainly at the level of postsynaptic postganglionic nerve terminals of autonomic nervous system resulting in autonomic storm.
Based on his research he used PRAZOSIN in treatment of scorpion sting which gave amazing results
Based on his research he used PRAZOSIN in treatment of scorpion sting which gave amazing results
In 1986, in the paper titled "Prazosin in the management of cardiovascular manifestations of scorpion sting" (The Lancet), he and his wife put forward for the first time, Prazosin as a physiological antidote for scorpion stings
His passion for research on a neglected condition in resource poor setting has now saved millions of lives across the world 🌎
He is none other than Padma Shri Dr. Himmatrao Saluba Bawaskar.
Along with his wife Dr. Pramodini Bawaskar, their contribution to medical research is invaluable.
Along with his wife Dr. Pramodini Bawaskar, their contribution to medical research is invaluable.
@himmatbawaskar
Your work and dedication to the profession of medicine is truly inspiring and will keep on motivating generations of medical professionals🙏
Your work and dedication to the profession of medicine is truly inspiring and will keep on motivating generations of medical professionals🙏
@himmatbawaskar References
1. Harrison's principles of Internal Medicine 21ed
2. Cytokine Storm. NEJM nejm.org
3. Epidemic thunderstorm asthma. The Lancet thelancet.com
4. A crusade against scorpion sting
journals.lww.com
1. Harrison's principles of Internal Medicine 21ed
2. Cytokine Storm. NEJM nejm.org
3. Epidemic thunderstorm asthma. The Lancet thelancet.com
4. A crusade against scorpion sting
journals.lww.com
journals.lww.com/jfmpc/fulltext…
A Crusade Against Scorpion Sting: Life and Works of Dr.... : Journal of Family Medicine and Primary Care
ll as disconnect between services and the community needs. The life of Dr Himmatrao Bawaskar defies...
nejm.org/doi/10.1056/NE…
Cytokine Storm | NEJM
Review Article from The New England Journal of Medicine — Cytokine Storm
thelancet.com/journals/lanre…
Epidemic thunderstorm asthma
On Nov 21, 2016, Melbourne (VIC, Australia) was experiencing the peak of an unprecedented spring hea...
@himmatbawaskar Correction about parathyroid crisis.
Primary hyperparathyroidism is caused by a single parathyroid adenoma in about 80%-85% of cases.
Primary hyperparathyroidism is caused by a single parathyroid adenoma in about 80%-85% of cases.
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