Epinephrine Injection Therapy Case Studies

Mr. XXXX is a 44 years old Caucasian male, a general construction worker who works on a nearby highway for the bridge project, and checked in this urgent care center for complaining of chest pain and shortness of breath (SOB). The chest pain is constant dull and pressure like pain, and started 3 hours ago. The pain is located on the center of chest. He rates the pain 4 out of 10 on a pain scale 0 to 10 while resting. The pain gets worse and increases after eating. He experienced increased chest pain and SOB with simple walking from the parking lot to this office. The pain was not resolved with taking PO 365mg of Aspirin 2 hours ago and resting. He was diagnosed with hyperlipedemia 10 years ago. He is taking medication to manage his high cholesterol level. He denies past history of chest pain, hypertension, and coronary artery disease. He denies any history of heart surgery or cardio artery bypass surgery. He is anxious and fearful for his first chest and SOB. He smokes a half pack a day for past 20 years. He drinks one bottle of bear every evening with meals. He denies taking any herbal medication or illicit drugs. He has been a good appetite. He reported 20 lbs weight gain since his retirement from military. He has an irregular meal time and does not exercise as much as he used to do in the military.

Physical Examination: General: The patient is an alert, oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78 and pulse 68 and regular. Temperature is 38.56 oC (101.4 oF). HEENT:Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears are clear. Throat is normal. Neck: The neck is supple with no carotid bruits. Lungs: The lungs are clear to auscultation and percussion. Heart: Regular rate and rhythm. Abdomen:Bowel sounds are normal. There is rebound tenderness with maximal discomfort on palpation in the right lower quadrant. Extremities: No clubbing, cyanosis, or edema.

PAST MEDICAL/SURGICAL HISTORY: As above. SOCIAL HISTORY: Status post heavy smoking, 50+-pack-year history. He quit 10 years ago. Status post alcohol abuse, quit 3 or 4 years ago. He lives by himself and no longer drives but has 2 daughters here in Miami who take him where he needs to go. FAMILY HISTORY: Patient’s wife died 14 years ago of COPD due to lifelong smoking. Brother has diabetes mellitus. Unremarkable family history otherwise. REVIEW OF SYSTEMS: No fever, no nausea, no vomiting. Patient has incontinence of bowel. No shortness of breath, no chest pain, no palpitations. PHYSICAL EXAMINATION: Well-developed, well-nourished white male who is alert and oriented x3. Wears bilateral hearing aids. Afebrile with blood pressure 130/70. NECK: No carotid bruits. LUNGS: Clear to auscultation bilaterally. HEART: S1, S2 normal. No murmur. No S3 or S4. ABDOMEN: Soft, nontender. No arterial bruits. No masses, no organomegaly. EXTREMITIES: No edema. No pulses present in the lower extremities. The right great toe is absent. The left great toe shows a 2 x 1 cm deep ulcer with redness around the toe with pus extruding. PLAN 1. Get consult with Dr. Beth Brian, Infectious Disease. 2. Follow up with Dr. Hirsch, Orthopedics. (Continued)

S- 3671 dispatched to a m pt C/O of abdominal pain and black stool. Pt is a 49 y/o m whose C/C is abdominal and lower back pain. Pt also states that he is experiencing cramping around his left ribcage. Pt states that he has been experiencing N/V/D for the past four days. Pt also states that his bm's have produced black, watery stool since the monday prior to the incident date. Pt is able to provide EMS personnel with a detailed medical Hx that includes HIV, acid reflux, and recently diagnosed COPD. Pt also states that he recently stopped smoking cigarettes. Pt is also able to provide EMS personnel with a list of medications that he is currently taking that includes Duloxetine, Stribild, Ranitidine, Aripiprazole, oxycodone, and proair. Pt states that he has not taken any of his prescribed medications for the past four days prior to the incident date. Pt states that he has allergies to Kaletra and gabapentin. Pt states that his primary

Mr. Howard, a 57-year-old man, had a 3-month history of progressive typical anginal chest pain. He reported that the symptoms first occurred with heavy exertion and involved what he described as“heaviness” in his chest. The symptoms were promptly relieved with rest. Over the past weeks, he had been experiencing increasingly frequent episodes of chest pain and diaphoresis. The episodes had become more prolonged, and he had experienced one episode of pain occurring at rest after a heavy meal. Mr. Howard was moderately obese and had a 20-year history of hypertension, which was being treated. Other risk factors in Mr. Howard’s history include hypercholesterolemia (350 mg/dL), which he was attempting to treat with dietary modifications, and a 30-year two-pack-a-day smoking history which continued up to the present time. Mr. Howard previously had surgery for a bilateral inguinal hernia repair, cholecystectomy, and arthroscopic surgery on his left knew. He also gave a history of problems with gastric reflux and was currently taking cimetidine (Tagamet).

Chweyah, dated 08/11/2017, indicated that the claimant presented for a follow-up visit after his discharge from the hospital on 08/08/2017. He was admitted on 08/04/2017 due to normocytic anemia, pain in both knees, starvation ketoacidosis, hypertension, gout with tophus, and duodenitis. The esophagogastroduodenoscopy revealed erythematous duodenopathy, erythematous mucosa in the antrum, and small hiatal hernia. He had a colonoscopy which revealed internal hemorrhoids. Objective findings showed blood pressure of 112/86 with a pulse of 105. He was diagnosed with quadriceps weakness, pain in both knees, normocytic anemia, type 2 diabetes mellitus, hypertension, stable chronic kidney disease stage III, and bilateral impacted cerumen. It was noted that he can return to work on 08/16/2017 with limitations of not standing for more than 10 minutes at a time for 1

The case study states Sam’s has a condition of insulin dependent diabetes and her complaint to her friend, of burning and frequency when going to the bathroom, we could provisionally diagnosis a probable urinary tract infection as a underlying trigger for the fever (Marshall, 1993, p274).

On 2-10-15, Neurologist, Dr. Johnson documented Mr. Durland complained of hemorrhoids, difficulty with bowel movements, a change in bowel habits, urgency, and rectal pain. Dr. Johnson documented that Mr. Durland’s PCP examined him, as well as a proctologist, urologist, neurosurgeon, GI physician, and a pain management physician. Dr. Johnson documented that Mr. Durland had various test and procedures, rectal exams, and no one had ever found anything. Dr. Johnson documented that Mr. Durland’s pain was perirectal/perineum and burning, occasionally he had pains down the medial aspect of both legs, right greater than left, and along the medial right thigh region. Mr. Durland complained that when it had "flared up" it was hard for him to sit and he had to lay or sit on his side because his perineum region was so tender. Mr. Durland denied numbness, was able to get erections, could ejaculate, and described the pain as being internal. Dr. Johnson documented that Mr. Durland did not have any radicular components to his pain. Mr. Durland stated that for the most part the pain was stable but did fluctuate and it was worse when he sat. Mr. Durland stated that his lumbar spinal injection had helped his pain to some degree. Dr. Johnson documented that Mr. Durland stated he had no previous lumbar spine problems. Dr. Johnson documented that Mr. Durland admitted to having a history of neck pain and migraine headaches which his primary care physician was treating with medication.

Melissa Johnson is a 45-year-old woman who today was seen on an emergency basis when she called the office complaining of left upper quadrant pain. The patient stated that the pain has been increasing for about three months. The patient’s most notable symptom is increased belching. The patient also experiences heart burn, increased satiety, and intermittent left upper quadrant pain. The patient denies any vomiting, change in bowel habits, melena, or dysphagia. She also denies having chills, fever or rigors. The patient states that she has not been examining her sugars, and she has not felt any chest pain with exertion or dyspnea. In addition, the patient denies any orthopnea, pedal edema, or paroxysmal nocturnal

Epinephrine is one of the most common medications administered in the field by EMS professionals of all levels. This naturally occurring catecholamine is one of the most potent tools that EMS professionals have at their immediate disposal for the treatment of anaphylaxis. The instructions depicted below outline the proper procedure for the administration of epinephrine to treat anaphylaxis in adult patients. This procedure should take approximately 3-5 minutes to perform and can be carried out by any EMS professional above the first responder level. The successful administration of epinephrine results in the temporary alleviation of the symptoms of anaphylaxis through the stimulation of both alpha and beta adrenergic

The device that was later called the EpiPen, an auto-injector with the intended purpose of delivering a precisely calibrated dosage of epinephrine without medical training, was created in 1974 and used by U.S. soldiers as a way to quickly treat poison gas symptoms on the battlefield. It was later approved for use with epinephrine, the trade name for adrenaline, for anaphylaxis. The manufacturer who gained the approval in 1987 was acquired by Pfizer and they sold the rights to the device to Merck. Mylan Pharmaceuticals purchased the marketing rights to the EpiPen in 2007 which at the time, cost about $57 each. Today EpiPens inflict pain on the patient who needs them with a price tag of more than $600 per pack of two. This is an increase of approximately 550 percent over a nine-year period. The cost of the device has become the object of intense scrutiny partially because it contains about a dollar’s worth of epinephrine which is used to treat anaphylactic shock and also because Mylan has a virtual monopoly on the device itself. Some experts claim the device known as the EpiPen costs only about four dollars to make. (Anaphylactic shock occurs when a person has a severe allergic reaction to a food or insect bite.) This is only the most recent in a series of similar events involving pharmaceutical companies. Mylan now finds itself under a very bright spotlight and is being held up as an example of “Big Pharma” taking advantage of those in need and an

High dose antisecretory therapy with an IV bolus followed by continuous infusion of a PPI (80 mg, then 8 mg/hour) is the recommended pharmacological treatment. It should be continued for 72 hours post endoscopy for those who have high-risk stigmata for rebleeding. Low dose therapy like twice daily IV bolus of PPI can also be used for 72 hours post-endoscopy. Administrating high dose IV PPI is more effective and cost effective (23). High dose PPI therapy in high risk group significantly reduces the risk for rebleeding, surgery and mortality rate (24).

A: Janie is a 60 year old Female with PMH of A-Fib, COPD, Hypothyroidism, HTN, Lung Cancer and recently diagnosed Pulmonary Embolism. Janie presents to ER for evaluation on SOB, cough with greenish sputum, sore thoart, hoarseness and generalized weakness. Janie lives at home with her husband, use to smoke ½ pack per week, but quit many years ago, denies alcohol or drugs. Family history is non-contributory. Allergies: NKDA. Differential diagnosis includes worsening Lung Ca, PE, COPD and CHF. Janie uses home O2 at 4 L/NC. V/S: T=98.7, HR=89, R=16, B/P=132/56, O2 sats=100% on 4L/NC, Pain=6/10. Labs: WBC=7.6, H&H=8.5/27, Na=141, Troponin=0.08/0.06, BNP=495, INR=4.2, UA=3+ protein, 1+ blood and 6-10 RBC. CXR: Impression:1). COPD with nonspecific coarsening of the basilar interstitium. 2). Mild cardiomegaly with borderline cardiac compensation. 3). Right

Patient is a 45 yo male; 5’7”, 221 lbs who entered the emergency room at 6:30 am on 9/7/14 with severe chest pain (onset at 6:00 am) radiating to his arm, L arm numbness and nausea and vomiting. Past medical history reported by wife includes peptic ulcer, tobacco use (1-2ppd for 27 years), elevated blood pressure (controlled by lopressor). Wife did not know of any family history but reports patient’s father is deceased, died at 42 in his sleep. Mother alive and with high blood pressure.

History of Present Illness: Mr. A. O. a 66 year-old-African American male came in the clinic for a monthly routine follow up visit complaining of severe cluster frontal headaches that radiates to his left eye, pain level eight out of ten, on and off for three days lasting for 30 to 45 minutes. He stated that he takes Tylenol 1000mg orally every eight hours with mild relieve, and will like his blood pressure medications increased. Also, he complained of edema to the upper and lower extremities, and right hand pain when he tries to make a fist. However, he denied shortness of breath,