Proceedings (Baylor University. Medical Center)
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Proc (Bayl Univ Med Cent) · Jul 2016
Change in prescription habits after federal rescheduling of hydrocodone combination products.
Nationally, health care providers wrote 259 million prescriptions for narcotic analgesics in 2012, or roughly one bottle of narcotics per US adult (1). In an effort to combat this ever-growing problem, the Drug Enforcement Administration changed the schedule of hydrocodone combination products from schedule III to schedule II on October 6, 2014. ⋯ While the rescheduling of hydrocodone combination products resulted in a reduced number of prescriptions and the total quantity dispensed of both the hydrocodone/acetaminophen 5/325 mg (Norco 5/325) and 10/325 mg (Norco 10/325) formulations, this was offset by a dramatic increase in alternative narcotic analgesics such as tramadol, codeine/acetaminophen 30/300 mg (Tylenol #3), and codeine/acetaminophen 60/300 mg (Tylenol #4), which do not have schedule II requirements. Additionally, there was no significant reduction in total pain medication prescribed after converting all agents to morphine equivalents.
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Proc (Bayl Univ Med Cent) · Apr 2016
Use of ultrasound guidance to remove entrapped stimulating popliteal catheters.
Peripheral nerve catheters are beneficial for continuous pain relief following surgery or trauma to an extremity. However, spring-loaded peripheral nerve catheters can become uncoiled and entrapped, resulting in difficulty in catheter removal. ⋯ One of the catheters was adhered to nearby tissue, and one had become uncoiled and anchored in place by the distal tip. Guidelines for the safe management of entrapped catheters are suggested, including the use of saline injections through the catheter under ultrasound guidance to assist in the evaluation and removal of the catheters.
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Proc (Bayl Univ Med Cent) · Apr 2016
Case ReportsBaclofen-responsive hiccups after esophageal stenting for malignancy-related dysphagia.
Hiccups can have multiple causes, including esophageal lesions. Hiccups after insertion of self-expanding metallic stents have been reported occasionally following stenting for lesions of the gastroesophageal junction. We report a patient who developed hiccups after insertion of a stent for squamous cell carcinoma of the proximal esophagus. The hiccups responded only to the initiation of baclofen therapy.
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John Finney (1863-1942) was born near Natchez, Mississippi. After receiving his medical degree from Harvard, he interned at Massachusetts General Hospital and then went to Baltimore to become one of the first interns at the new Johns Hopkins Hospital. He met William Osler the day the hospital opened and became a lifelong admirer of "the Chief." Finney specialized in gastrointestinal surgery and was recognized for his expertise in the field. ⋯ Finney became chief surgical consultant for the Allied Expeditionary Forces in World War I. He was decorated by the United States, France, and Belgium. Finney was a master surgeon and a role model for generations of students and physicians.