male in his 30's presenting to ER with ALOC (GCS 3), hypoten | Figure 1

MSarto

Registered Nurse

male in his 30's presenting to ER with ALOC (GCS 3), hypotensive Hx: depression. Any guesses as to what's going on? Will post answer with next EKG posting.

Why you should join Figure 1

Details

Bottom line
Duloxetine and milnacipran may reduce pain in people with fibromyalgia. However, some of these people may also experience side effects, such as nausea and drowsiness. A minority of people with fibromyalgia experience symptom relief without side effects from duloxetine and milnacipran.

Key results and quality of the evidence
Duloxetine and milnacipran were better than placebo in reducing pain by 50% or more and in improving global well-being (low-quality evidence). Duloxetine and milnacipran were better than placebo in improving health-related quality of life and in reducing fatigue (low-quality evidence). Duloxetine and milnacipran were not better than placebo in reducing sleep problems (low-quality evidence). More people dropped out of the trial due to side effects with duloxetine and milnacipran than with placebo (low-quality evidence). More people reported nausea and drowsiness with duloxetine and milnacipran than with placebo (low-quality evidence). Duloxetine, milnacipran and placebo did not differ in the frequency of serious side effects experienced (very low-quality evidence).

Review question

Do pharmacological treatments, non‐invasive brain stimulation, psychological treatments, or combination treatments reduce the proportion of people with depression or the extent of depressive symptoms after stroke?

Background
Depression is common after stroke yet often is not detected or inadequately treated.

Search date
We identified studies by searches conducted on 13 August 2018.

Key results
We included 49 trials (56 treatments) involving 3342 participants. Pharmacological treatments resulted in fewer people meeting the study criteria for depression and less than 50% reduction in depression scale scores at end of treatment. Psychological therapy reduced the number of people meeting the study criteria for depression at end of treatment. More people in the pharmacological treatment group reported central nervous system and gastrointestinal side effects than in the placebo groups.

Conclusion
Antidepressant drugs may benefit people with persistent depressive symptoms after stroke, but care is required in their use, as little is known about their side effects. Psychological therapy may offer a treatment option. Future research should include a broader group of people with stroke.

Cases:

Case 1

52 yo/f presents to the emergency department with a cc of chest pain and sob.
She is A/ox4 with skin PWD. She denies any prior cardiac hx. Past medical hx includes breast cancer. Initial 12 lead is posted above.

Case 2

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis.
He had a history of hypertension, long-term smoking, and a sedentary lifestyle. On physical examination, bibasilar crackles were noted on lung auscultation. An electrocardiogram (ECG) was performed in the primary care setting, and the patient was promptly referred to the emergency department.

Case 3

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back.
She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.

Case 4

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days.
Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.