Should You Prescribe Oral Thiamine for Chronic Alcoholics?
Background: Alcoholism is a chronic disease with a staggering impact on society, costing the nation approximately 100 billion dollars per year, an expenditure greater than the costs associated with all cancers and respiratory diseases combined (Whiteman 2000). Large public hospital emergency department studies have demonstrated the enormous strain of alcohol use on resources, and the disproportionate burden that the care of the alcohol abusing patient places on the emergency medical system and the ED (Zook 1980). In one observational cohort, 24% of adult patients brought to the ED by ambulance were determined to likely suffer from alcoholism, further underscoring the tremendous frequency of this disease (Whiteman 2000). Read more →
Button Batteries: Small, disc shaped battery cells which are designed for use in small electronic devices. Common sources are kids toys, watches, calculators and hearing aids. Most batteries use lithium as a power source
Background: 
Background: As I walk to the bedside to re-examine my patient with refractory hypotension, I start thinking what else can I do? My patient came into the hospital with septic shock secondary community acquired pneumonia requiring me to intubate her due to impending respiratory failure. I subsequently placed a central venous catheter and an arterial line as I carefully volume resuscitated her. I turned up her tidal volume momentarily on the ventilator to assess for pulse pressure and stroke volume variation, did a bedside echo, and attempted a passive leg raise, but it appears that she is volume replete. I started a norepinephrine infusion, and as the dose escalated, I added a vasopressin infusion, but she still remains hypotensive even after giving her stress dose steroids. As I contemplate my next move I am haunted by her bedside monitor alarming; MAP 50 mm Hg. What’s my next move? 
