User talk:Pcoti
Hey Peter, you can put a brief bio on your page and a picture using the image upload button. This helps us keep track of everyone Daniel Ostermayer (talk) 22:37, 19 July 2015 (UTC)
Hi Peter, thanks for contributing. A couple of things:
- We're trying to move away from general citations at the bottom (we're taking this off of the other notes). Please use the reference function to cite exactly what you are referencing. In general, we prefer not citing secondary sources (such as Rosen's) but rather the primary source.
- Please be very careful about the diagnostic workup sections. I know you are trained as an EMT, but you are putting in some information that is incorrect and/or misleading. Many physicians are using WikEM to determine their workups, so you want to be careful for any information that you don't fully understand (such as that is outside your current scope of practice).
Ross Donaldson (talk) 14:52, 22 July 2015 (UTC)
- Would it be OK to add the info on DC'ing pyridostigmine in myasthenic crisis due to increase secretions which can compromise the airway? Citing the following: Kumar, Vikas; Kaminski, Henry J. (7 October 2010). "Treatment of Myasthenia Gravis". Current Neurology and Neuroscience Reports 11 (1): 89–96. doi:10.1007/s11910-010-0151-1. ISSN 1528-4042. "Cholinesterase inhibitors are often discontinued in patients on mechanical ventilation because of their propensity to increase respiratory secretions." Peter Coti (talk) 15:05, 22 July 2015 (UTC)
Hi Peter, no that doesn't make much sense. Pyridostigmine is one of the main treatments of patients in a myasthenic crisis, so it should be given (not withheld). Although I have not yet pulled up the reference to which you are refering, I believe they are talking about patients with myasthenia who have been intubated and are on the ventilator (i.e. for some time in the ICU). In that case, there may be an indication to withhold the medication due to secretions, but that information is not relevant in the emergency context. It is directing the doctors to do the opposite of the apropriate care for patients in that context. Ross Donaldson (talk) 15:42, 22 July 2015 (UTC)
- Double checked the article and they state that it would not be beneficial as much as other treatments when someone reaches the point of respiratory failure. I also checked with Rosens (p. 1444) and it backs this up stating such as IVIG/plasmaphaherisis should be preformed in the ED in place of cholinesterase inhibitors. I do not mean to make a big stink over this, merely show you how I reached this conclusion. Also, as a person with MG I have a vested interest in ensuring that medical professionals have the proper content at their fingertips. I will not edit MG again, but I hope you reconsider this decision. Peter Coti (talk) 15:58, 22 July 2015 (UTC)
Hi Peter, I don't disagree with the point that those medications may not be particularly useful once MG patients are in respiratory failure, however the article overall is for the treatment of MG and the majority of patients presenting to the ER with such do not have respiratory failure. You are conflating two different types of presentions, patients with symptomatic MG and those with MG and respiratory failure. A separate section could be made about the latter, but stating that you should not use the medications for the former is just not correct and was confusing as previously written. From UTD, "We recommend treatment with acetylcholinesterase inhibitors as the first line of treatment for symptomatic MG (Grade 1B)." Ross Donaldson (talk) 17:47, 22 July 2015 (UTC)
- I guess this is a classic case of assuming. I assumed that the article content was meant to deal with the treatment of a myasthenic crisis, rather than ED diagnosis, which makes much more sense and I probably should have realized that, my apologize. In that case I think it would be a good idea to make a subsection of treatment for myasthenic crisis. Peter Coti (talk) 18:28, 22 July 2015 (UTC)
