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Choking and seizures

A teenager I saw in follow-up from the ER has had 3
episodes of what was described as "seizure" activity
(slurred and incoherent speech, stumbling, no memory
of the events, post-ictal state). His workup in the
ER has been negative including head CT and EEG. His
family history is unknown - he's adopted. He admitted
to frequently playing the "choking game" at school
with his friends but none of these episodes occurred
while or after he was playing. He's promised to stop
playing this game but my quandry is whether to start
him on an anti-convulsant as these episodes occurred
with no relationship to playing these "choking games".
Would you?

Eve

Rural peds
"A hundred years from now it will not matter what my bank account was,
the sort of house I lived in, of the kind of car I drove...
but the world may be different because
I was important in the life of a child"

____________________________________________________________________________________
Never miss a thing. Make Yahoo your home page.
http://www.yahoo.com/r/hs

Choking and seizures

This one piqued my interest. Just as an FYI, Vegas seems to be on the
"cutting edge" of drug trends, so I thought I'd let y'all know that
we're starting to see more and more use of atypical medications to
"get high." Coracidin / "Skittles" was the big thing last year, but
now it's on to bigger and better things. The teenager you mentioned
sounds suspiciously like one I saw last week with slurred speech,
stumbling / ataxia, labile emotions, excessive somnolence and yet had
stable vital signs, no pupil abnormalities, and completely normal
Glucose, Lytes, CT, and Drug Screen. Turns out the new thing is
taking Clonidine since it gives you the effects of the opiates but is
undetectable on standard ER drug tests. After 8 hrs in the ER, she
admitted to taking it. They're calling it "167" in reference to the
numbers on the Clonidine tablets themselves (6, 7, and 11). The girl
who gave it to her told her it was Oxycontin. Perhaps your patient may
have done something similar?

BTW, is anyone else seeing a high level of "pharming" parties where
the teenagers raid the parental medicine cabinet, meet at someone's
house, dump all the pills in a giant bowl, and take a handful of
whatever is there? It's rampant here. Coming soon to a theater near
you?! :(

Johnn
Johnn Trautwein, MD MBA
Pediatric Emergency Medicine
St. Rose Dominican Hospital - Siena Campus
University Medical Center
Las Vegas, NV
hidden@email-address

On Feb 13, 2008, at 7:47 PM, Eve Switzer wrote:

> A teenager I saw in follow-up from the ER has had 3
> episodes of what was described as "seizure" activity
> (slurred and incoherent speech, stumbling, no memory
> of the events, post-ictal state). His workup in the
> ER has been negative including head CT and EEG. His
> family history is unknown - he's adopted. He admitted
> to frequently playing the "choking game" at school
> with his friends but none of these episodes occurred
> while or after he was playing. He's promised to stop
> playing this game but my quandry is whether to start
> him on an anti-convulsant as these episodes occurred
> with no relationship to playing these "choking games".
> Would you?
>
> Eve
>
>
>
>
> Rural peds
> "A hundred years from now it will not matter what my bank account was,
> the sort of house I lived in, of the kind of car I drove...
> but the world may be different because
> I was important in the life of a child"
>
>
>
>
>
_____________________________________
> Never miss a thing. Make Yahoo your home page.
> http://www.yahoo.com/r/hs
>

> This message is from PEDTALK - a Pediatric Focused email discussion
> group.

> Admin questions: "hidden@email-address" or "http://www.pcc.com/
> lists/"

>

Choking and seizures

John- I thought what happens in Vegas, stays in Vegas. You can keep those
pharma parties! I am going to remind parents to clean out med cabinets
anyway!
Regards-
Kim B in TX
----- Original Message -----
From: "Johnn Trautwein"
To:
Sent: Wednesday, February 13, 2008 10:20 PM
Subject: Re: Choking and seizures

> This one piqued my interest. Just as an FYI, Vegas seems to be on the
> "cutting edge" of drug trends, so I thought I'd let y'all know that
> we're starting to see more and more use of atypical medications to
> "get high." Coracidin / "Skittles" was the big thing last year, but
> now it's on to bigger and better things. The teenager you mentioned
> sounds suspiciously like one I saw last week with slurred speech,
> stumbling / ataxia, labile emotions, excessive somnolence and yet had
> stable vital signs, no pupil abnormalities, and completely normal
> Glucose, Lytes, CT, and Drug Screen. Turns out the new thing is
> taking Clonidine since it gives you the effects of the opiates but is
> undetectable on standard ER drug tests. After 8 hrs in the ER, she
> admitted to taking it. They're calling it "167" in reference to the
> numbers on the Clonidine tablets themselves (6, 7, and 11). The girl
> who gave it to her told her it was Oxycontin. Perhaps your patient may
> have done something similar?
>
> BTW, is anyone else seeing a high level of "pharming" parties where
> the teenagers raid the parental medicine cabinet, meet at someone's
> house, dump all the pills in a giant bowl, and take a handful of
> whatever is there? It's rampant here. Coming soon to a theater near
> you?! :(
>
> Johnn
> Johnn Trautwein, MD MBA
> Pediatric Emergency Medicine
> St. Rose Dominican Hospital - Siena Campus
> University Medical Center
> Las Vegas, NV
> hidden@email-address
>
>
>
> On Feb 13, 2008, at 7:47 PM, Eve Switzer wrote:
>
>> A teenager I saw in follow-up from the ER has had 3
>> episodes of what was described as "seizure" activity
>> (slurred and incoherent speech, stumbling, no memory
>> of the events, post-ictal state). His workup in the
>> ER has been negative including head CT and EEG. His
>> family history is unknown - he's adopted. He admitted
>> to frequently playing the "choking game" at school
>> with his friends but none of these episodes occurred
>> while or after he was playing. He's promised to stop
>> playing this game but my quandry is whether to start
>> him on an anti-convulsant as these episodes occurred
>> with no relationship to playing these "choking games".
>> Would you?
>>
>> Eve
>>
>>
>>
>>
>> Rural peds
>> "A hundred years from now it will not matter what my bank account was,
>> the sort of house I lived in, of the kind of car I drove...
>> but the world may be different because
>> I was important in the life of a child"
>>
>>
>>
>>
>>
_____________________________________
>> Never miss a thing. Make Yahoo your home page.
>> http://www.yahoo.com/r/hs
>>
>> -----------------------------------------------------------------------
>> This message is from PEDTALK - a Pediatric Focused email discussion
>> group.

>> Admin questions: "hidden@email-address" or "http://www.pcc.com/
>> lists/"

>>
>

>
>

Choking and seizures

On Feb 14, 2008, at 12:56 PM, Kim at Dogwood Ridge wrote:

>> BTW, is anyone else seeing a high level of "pharming" parties where
>> the teenagers raid the parental medicine cabinet, meet at someone's
>> house, dump all the pills in a giant bowl, and take a handful of
>> whatever is there? It's rampant here. Coming soon to a theater near
>> you?! :(

I'm only 44, but I heard about this back in the 1960s... and I'm sure
there have been variations of the game from before then as well.

John

Choking and seizures

John Canning wrote:
>>> BTW, is anyone else seeing a high level of "pharming" parties where
>>> the teenagers raid the parental medicine cabinet, meet at someone's
>>> house, dump all the pills in a giant bowl, and take a handful of
>>> whatever is there? It's rampant here. Coming soon to a theater near
>>> you?! :(
> I'm only 44, but I heard about this back in the 1960s... and I'm sure
> there have been variations of the game from before then as well.

Pharming parties date back in literature at least to William
Burroughs and the 50s.

In this week's issue of Sports Illustrated, there's a PSA-style
ad warning against this very behavior.

Just trying to stay culturally literate.

--
Chip Hart - Pediatric Solutions * Physician's Computer Company
chip @ pcc.com * 1 Main St. #7, Winooski, VT 05404
800-722-7708 * http://chipsblog.pcc.com
f.802-846-8178 * Pediatric Software Just Got Smarter.
Your Practice Just Got Healthier.

Choking and seizures

Isn't this week's SI the swimsuit issue, Chip?
Shouldn't you be working instead of reading?

----- Original Message -----
From: "Chip Hart"

> In this week's issue of Sports Illustrated, there's a PSA-style
> ad warning against this very behavior.
>
> Just trying to stay culturally literate.

Choking and seizures

Walter Hoerman MD wrote:
> Isn't this week's SI the swimsuit issue, Chip? Shouldn't you be working
> instead of reading?

As you should know, the Swimsuit Edition is always an *extra*
issue - I'm referring to the normal print edition.

Not much pediatric happening in the Swimsuit Edition again this
year. I scoured it for important content.

--
Chip Hart - Pediatric Solutions * Physician's Computer Company
chip @ pcc.com * 1 Main St. #7, Winooski, VT 05404
800-722-7708 * http://chipsblog.pcc.com
f.802-846-8178 * Pediatric Software Just Got Smarter.
Your Practice Just Got Healthier.

Choking and seizures

> BTW, is anyone else seeing a high level of
> "pharming" parties where
> the teenagers raid the parental medicine cabinet,
> meet at someone's
> house, dump all the pills in a giant bowl, and take
> a handful of
> whatever is there? It's rampant here. Coming soon to
> a theater near
> you?! :(

Sounds like a recent Law and Order episode I saw on
TV....

Eve

Rural peds
"A hundred years from now it will not matter what my bank account was,
the sort of house I lived in, of the kind of car I drove...
but the world may be different because
I was important in the life of a child"

____________________________________________________________________________________
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Find them fast with Yahoo! Search. http://tools.search.yahoo.com/newsearch/category.php?category=shopping

Choking and seizures

Eve,

Why not get a Neurology consult first?

Dan Nussbaum

**************
The year's hottest artists on the red carpet at the
Grammy Awards. Go to AOL Music.

(http://music.aol.com/grammys?NCID=aolcmp00300000002565)

Choking and seizures

Would love to but it takes about 3-4 months to get in
to see the pedi neuro around here. :-(

Eve

--- hidden@email-address wrote:

> Eve,
>
> Why not get a Neurology consult first?
>
> Dan Nussbaum
>
>
> **************
> The year's hottest artists on the red carpet at the
> Grammy Awards. Go to AOL Music.
>
>
(http://music.aol.com/grammys?NCID=aolcmp00300000002565)
>
>

> This message is from PEDTALK - a Pediatric Focused
> email discussion group.

> Admin questions: "hidden@email-address" or
> "http://www.pcc.com/lists/"
> To unsubscribe: mail "hidden@email-address" with
> "unsubscribe"

>
>

Rural peds
"A hundred years from now it will not matter what my bank account was,
the sort of house I lived in, of the kind of car I drove...
but the world may be different because
I was important in the life of a child"

____________________________________________________________________________________
Be a better friend, newshound, and
know-it-all with Yahoo! Mobile. Try it now. http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ

RE: Choking and seizures

Message from Kevin M. Windisch MD, FAAP hidden@email-address

I'd get a video tele eeg first.

kmw

-----Original Message-----
From: hidden@email-address [mailto:hidden@email-address] On Behalf Of Eve
Switzer
Sent: Wednesday, February 13, 2008 7:47 PM
To: hidden@email-address
Subject: Choking and seizures

A teenager I saw in follow-up from the ER has had 3
episodes of what was described as "seizure" activity
(slurred and incoherent speech, stumbling, no memory
of the events, post-ictal state). His workup in the
ER has been negative including head CT and EEG. His
family history is unknown - he's adopted. He admitted
to frequently playing the "choking game" at school
with his friends but none of these episodes occurred
while or after he was playing. He's promised to stop
playing this game but my quandry is whether to start
him on an anti-convulsant as these episodes occurred
with no relationship to playing these "choking games".
Would you?

Eve

Rural peds
"A hundred years from now it will not matter what my bank account was,
the sort of house I lived in, of the kind of car I drove...
but the world may be different because
I was important in the life of a child"

____________________________________________________________________________
________
Never miss a thing. Make Yahoo your home page.
http://www.yahoo.com/r/hs

No virus found in this incoming message.
Checked by AVG Free Edition.
Version: 7.5.516 / Virus Database: 269.20.4/1276 - Release Date: 2/13/2008
9:41 AM

No virus found in this outgoing message.
Checked by AVG Free Edition.
Version: 7.5.516 / Virus Database: 269.20.5/1278 - Release Date: 2/14/2008
10:28 AM

RE: Choking and seizures

If you haven't already, how about getting a urine or serum drug scrren. Also consider "huffing" which may not be detected in the UDS.

-E
"Kevin M. Windisch MD, FAAP" wrote:
I'd get a video tele eeg first.

kmw

-----Original Message-----
From: hidden@email-address [mailto:hidden@email-address] On Behalf Of Eve
Switzer
Sent: Wednesday, February 13, 2008 7:47 PM
To: hidden@email-address
Subject: Choking and seizures

A teenager I saw in follow-up from the ER has had 3
episodes of what was described as "seizure" activity
(slurred and incoherent speech, stumbling, no memory
of the events, post-ictal state). His workup in the
ER has been negative including head CT and EEG. His
family history is unknown - he's adopted. He admitted
to frequently playing the "choking game" at school
with his friends but none of these episodes occurred
while or after he was playing. He's promised to stop
playing this game but my quandry is whether to start
him on an anti-convulsant as these episodes occurred
with no relationship to playing these "choking games".
Would you?

Eve

Rural peds
"A hundred years from now it will not matter what my bank account was,
the sort of house I lived in, of the kind of car I drove...
but the world may be different because
I was important in the life of a child"

____________________________________________________________________________
________
Never miss a thing. Make Yahoo your home page.
http://www.yahoo.com/r/hs

This message is from PEDTALK - a Pediatric Focused email discussion group.
List address: "hidden@email-address"
Admin questions: "hidden@email-address" or "http://www.pcc.com/lists/"
To unsubscribe: mail "hidden@email-address" with "unsubscribe"
in the body of the message.

No virus found in this incoming message.
Checked by AVG Free Edition.
Version: 7.5.516 / Virus Database: 269.20.4/1276 - Release Date: 2/13/2008
9:41 AM

No virus found in this outgoing message.
Checked by AVG Free Edition.
Version: 7.5.516 / Virus Database: 269.20.5/1278 - Release Date: 2/14/2008
10:28 AM

This message is from PEDTALK - a Pediatric Focused email discussion group.
List address: "hidden@email-address"
Admin questions: "hidden@email-address" or "http://www.pcc.com/lists/"
To unsubscribe: mail "hidden@email-address" with "unsubscribe"
in the body of the message.

---------------------------------
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Choking and seizures

I just read on another listserve about a new idiotic and dangerous
risk-taking behavior among young teens: inhaling "Dust-Off" canned
air thru the strawlike nozzle it comes with. It's not exactly the
same as huffing, but if he's experimenting with the "choking game" he
could also be experimenting with huffing and Dust-Off too. Among this
age group, taking high doses of Coricidin or other OTC cold meds with
dextromethorphan, to get high, was pretty popular a few years ago.

About Dust-Off, see:http://www.snopes.com/medical/toxins/dustoff.asp

Stephanie Walker, FNP
>
> Date: Thu, 14 Feb 2008 09:10:03 -0800
> From: "Kevin M. Windisch MD, FAAP"
> Subject: RE: Choking and seizures
>
> I'd get a video tele eeg first.
>
> kmw
>
> - -----Original Message-----
> From: hidden@email-address [mailto:hidden@email-address] On
> Behalf Of Eve
> Switzer
> Sent: Wednesday, February 13, 2008 7:47 PM
> To: hidden@email-address
> Subject: Choking and seizures
>
> A teenager I saw in follow-up from the ER has had 3
> episodes of what was described as "seizure" activity
> (slurred and incoherent speech, stumbling, no memory
> of the events, post-ictal state). His workup in the
> ER has been negative including head CT and EEG. His
> family history is unknown - he's adopted. He admitted
> to frequently playing the "choking game" at school
> with his friends but none of these episodes occurred
> while or after he was playing. He's promised to stop
> playing this game but my quandry is whether to start
> him on an anti-convulsant as these episodes occurred
> with no relationship to playing these "choking games".
> Would you?
>
> Eve

Choking and seizures

On the other hand, maybe he is having seizures.... sometimes a cigar is a
just a cigar......

Maureen McLellan

**************The year's hottest artists on the red carpet at the Grammy
Awards. Go to AOL Music.
(http://music.aol.com/grammys?NCID=aolcmp00300000002565)

re: Choking and Seizures

Thanks for the input. How does one verify "huffing"
short of getting the kid to admit to it?

Eve

Rural peds
"A hundred years from now it will not matter what my bank account was,
the sort of house I lived in, of the kind of car I drove...
but the world may be different because
I was important in the life of a child"

____________________________________________________________________________________
Be a better friend, newshound, and
know-it-all with Yahoo! Mobile. Try it now. http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ