Finding Wellness in Nature

This is my own personal image of Blue Mountain Lake from Castle Rock Trailhead in the Adirondacks last September.

Working in the ER is tough, and hopefully sometime in the next week, we can all spend some quality time outdoors. Today’s POTD is on finding Wellness in nature.

This study published in Nature on June 13, 2019 is titled “Spending at least 120 minutes a week in nature is associated with good health and wellbeing”.

Here’s a summary:

The authors studied the association between recreational nature contact in the last seven days and self-reported health and well-being.

They ascertained data from nearly 20,000 participants in the Monitor of Engagement with the Natural Environment Survey, a UK survey that tries to capture time spent in the natural environment.

The likelihood of reporting good health or high well-being was statistically significant with > 120 minutes of outdoor engagement compared to no nature contact. It can be either 120 minutes at a time or several shorter blocks each week, it did not matter.

The peak benefit was around 200-300 minutes per week of recreational nature contact.

Hopefully one day when we finally defeat COVID, we’ll have the freedom to once again travel freely. In the meantime, why not hit up a local park, wander around the city, or for a hike? Socially distancing of course. Here’s one website I’ve been using extensively since medical school:

https://hikethehudsonvalley.com/the-hikes/

Sources

https://www.nature.com/articles/s41598-019-44097-3

S-LAMS for suspected acute strokes

The red phone in resus rings and the nurse tells you: “r/o LVO (large vessel occlusion), LAMS is 5”.

Here in NYC, our EMS uses the Stratified Los Angeles Motor Scale or S-LAMS in the field to help determine where to transport potential stroke patients.

FACIAL DROOP: Absent 0, Present +1

ARM DRIFT: Absent 0, Drifts down +1, Falls rapidly +2

SPEECH DEFICIT: Absent 0, Present +1

GRIP STRENGTH: Normal 0, Weak grip +1, No grip +2

If the score is < 3, the patient should go to the closest primary stroke center.

If the score is > 4, they will call online medical control (OLMC) for a transport decision, often to the closest thrombectomy stroke center (Maimonides is one!). This is because in LVO, endovascular mechanical thrombectomy is the treatment of choice. EMS has to call OLMC to discuss the patient because sometimes there are exclusion criteria for transport to a thrombectomy center.

Time is brain and the S-LAMS scoring system helps get our most concerning patients to the center most suitable to care for them.

Neuroleptic Malignant Syndrome/Serotonin Syndrome

Let's talk about hyperthemia today, the weird kind. NMS and SS - I often get confused between the two, so this is as much as I can remember:

NMS is SLOW, it happens slowly and takes forever to resolve. Fever + rigidity.

SS is FAST, hyper reflexive and agitated, quick on and relatively quick off. Fever + clonus.

Both have fever/elevated temp. Treat both with benzos. For NMS, add on bromocriptine (SLOW down BRO). For SS, just use the other weird-sounding drug (cyproheptadine).

I think it's also important to learn to recognize potential offending agents when you are doing med recs on patients.

Definitely not a comprehensive list but here are some our patients might be taking (or you are giving them):

NMS

typical antipsychotics > atypicals. Classically, haldol, droperidol, thorazine, pheneragan. Metoclopramide. Less rare but atypicals like clozapine, olanzapine, risperidone, quetiapine, ziprasidone.

SS

sertraline, fluoxetine, citalopram, paroxetine, trazadone, buspirone, venlafaxine, valproate, tramadol, fentanyl, meperidine, ondansetron, metoclopramide, sumatriptan, linezolid, dextromethorphan, MDMA, LSD, St. John’s wort, ginseng.

Check this out for more details and some of the more nitty gritty:

http://www.emdocs.net/toxcard-differentiating-serotonin-syndrome-neuroleptic-malignant-syndrome/