Hyperventilation Tetany ER Visits: Distinguishing from Cardiac and Neurological Emergencies

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Priya, a 28-year-old paralegal in San Diego, had just bombed an oral argument practice when her hands began to claw inward involuntarily. Her lips went numb. Her jaw tightened. By the time her supervisor walked her to the urgent care two blocks away, she was convinced she was having a stroke. The clinician took one … Read more

Hyperventilation Tetany ER Visits: Distinguishing from Cardiac and Neurological Emergencies

Free stock photo via Pexels

Priya, a 28-year-old paralegal in San Diego, had just bombed an oral argument practice when her hands began to claw inward involuntarily. Her lips went numb. Her jaw tightened. By the time her supervisor walked her to the urgent care two blocks away, she was convinced she was having a stroke. The clinician took one … Read more

Refusal of Lifesaving Treatment Mental Capacity: When Psych Holds Become Medical Emergencies

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Robert, a 61-year-old retired electrician in Cleveland, walked into the emergency department with crushing chest pain, a troponin level off the chart, and a clear command from his cardiologist that he needed immediate cardiac catheterization to prevent a fatal infarction. He refused. Not in a confused, mumbling way, but firmly, with eye contact, telling the … Read more

Refusal of Lifesaving Treatment Mental Capacity: When Psych Holds Become Medical Emergencies

Free stock photo via Pexels

Robert, a 61-year-old retired electrician in Cleveland, walked into the emergency department with crushing chest pain, a troponin level off the chart, and a clear command from his cardiologist that he needed immediate cardiac catheterization to prevent a fatal infarction. He refused. Not in a confused, mumbling way, but firmly, with eye contact, telling the … Read more

Acute Lithium Withdrawal: Why Stopping Mood Stabilizers Cold Triggers Mania

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Rosa had been stable on lithium for eleven years. She lived in Sacramento, taught middle-school art, married a patient man named Joseph, and had not been hospitalized since her early twenties. When she and Joseph began trying for a baby, her OB suggested she stop lithium quickly, citing concerns about Ebstein’s anomaly that, while real, … Read more

Severe Premenstrual Dysphoric Disorder: When PMDD Becomes a Mental Health Crisis

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Hannah, a thirty-one-year-old paralegal in Boston, kept a small spiral notebook on her nightstand. For nine months she had been tracking the days. The pattern was unmistakable. Eight to ten days before each period, the world would tilt: a kind of hopelessness that arrived without warning, intrusive thoughts about not waking up, sudden rage at … Read more