Q: 52 year old male with chronic pain and muscle spasm problem and on baclofen pump brought to ED with delirium and mental status change.


Answer: Baclofen withdrawal syndrome

Abrupt withdrawal of baclofen due to mechanical or other reason may cause serious and even life-threatening symptoms including fluctuation of consciousness, agitation, restlessness, delusions, hallucinations, delirium, tachycardia, autonomic changes, seizures, spasticity and tremors. Severe rebound spasm may cause severe rhabdomyolysis.

Treatment is to resume the drug. If intrathecal route is not available, oral replacement should be started ASAP.

Q: What is the IV to PO conversion of Tacrolimus (Prograf)?


Answer: Oral dose = 4 x IV dose

The oral dose should be divided q 12 hrs with monitoring of usual target level = 5 - 15 mg/L.

Q: Etomidate has its peak effect within how many minutes?


Answer: one minute

Etomidate causes loss of consciousness after one arm-brain circulation time and has its peak effect around one minute.

Q: What are the plateau waves in ICP monitoring?

Answer: Normal ICP wave form has 3 upstrokes - P1, P2 and P3. Presence of Plateau waves, also called Lundberg A waves are clinically significant and represent very high ICP or very advanced intracranial hypertension. Plateau waves come as steep increases in ICP lasting for 5 to 10 minutes. They are always pathological and indicative of probable early brain herniation.This waveform is seen in a patient with an ICP 50 – 100 mm Hg