Cape & Islands
E M S System
The Medical Director for Cape Cod Hospital is Jeffery Herbst MD.
Dr Herbst has been with Cape Cod Hospital since 2001 and has served as Medical Director since 2004.
Dr Herbst has been with Cape Cod Hospital since 2001 and has served as Medical Director since 2004.
Comments from Dr. Herbst
Cape Cod Hospital
Medical Director
Medical Director
As the medical director I would like to utilize this space on the
website to share a variety of things including informational and
teaching topics. Feel free to request a topic or respond with any
questions or clarifications. If you are left curious about
something, so are many of the rest of the readers.
Bath Salts
Over the last few months we are starting to see patients high
on "bath salts". This designer drug is not in any way related to
bath products or salt (actually I'm not sure how it got this name -
anyone?). It is a sympathomimetic, thus a stimulant and causes
symptoms similar to meth, ecstacy or cocaine. Hallucinations and
psychotic behaviour are more frequent with this drug than with
cocaine/meth. It is addictive and potentially dangerous and
interestingly still legal and available OTC (Zoom 2, Spice and Aura
are a couple common brands). It may take the FDA a while to
"illegalize" this stuff so it may be around a while. EMS/ER
treatment would be similar to cocaine/meth, mainly attempting to
control agitation using benzo's when needed. Asking witnesses about
bath salts may be helpful as the intoxicated patient may be too
confused or psychotic to tell us what's going on.
Do not administer nitroglycerin to inferior wall MI patients
Many IWMI patients (those with II, III, F ST elevation) have an
ischemic right ventricle. The problem here is that the ischemic,
weakened right ventricle cannot easily pump the blood through the
lungs to get to the left ventricle. Nitroglycerin is used in acute
MI patients to dilate the large veins thus decreasing the preload
that the weakened left heart has to pump. This might be beneficial
for some LEFT sided ischemic patients. However, in RIGHT ventricular
ischemia the heart depends on an adequate preload (or an adequate
pressure head of blood coming into the right heart) to help blood
passively circulate through the right heart and pulmonary bed to the
left ventricle. If you give them nitro, the blood will already be at
low pressure when arriving at the right ventricle and they can
"crash" on you from cardiac collapse. I hear about this happening in
the field occasionally and we try to review the error as a teaching
point, but this has happened several times lately so I am
broadcasting this important issue.
You are all doing a great job and the nursing and physician staff
have never been so satisfied with your excellent performance and
professionalism. I will try to keep you posted about the bright
sides and the concerning negative elements of our EMS system. I
expect you to communicate your perceived positive and negative
concerns regarding our ER performance just as well.
See you at the shop, Jeff Herbst
website to share a variety of things including informational and
teaching topics. Feel free to request a topic or respond with any
questions or clarifications. If you are left curious about
something, so are many of the rest of the readers.
Bath Salts
Over the last few months we are starting to see patients high
on "bath salts". This designer drug is not in any way related to
bath products or salt (actually I'm not sure how it got this name -
anyone?). It is a sympathomimetic, thus a stimulant and causes
symptoms similar to meth, ecstacy or cocaine. Hallucinations and
psychotic behaviour are more frequent with this drug than with
cocaine/meth. It is addictive and potentially dangerous and
interestingly still legal and available OTC (Zoom 2, Spice and Aura
are a couple common brands). It may take the FDA a while to
"illegalize" this stuff so it may be around a while. EMS/ER
treatment would be similar to cocaine/meth, mainly attempting to
control agitation using benzo's when needed. Asking witnesses about
bath salts may be helpful as the intoxicated patient may be too
confused or psychotic to tell us what's going on.
Do not administer nitroglycerin to inferior wall MI patients
Many IWMI patients (those with II, III, F ST elevation) have an
ischemic right ventricle. The problem here is that the ischemic,
weakened right ventricle cannot easily pump the blood through the
lungs to get to the left ventricle. Nitroglycerin is used in acute
MI patients to dilate the large veins thus decreasing the preload
that the weakened left heart has to pump. This might be beneficial
for some LEFT sided ischemic patients. However, in RIGHT ventricular
ischemia the heart depends on an adequate preload (or an adequate
pressure head of blood coming into the right heart) to help blood
passively circulate through the right heart and pulmonary bed to the
left ventricle. If you give them nitro, the blood will already be at
low pressure when arriving at the right ventricle and they can
"crash" on you from cardiac collapse. I hear about this happening in
the field occasionally and we try to review the error as a teaching
point, but this has happened several times lately so I am
broadcasting this important issue.
You are all doing a great job and the nursing and physician staff
have never been so satisfied with your excellent performance and
professionalism. I will try to keep you posted about the bright
sides and the concerning negative elements of our EMS system. I
expect you to communicate your perceived positive and negative
concerns regarding our ER performance just as well.
See you at the shop, Jeff Herbst