Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
All cells in the body need glucose and oxygen to perform their functions by
aerobic (oxygen requiring). While other parts of the body can
continue for short periods of time without oxygen (anaerobically),
the brain cannot. Without glucose, brain function stops.
Hypoglycemia (low
blood sugar) most often occurs in
people with diabetes who have given themselves too much insulin or have not
taken in enough food.
In normal physiology, the pancreas makes insulin and balances the amount it
produces with the amount of glucose in the blood stream. Diabetics need
to inject insulin into their body, or take medication to stimulate the pancreas
to make insulin. Monitoring blood sugars is critical to avoid hypoglycemic coma.
Poisons
There are two sources of poisons that can affect the brain, those that we
take in (through ingestion or inhaling), and those that the body generates and cannot
dispose of in some way.
If the body can be considered a factory, it needs to have the ability to get
rid of the waste products that are made when the body generates energy. These
waste products can cause different organs in the body to fail, including the
brain.
The liver performs many functions including glucose and protein
manufacturing. It also breaks down and metabolizes chemicals in the body. When
the liver fails different chemicals like ammonia can accumulate and can cause
brain cells to stop functioning. Hepatic encephalopathy (hepatic=liver +
encephalo=brain + pathy=disease) or hepatic coma occurs when the liver fails
because of an acute or chronic injury. The most common cause is
cirrhosis due to
alcoholism.
The kidneys filter blood to rid the body of waste products. When the kidneys fail, a variety of waste products can accumulate in the bloodstream and cause
direct or indirect damage to the brain. An example of indirect causes would be
an elevated potassium level affecting heart electrical activity. Direct causes
include uremia, where blood urea levels rise and are directly toxic to brain
cells. Common causes of kidney failure include poorly controlled diabetes and
high blood pressure.
The thyroid acts as the thermostat for the body and regulates the speed at
which the body functions. If thyroid levels gradually drop too low over a period
of time myxedema coma can occur because of profound hypothyroidism.
Ingestions can cause the brain to slow down, speed up or alter its perception
of the world. Some ingestions may cause coma in an indirect way. Acetaminophen
overdose has a delayed effect. It is directly toxic to the liver, but takes a few days before liver failure occurs, leading to hepatic coma and potentially death.
Alcohol is probably the most common cause of ingested poison or toxin,
leading to altered mental status and coma. In acute alcohol intoxication, the
brain is directly poisoned. Blood alcohol levels fall when the alcohol is metabolized
by the liver, but depth of intoxication can be so great it shuts off
many of the involuntary brain activities that control breathing and maintain
muscle function. Opiates like pain pills or heroin can cause similar slowing of
brain function.
Cocaine and amphetamines are the common "uppers" or brain stimulants. These
brain stimulants
cause an adrenaline-like body response, thus blood pressure and heart rate
spiral out of control and the risk of
heart attack, heart
rhythm disturbances, or bleeding in the brain are increased.
Kidney failure can occur from an acute event or a chronic condition or disease. Prerenal kidney failure is caused by blood loss, dehydration, medication. Some of the renal causes of kidney failure are from sepsis, medications, rhabdomyolysis, multiple myeloma, and acute glomerulonephritis. Post renal causes of kidney failure include bladder obstruction, prostate problems, tumors, or kidney stones. Treatment options included diet, medications, or dialysis.
Pneumonia is inflammation of one or both lungs with consolidation. Pneumonia is frequently but not always due to infection. The infection may be bacterial, viral, fungal or parasitic. Symptoms may include fever, chills, cough with sputum production, chest pain, and shortness of breath.
High blood pressure, also known as hypertension, is a repeatedly
elevated blood pressure exceeding 140 over 90 mmHg -- a systolic pressure above
140 with a diastolic pressure above 90. There are two causes of high blood pressure, primary and secondary. Primary high blood pressure is much more common that secondary and its basic causes or underlying defects are not always known. It is known that a diet high in salt increases the risk for high blood pressure, as well as high cholesterol. Genetic factors are also a primary cause. Secondary high blood pressure is generally caused by another condition such as renal hypertension, tumors, and other conditions. Treatment for high blood pressure is generally lifestyle changes and if necessary, diet.
Dehydration is the excessive loss of body water. There are a number of causes of dehydration including heat exposure, prolonged vigorous exercise, and some diseases of the gastrointestinal tract. The best way to treat dehydration is to prevent it from occurring.
Hypothyroidism is any state in which thyroid hormone production is below normal. Normally, the
rate of thyroid hormone production is controlled by the brain at the pituitary.
Hypothyroidism is a very common condition and the symptoms of hypothyroidism are
often subtle.
Anemia is the condition of having less than the normal number of red blood cells or less than the normal quantity of hemoglobin in the blood. The oxygen-carrying capacity of the blood is, therefore, decreased.
Cirrhosis of the liver refers to a disease in which normal liver cells are replaced by scar tissue caused by alcohol and viral hepatitis B and C. This disease leads to abnormalities in the liver's ability to handle toxins and blood flow, causing internal bleeding, kidney failure, mental confusion, coma, body fluid accumulation, and frequent infections. Symptoms include yellowing of the skin, itching, and fatigue.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
A stroke results from impaired oxygen delivery to brain cells via the bloodstream. A stroke is also referred to as a CVA, or cerebrovascular incident. Symptoms of stroke include: sudden numbness or weakness of the face, arm or leg. Sudden confusion, trouble speaking or understanding. Sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, or loss of balance, and/or sudden severe headache with no known cause. A TIA, or transient ischemic attack is a short-lived temporary impairment of the brain caused by loss of blood supply. Stroke is a medical emergency.
Edema is the swelling of tissues as a result of excess water accumulations. Peripheral edema occurs in the feet and legs. There are two types of edema, non-pitting edema and pitting edema. Causes of pitting edema is caused by systemic diseases, most commonly involving the heart, liver, and kidneys. Local conditions that cause edema are thrombophlebitis and varicose veins. Edema is generally treated with medication.
Heart attack happens when a blood clot completely obstructs a coronary
artery supplying blood to the heart muscle. A heart attack can cause chest pain, heart failure, and electrical
instability of the heart.
Hypoglycemia is a syndrome caused by low blood sugar. Symptoms of hypoglycemia include palpitations, trembling, intense hunger, sweating, nervousness, and weakness. Consuming lifesavers, table sugar, soda, and juice are good treatment options for hypoglycemia.
Alcoholism is a disease that includes alcohol craving and continued drinking despite repeated alcohol-related problems, such as losing a job or getting into trouble with the law.
Internal bleeding occurs when an artery or vein is damaged and blood to escapes the circulatory system and collects inside the body. Internal bleeding can be caused by a variety of situations such as blunt trauma, deceleration trauma, medications, fractures, and spontaneous bleeding. Treatment of internal bleeding depends on the cause of the bleeding.
COPD (chronic obstructive pulmonary disease) is a disorder that persistently obstructs bronchial airflow. COPD mainly involves three related conditions, chronic bronchitis, chronic asthma, and emphysema. Symptoms of COPD include chronic cough, shortness of breath, frequent respiratory infections, wheezing, morning headaches, and pulmonary hypertension. Treatment of COPD is focused on the related condition(s).
Brain aneurysm (cerebral aneurysm) is caused by microscopic damage to artery walls, infections of the artery walls, tumors, trauma, drug abuse. Symptoms include headache, numbness of the face, dilated pupils, changes in vision, the "worst headache of your life," or a painful stiff neck. Immediate treatment for a brain aneurysm is crucial for patient survival.
Malaria is an infectious disease transmitted by the bite of an infected Anopheles mosquito. Symptoms of malaria include chills, pain, fever, and sweating. Though mild cases of malaria can be treated with oral medication, severe cases require intravenous drug treatment and fluids.
Tylenol liver damage (acetaminophen) can occur from accidentally ingesting too much acetaminophen, or intentionally. Acetaminophen is a drug contained in over 200 OTC and prescription medications from NyQuil to Vicodin. Avoiding unintentional overdoses include reading medication labels, write down the dosages of medications you are taking, do not drink excessive alcohol while taking acetaminophen. In severe cases, a liver transplant may be necessary.
Epilepsy is a brain disorder in which the person has seizures. There are two kinds of seizures, focal and generalized. There are many causes of epilepsy. Treatment of epilepsy (seizures) depends upon the cause and type of seizures experienced.
Rhabdomyolysis is a rapid deterioration and destruction of skeletal muscle. Some of the causes of rhabdomyolysis include severe burns, muscle trauma, coma, seizures, electrolyte imbalance, medications (statins), viruses, bacteria. Treatment of rhabdomyolysis depends on the cause.
Heart rhythm disorders vary from minor palpitations, premature atrial contractions (PACs), premature ventricular contractions (PVCs), sinus tachycardia, and sinus brachycardia, to abnormal heart rhythms such as tachycardia, ventricular fibrillation, ventricular flutter, atrial fibrillation, atrial flutter, paroxysmal supraventricular tachycardia (PSVT), Wolf-White-Parkinson syndrome, brachycardia, or heart blocks. Treatment is dependant upon the type of heart rhythm disorder.
Encephalopathy means brain disease, damage, or malfunction. Causes of encephalopathy are varied and numerous. The main symptom of encephalopathy is an altered mental state. Other symptoms include lethargy, dementia, seizures, tremors, and coma. Treatment of encephalopathy depends on the type of encephalopathy (anoxia, diabetic, Hashimoto's, hepatic, hyper - hypotensive, infectious, metabolic, infections, uremic, or Wernicke's) are examples of types of encephalopathy.
Concussion is a short-lived loss of brain function that is due to head trauma. There are two types of concussion, simple and complex. Symptoms of concussion include headache, nausea, dizziness, dazed feeling, irritability, visual symptoms. Physical signs include poor concentration, emotional changes, slurred speech, and personality changes. Concussion is diagnosed with physical examination and testing. Treatment for concussion in general are treatment for control of the symptoms, and time.
Hypothermia is having a body core temperature of less than 35 C or 95 F. Most causes of hypothermia are preventable. Risk factors for hypothermia include age, mental status, medical conditions, and medications. Symptoms of hypothermia generally depend upon the severity of the condition. Treatment depends upon the severity of hypothermia. If not treated early, hypothermia can lead to cardiac arrest, coma, or death.
In the United States, head injuries are one of the most common causes of death and disability. Head injuries due to bleeding are generally classified by the location of the blood within the scull, these include: epidural hematoma, subdural hematoma, subarachnoid bleed, intracranial bleed, sheer injury, edema, and skull fracture. Some common symptoms of a head injury include: vomiting, bleeding from the ear, speech difficulties, paralysis, difficulty swallowing, and body numbness. Treatment of a head injury depends on the type and severity of the injury.
Sudden cardiac arrest is an unexpected, sudden death caused by sudden cardiac arrest (loss of heart function). Causes and risk factors of sudden cardiac arrest include (not inclusive): abnormal heart rhythms (arrhythmias), previous heart attack, coronary artery disease, smoking, high cholesterol, Wolff-Parkinson-White Syndrome, ventricular tachycardia or ventricular fibrillation after a heart attack, congenital heart defects, history of fainting, and heart failure, obesity, diabetes, and drug abuse. Treatment of sudden cardiac arrest is an emergency, and action must be taken immediately.
Myxedema coma is the loss of brain function due to severe longstanding low levels of thyroid hormone in the blood. Myxedema coma is a life-threatening complication of hypothyroidism. Examples of triggers of myxedema coma include medications, infections stroke, trauma and more. Some of the ymptoms of myxedema coma include: hypothermia, seizures, coma, difficulty breathing and more. Treatment of myxedema coma depend on the severity of the condition.
Anthrax is a deadly infectious disease that may be transmitted to humans by infected animals or by biological warfare. There are three types of anthrax: cutaneous, inhalation, and gastrointestinal. Symptoms of cutaneous anthrax include a swollen glands, muscle ache, headache, fever, nausea, vomiting, and a red-brown raised spot that enlarges, blisters, and hardens, forming an ulcer crater with black crust. Symptoms of inhalation anthrax are flulike and may progress to respiratory distress, shock, coma, and death. Symptoms of gastrointestinal anthrax include loss of appetite, bloody diarrhea, and abdominal pain. Treatment for cutaneous anthrax involves penicillin, tetracycline, erythromycin, and ciprofloxin. Inhalation anthrax necessitates treatment with IV therapy with antibiotics.
Acute respiratory distress syndrome (ARDS) is a lung condition in which trauma to the lungs leads to inflammation of the lungs, accumulation of fluid in the alveolar air sacs, low blood oxygen, and respiratory distress. Causes of ARDS include: pneumonia, aspiration, severe blow to the chest, sepsis, severe injury with shock, drug overdose, and/or inflamed pancreas. Treatment for ARDS include extra oxygen, and/or medication.
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