Andres Larsen Jul 11, 2016:

@Joseph There is, as you state, no diagnosis. There are only the observations made on admission. This does not preclude the presence of drug medication interactions prior to admission. So it could very well be that on admission the patient is observed as not appearing to be “toxic”, in other words, this patient is being admitted with no apparent signs of drug medication interaction toxicity present

That is extremely important as this patient who just had a stroke is definitely going to be medicated after admission

Joseph Tein (asker) Jul 11, 2016:

@Taña Hi there, thanks for your comment. This is a good point; I'll check further in the patient's history (haven't come across the type of stroke yet).

Taña Dalglish Jul 11, 2016:

More subarachnoid:

• Are often caused by high blood pressure.
In addition to high blood pressure, factors that
increase the risk of hemorrhagic strokes include:
• cigarette smoking
• use of oral contraceptives (particularly those with
high estrogen content)
**** • excessive alcohol intake *****
*** • use of illegal drugs **

Taña Dalglish Jul 11, 2016:

@ Joseph Joseph: While not my area, don't you think you should define, if you know, what kind of stroke? While not my area of expertise, I think the starting point is to determine what type (as there are hemorrhagic and subarachnoid hemorrhages). Do you know if the medical history has detailed "excessive alcohol use". I ask this because below under "subarachnoid" one of the causes is "excessive alcohol use". So I do not necessarily agree that is simply drug use, alcohol, or both! So ....???

http://www.strokeassociation.org/idc/groups/stroke-public/@w...
Hemorrhagic Stroke
There are two kinds of hemorrhagic stroke: Intracerebral hemorrhages (most common type of hemorrhagic stroke);
• Occur when a blood vessel bleeds or ruptures into
the tissue deep within the brain.
• Are most often caused by chronically high blood
pressure or aging blood vessels.
• Are sometimes caused by an arteriovenous
malformation (AVM). An AVM is a cluster of
abnormally formed blood vessels. Any one of these
vessels can rupture, also causing bleeding into the brain.
Subarachnoid hemorrhages:
• Occur when an aneurysm (a blood-filled pouch that
balloons out from an artery)

Joseph Tein (asker) Jul 11, 2016:

Hi Robert and Andres,

Thanks for your comments and observations. I don't think in this context it refers to drug abuse, which would be included in the patient's history. This is a description of the patient when he was admitted, included with a number of other observations of respiration, state of consciousness and other parameters.

Andres Larsen Jul 11, 2016:

paciente no luce tóxico (no luce mal) Infecciones de vías respiratorias superiores - Medicina
m.exam-10.com/medicina/5213/index.html
18 jun. 2015 - No tiene la clásica tos de un resfriado común y el ***paciente no luce tóxico (no luce mal)***. Afecta principalmente a niños de 6 meses a 3 años, ...

resumen - Servicios
medicina-ucr.com/.../22-infecciones-de-vc3adas-respiratorias-superiores....
Cuando ha habido falla terapéutica, es decir, cuando el paciente no ha ... No tiene la clásica tos de un resfriado común y el ***paciente no luce tóxico (no luce mal)*** ...

Robert Carter Jul 11, 2016:

Yes, poisoning/toxicity certainly sounds more likely than just specifically drug abuse, Andres.

Robert Carter Jul 11, 2016:

Hi Joseph. Mightn't it be referring to drug abuse, i.e. toxicómano?