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A 24 year old was brought to the ER with a heart rate of 212

His batchmates carried him in from the hostel. Palpitations. Breathlessness. Panic

Couldn’t sit still, kept grabbing the bed rail

HR 212 on the monitor. Narrow complex tachycardia

No prior cardiac history. No previous episodes. Completely healthy till tonight

History revealed they’d been drinking. Smoking cigarettes. Normal hostel night

Then someone brought a joint. Single joint. Passed around between five of them

Four of them were fine

Only he ended up here

Same alcohol. Same cigarettes. Same joint. Same room

So what was different about him?

We tried a Valsalva

The rhythm broke. He converted back to sinus.

Once he settled down, we took the history again. Properly this time

Specifically, anything in the last 48 hours. Anything at all. Even something you don’t think counts.

He thought for a moment

Then he said

He had taken one tablet the previous day. Something small. Something he bought over the counter. Something he didn’t mention because it didn’t feel important

Fluconazole 150 mg

One tablet. Taken for a minor fungal issue. Available without prescription. Forgotten about completely

Fluconazole is a potent CYP inhibitor. That’s one of the pathways responsible for clearing THC from the body

Block that pathway and THC doesn’t metabolize normally

Instead it accumulates as 11-OH-THC, its active metabolite which crosses the blood brain barrier more efficiently than THC itself and produces stronger sympathetic stimulation

Fluconazole has a half life of about 30 hours

It was still fully active when that joint came around

His friends cleared the THC normally

His liver couldn’t

The same joint effectively became a much larger dose

His sympathetic system fired

His heart rate hit 212

Same alcohol. Same cigarettes. Same joint

But one over the counter tablet had quietly changed the evening

Drug interactions don’t care why you took the drug

They don’t care that it was just ONE tablet

Sometimes the critical detail is the one patients leave out

The small thing they thought wasn’t worth mentioning.

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Imaging tells you what it sees.
Clinical exam tells you what’s happening!

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Imaging tells you what it sees.
Clinical exam tells you what’s happening!

[quote @itsmubashi]

Daily reminder :

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@DipankarDoc 👏🎯

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Name this OBSOLETE technique ______ ❓

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@PerceptioApp 🎯

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Name this OBSOLETE technique ______ ❓

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Type of gait?

Most likely diagnosis ?

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Heavy SMOKER presenting with this

what’s the cause❓

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What is the most likely diagnosis ??

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Painless, soft, compressible forehead mass

Diagnosis ?

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Painless, soft, compressible forehead mass

Diagnosis ?

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@Psychiatrist42 a positive result indicates Troponin T >100 ng/L, so it’s far from “terrible”

likely just a lack of exposure to such tests in your speciality!?

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What’s your immediate NEXT move ??

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Qualitative trop exists for a reason, faster triage and to support ECG findings when time matters

Studies show bedside/POC troponin can reach ~90–98% specificity and even >90% sensitivity, especially when repeated or timed properly

It’s less precise than lab hs-troponin, but that’s the trade off for speed, early decision making, and real world emergency use

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What’s your immediate NEXT move ??

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What’s the name of this procedure?

When is it done ?

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Critical OB decision

Your Move: ______?

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@esanum crisp summary 🎯

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First line treatment ______ ❓

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@DrsansariOrd 🎯