Summary/Chart Directions for the Completed Interview

How did the interview go overall? What were the main ideas that the interviewee
provided about your topic/hypothesis? What surprised you about the interview
itself? What are some questions you wish you asked? What might you do
differently the next time you interview a professional?

My interview with Dr. Matt Woodward, a Critical Care fellow at the University of
Maryland Medical Center, was very informative. Unfortunately, the specific scope of my
topic, involving the use of propranolol as a medication intended to remove emotional
turbulence of memories, was not directly explored. The fields of my topic, though medical,
are geared towards psychiatry, bioethics and law, so Dr. Woodward, as a neurologist,
could only speak on the use of propranolol in the Neuro ICU. My current hypothesis is that
despite ethical issues of personal identity and legal/social obligation, propranolol is a valid
treatment for those with Post-traumatic stress disorder. My interviewee has never treated
a patient with PTSD, nor read literature on ethics of the medication, but he provided plenty
of information on the medication. He acknowledged that propranolol has been used for a
variety of issues in the past such as myocardial infarction, high blood pressure and
migraines, so it is often called dirty because it does not have a specific use. However, in
an ICU setting it is useful because it is non-selective. He also addressed ethics; since the
only side effects are bradycardia and hypotension, the drug is low risk and does not
require consent for unconscious, comatose patients.

The next time I interview a professional, I should find a balance between questions
directly related to my topic that I want to know and questions that steer from my topic, but
are answerable by my interviewee. Since Dr. Woodward is not a psychiatrist, I should
have avoided questions related to PTSD and ethics. Next time, I should do more research
into propranolol in the ICU setting, so I can ask about certain conditions and problems it
addresses. Apart from my research, I am very glad I asked questions about healthcare
overall and his experience in medicine. When I asked about the skills he employs to
communicate emotionally fragile topics to patient’s families, I was surprised to hear that
brain death is easy to convey since it is a legal definition, and there is no decision that the
families have to make. I also was interested to hear how deprived hygienic conditions and
lack of access to health care in developing countries influences incidence of status
epilepticus because this condition is what I am charting in the database; there are a lot
more infectious causes in developing countries in comparison to the United States.

Questions: Responses:
 How is propranolol used in an ICU
setting? A study I read by the NIH tested
the use of propranolol to reduce
sympathetic storming for patients with
traumatic brain injury. Do doctors target
propranolol for sympathetic storming in
the Neuro-ICU?
What ethical considerations are patients
made aware of before given propranolol?
What are some common side effects of
propranolol for patients with traumatic brain
injury?
What is your perspective on propranolol as
a treatment for patients with Post-traumatic
stress disorder?
Yes, it is used for parasympathetic
hyperactivity in the nervous system.
Pharmacologically, people refer to it as a
“dirty medication” because it has a
broad mechanism of action. It is useful
for storming because it is a
non-selective beta-blocker. It certainly
has its benefits in the outpatient setting,
such as for migraines.
A lot of patients who use it in the ICU
setting are not communicative to have
any discussion about treatment choices.
What we talk to a patient's family about
is the risk. Propranolol at a low dose
and proper titration is a low risk. I don’t
see huge ethical considerations about
that, even though it is not FDA-approved
for an ICU purpose.
The biggest ones are bradycardia and
hypotension, especially at high doses.
Of course, a patient may have an
allergic reaction to anything, which is
unanticipated. If it is outpatient, I would
have a long discussion about it because
I am not able to monitor the patient’s
use.
I don’t know a ton about PTSD because
it is out of the scope of Neurology. I
have seen propranolol as a medication
regimen for nightmares related to
trauma.