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Codeine is bad for children

Despite warnings by the FDA in 2013 to stop prescribing codeine to children due to the risk of respiratory depression and death, a study to be released this week in Pediatrics indicates that 5% of children post-tonsillectomy/adenoidectomy are still being prescribed this medication.   Why is codeine so dangerous?   Codeine is metabolized to morphineRead more

52 in 52: PECARN tool to identify pediatric patients with low risk head injuries

Article Citation                                                                                                                             Kuppermann N, Holmes JF, Dayan PS, Hoyle JD Jr, et al; Pediatric Emergency Care Applied Research Network (PECARN). Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study. Lancet. 2009 Oct 3;374(9696):1160-70.    What we already know about the topic According to the CDC,Read more

Presentation of acute aortic dissections

A 91 yo female presents with sudden onset right arm pain with decreased pulses. Since arrival to the ED, her mental status has also progressively decreased. Her blood pressure is 170/60, HR 60, T97.8, RR20, sats 100% RA. You suspect she has had an aortic dissection and indeed a CTA of her chest / abdomenRead more

Combination of acetaminophen and ibuprofen for acute extremity pain

Article Citation                                                                                                                             Chang AK et. al. Effect of a Single Dose of Oral Opioid and Nonopioid Analgesics on Acute Extremity Pain in the Emergency Department: A Randomized Clinical Trial.JAMA. 2017 Nov 7;318(17):1661-1667. doi: 10.1001/jama.2017.16190.   What we already know about the topic According to the latest CDC data from 2015, opioids were involved inRead more

IUDs and the risk for ectopic pregnancy

17 yo female with progestin secreting IUD, LMP 9/22/17, no prior medical problems presents to the ED with bilateral lower abdominal pain for the last day. She also notes that she has had some intermittent vaginal bleeding for the last 3 weeks. Her HR is 98, BP 130/99, RR16, sat 100% on RA. On examRead more

The 52 in 52 review: Thrombolysis with Alteplase 3 to 4.5 Hours after Acute Ischemic Stroke

Article Citation                                                                                                                             Hacke W, Kaste M, Bluhmki E, Brozman M, et al; ECASS Investigators. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008 Sep 25;359(13):1317-29. PMID: 18815396   What we already know about the topic  Last week we reviewed the 1995 NINDS trial that showed that t-PA givenRead more

Fight bite

21 yo male presents with laceration over his distal 4th metacarpal. Initially the patient doesn’t recall how the injury occurred, but with additional probing you discover he was in an altercation last night and punched another person in the mouth. A x-ray shows no fracture and no retained foreign body. What do you do now?Read more

Oculomotor palsy

A 74 yo female with hx of diabetes, HTN presents to the ED with new onset painless left sided diplopia for the last 24 hours. No change in visual acuity. The patient has no other symptoms. You examine the eye and left sided ptosis and a “down and out pupil”. The pupil is reactive toRead more

The 52 in 52 Review: Tissue Plasminogen Activator for Acute Ischemic Stroke

Article Citation: The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute iscAhemic stroke. N Engl J Med. 1995 Dec 14;333(24):1581-7.PMID: 7477192 What we already knew about the topic: According to the AHA, around 800,000 people a year in the United States experience a stroke, whether first timeRead more

ER venous panel or BMP?

You have a patient who is in acute renal failure. You have sent an ER-venous panel that shows a Cr of 4.6, a BUN of 95, and a K of 6.5. You discuss these findings with your nephrology colleagues who request you get the “more accurate” basic metabolic panel. But is it?   Answer: ItRead more