The 52 in 52 Review: CRB-65 predicts death from community-acquired pneumonia

“I quit school in the sixth grade because of pneumonia. Not because I had it, but because I couldn’t spell it.” – Rocky Graziano   Article Citation: Bauer TT, Ewig S, Marre R, Suttorp N, Welte T; CAPNETZ Study Group. CRB-65 predicts death from community-acquired pneumonia. J Intern Med. 2006 Jul;260(1):93-101. PMID: 16789984   What weRead more

Does diazepam work for acute lower back pain?

“If there’s a pill, then pharmaceutical companies will find a disease for it.” – Jeremy Laurance   A recent study conducted at an urban health care center (Friedman et al. 2017) compared outcomes for diazepam in conjunction with naproxen against naproxen alone for acute, non-traumatic, non-radicular lower back pain. For lower back pain, common treatmentRead more

Hyperpronation for Nursemaid’s elbow reduction

“Childhood means simplicity. Look at the world with the child’s eye – it is very beautiful.” -Kailash Satyarthi   Nursemaid’s elbow is a radial head subluxation, typically caused by a “pulling” mechanism. It occurs most often in children six months to five years of age. The child will present with pain and will not useRead more

Fight Bites

  “Dogs never bite me. Just humans.” -Marilyn Monroe   Human bites are the third most common bite after dog and cat bites. They occur more frequently in males, typically between the late teens and in the twenties. Closed fist bites are typically caused by punching another individual in the mouth. The dorsal aspects ofRead more

The 52 in 52 Review: Tap Water for Wound Irrigation

Article Citation: Weiss EA, Oldham G, Lin M, Foster T, Quinn JV. Water is a safe and effective alternative to sterile normal saline for wound irrigation prior to suturing: a prospective, double-blind, randomised, controlled clinical trial. BMJ Open. 2013 Jan 16;3(1). PMID: 23325896   What we already know about the topic: Traumatic wounds are a frequentRead more

A Pain in the Back – Do Patients Need More Than Nsaids?

A recent double-blinded, RCT from JAMA investigated the relative efficacies of naproxen + placebo, naproxen + cyclobenzaprine and naproxen + oxycodone/acetaminophen on functional impairment in acute onset (<2 weeks), non-traumatic, non-radicular low back pain in the non-elderly (<64).  Their findings: Of 390 patients that met inclusion criteria, there was no added benefit on functional impairmentRead more

Tylenol for Low Back Pain: No Better Than Placebo

This recent meta-analysis in the BMJ found that paracetamol (acetaminophen) was no better than placebo for the treatment of low back pain.  Read more

4th of July Games

4 teasers for the 4th of July weekend. 1. What is this and why is it dangerous? 2. Patient had a DVT + PE, then got an IVC filter, then had another PE. How? 3. Fun Sporcle quiz – 3 letter body parts, 2 min 4. Higher level Sporcle quiz – Doses and drips, 5 min (goodRead more

Might as well finish the week off with just a bit more about suturing!!! Aftercare (what do you tell your patients!!) – Ointment (antibiotic for example) and dressing immediately after lac repair: Not much out there evidence wise what I could find indicates doing this Moisture promotes re-epithelialization Xeroform with gauze isn’t a bad ideaRead more

A 29 y/o female with NIDDM and poorly controlled chronic asthma present s with 3days of sob and wheezing typical of her prior asthma exacerbations.  After two nebulizer treatments and dose of corticosteroids her PEFR is measured at 55% of predicted.  Should she be admitted?Read more