Pearl - Corticosteroid Use in the Pediatric ED.

Source: ebmedicine.net

-A single dose of dexamethasone in the ED is efficacious for asthma exacerbation, and particularly valuable when patient/family compliance is a concern.

-There is no proven efficacy for giving corticosteroids in the setting of anaphylaxis; this should not delay epinephrine administration.

-In patients with bacterial meningitis, corticosteroids should ideally be administered before antibiotics, however, some sources support their administration up to 4 hours after antibiotics.

-Caution is indicated in patients with hypercoagulable states and bacterial meningitis, due to one citation suggesting the possible increased risk of central venous thrombosis.

-Patients on chronic steroids, immunodeficiency, or those with adrenal suppression, may require higher or additional doses of steroids and may not respond to standard dosing.

Thanks for reading,

Vish

Trauma Tuesday - Why crash-2 and women matter.

Pearl -Tranexamic Acid (TXA) for the Hemorrhaging Trauma Patient

Early TXA administration has been shown to decrease deaths from acute severe bleeding. It works by inhibiting the breakdown of fibrin thus preserving the clot matrix. A 1g loading dose over 10 mins and another 1g over 8 hrs may reduce mortality.

Coming soon, the CRASH-3 trial, which evaluates its use in patients with TBI. http://crash3.lshtm.ac.uk/

WOMAN - http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30638-4/fulltext

MATTERs - https://www.ncbi.nlm.nih.gov/pubmed/22006852

CRASH-2 - https://www.ncbi.nlm.nih.gov/pubmed/23477634

Pearl of the day - Managing Oncologic Emergencies

Metastatic spinal cord compression - Corticosteroids are first line. In most cases, give dexamethasone 10mg IV.

Tumor lysis syndrome - First line therapy is IV fluids. Worsening renal function will require hemodialysis/CRRT. Avoid IV calcium for hypocalcemia because the concurrent hyerphosphatemia will cause worsening precipitation.

Neutropenic fever - Patients need at least 2 sets of blood cultures. Additionally, cultures need to be drawn from each lumen of any indwelling lines.

Neutropenic fever patients with abdominal pain/diarrhea should be tested for C.diff, even in the absence of traditional risk factors.

More:

MASCC Risk Index: www.mdcalc.com/ mascc-risk-index-febrile-neutropenia - may help determine suitability for inpatient vs. outpatient management of febrile neutropenia.

ANC calculator: www.mdcalc.com/absolute-neutrophil-count-anc - determines severity of neutropenia.

 

Source: EBMedicine.net