Oral steroids are a mainstay of treatment for severe posion ivy induced contact dermatitis. The doses, duration of therapy, and taper/nontaper debate has raged for decades: read on a for quick summary of a paper comparing a short steroid burst to a 15 day taper!
You are caring for a 2 yo with multifocal pneumonia who is hypoxic on standard nasal canula. You decide to institute high flow nasal canula (HFNC) in an effort to stave off orotracheal intubation. Your repspiratory therapist requests parameters including flow rate (typically 0-40 LPM). What is the optimal flow rate to decrease work of breathing in this pediatric patient?
A 58 yo patient with a hx of CLL presents with a chief complaint of dyspnea, wheezing, and cough for 3 days. He is noted to be tachypneic with o2 sats of 91% on RA. There is diffuse expiratory wheezing. Peripheral WBC count is 199,000, increased from a baseline of ~80,000. A CT scan shows scattered interstital infiltrates. What is going on with this patient and what is the indicated therapy?
You are treating a patient for diabetic ketoacidosis in the ED. Thing is, the patient isn't very ill and only has mild DKA (pH 7.25-7.3). Is starting a continuous insulin infusion and admitting the patient to an intensive care unit bed really the best use of resources? Read on for an alternative suggested regimen using subcutanoues doses of rapid acting insulin
For decades now, aggressive fluid replacement in pediatric DKA patients has been thought to contribute to cerebral edema and neurologic injury. This has resulted in a general policy of cautious fluid replacement with isotonic crystalloid, and perhaps even contributed to under-resuscitation of these patients. In this first large, randomized, prospective study to examine the role of type of fluid (0.9% NaCl vs 0.45% NaCl) and rate of administration, the hope was to detemine if type of fluid, rate of adminstration, or both were associated with cerebral edema and neurologic injury in this patient population. Read on for the key results of this practice changing paper!
If you're reading this....stop and go to the beach or something! We'll be back next week with more fantastic content!
Neutropenic Enterocolitis aka typhlitis, necrotizing enterocolitis, ileocecal syndrome
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The Surviving Sepsis Campaign has published a 2018 update to their guidelines for sepsis care. The new recommendations have sparked major controversy in the emergency medicine, critical care, and infectious disease communities. Read on for a brief summary of the most controversial points and links to further reading!
This week's post comes courtesy of our ED pharmacist Rachel Rafeq. Surprise! Metronidazole is no longer first line therapy for c-diff infections! Check out this handy table for the updated guidelines from the Infectious Disease Society of America for the latest treatment regimens
