Please stop with the STAT ORAL ANTIHYPERTENSIVES…you are harming patients

A Hypertensive emergency is any elevation in blood pressure in the presence of end-organ dysfunction. Aggressively treating severe asymptomatic hypertension (very high blood pressure without clear end organ damage) is not indicated, not supported by the literature and DANGEROUS. First, do no harm.

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MBWA! Evidence based Dog Bite Management

  • It appears safe to close all dog bites regardless of location as long as they are < 8 hours old, and copious high-pressure irrigation
  • In patients with non-hand location dog bites, antibiotics are not needed if we leave the wound open for secondary repair.
  • If we primarily close the wound, we should continue to provide antibiotic prophylaxis until someone performs a randomized trial of primary closure +/- antibiotic prophylaxis.

 

Cheap solutions: Topical Tranexamic Acid for Nose Bleeds and Oral Bleeds

Topical Tranexamic Acid for Epistaxis or Oral BleedsRecently, there has been a lot of buzz about the use of topical tranexamic acid for epistaxis or oral bleeds on multiple social media platforms. Everyone seems so happy that it works so well, but we thought we would look through the literature and see what the evidence for use of topical tranexamic acid (TXA) is and how best to compound it for these clinical dilemmas. We performed a PubMed, and Ovid search using the terms “topical” AND/OR “oral solution” AND/OR “intranasal” PLUS “tranexamic acid” to answer our questions at hand.

 

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Bronchiolitis

  • Chest x-rays do not predict disease severity and might lead to unnecessary antibiotic usage.
  • Viral testing doesn’t change management and doesn’t predict risk of complications.
  • Chest PT makes us feel better but not the patients.
  • Hypertonic saline has not been proven effective in the ED although it may shorten length of stay when used as an inpatient. However, recently there were two RCTs that showed conflicting results on the effectiveness of hypertonic saline in the ED.
  • There isn’t much benefit to routine continuous pulse oximetry, as its use can vary and may lead to increased hospitalization rates.
  • Supplemental oxygen isn’t indicated unless said pulse oximetry is lower than 90%.

 

The evidence behind treating fever in children

  • Antipyretics don’t appear to lengthen duration of fever in ill children
  • Antipyretics an be combined for effect, but to what end?
  • Antipyretics don’t appear to decrease risk of febrile seizure recurrence
  • Fever:  Not your enemy!