An Evidence Based Approach to Wound Irrigation

  • Tap water is equally efficacious as saline for routine wound irrigation in uncomplicated wounds and immunocompetent patients.
  • Ideal irrigation pressure can be achieved using a tap faucet; avoid IV bags and bottles.
  • Very little data exist regarding ideal volumes of irrigation – texts recommend 60 cc/cm.

Magnesium sulfate for moderate to severe asthma exacerbation

magnesium-asthma

If inhaled salbutamol and iprotropium (remember, double nebs decrease the risk of admission) plus systemic glucocorticoids don’t help, give IV Magnesium sulfate 50 mg/kg IV over 20 minutes (max dose 2 grams, use this dose for adults)

When your child (> 6 months) is burning up…

  • “Fever is not a disease. It is merely the child’s immune system APPROPRIATELY responding to an infectious process which is viral the majority of the time.”
  • “We treat fever with anti-pyretics because it makes the child feel bad, not because fever in and of itself is bad.”
  • “The “number” on the thermometer is not nearly as important as how the child looks (interactivity, energy, hydration).”
  • “Length of the fever is actually more concerning than height in most cases. If the fever lasts for more than 5 days, the child should at least have a repeat physical exam by a clinician.”
  • “Come back if you are worried about the child.”

If a patient appears delirious, you should search for the underlying cause. The mnemonic DELIRIUM is helpful to recall some of them:

D rugs: Medication side effects
E lectrolyte abnormalities
L ack of drugs – Withdrawal from a medication
I nfection
R educed sensory input – Patients who are hard of hearing or have impaired vision
I ntracranial pathology
U rinary or fecal retention
M yocardial and pulmonary – Infarction, CHF exacerbation, COPD exacerbations, and other disease processes that cause hypercapnia or hypoxia

With the cold comes fires, here’s a great resource for managing burns

 

The aim of these guidelines is to provide a consistent standard of management for burn injuries managed outside of a Burn Service, particularly in the early stages after injury, to improve patient care and outcomes. The guidelines are based on scientific evidence where available and consensus expert opinion

How Long Does a Cough From Respiratory Illness Last?

It is completely normal and expected to have a cough for 2 or even 3 WEEKS after onset of illness!!! It is also important to emphasize to your patients that they should ONLY seek care if they are having worsening symptoms or have alarm symptoms (i.e. High fever, bloody or rusty sputum, and/or worsening shortness of breath)