Nose Bleeding…evidence based practice

  1. Gauze ribbons, nasal tampons and nasal balloon catheters all appear to be equally effective in controlling epistaxis, however, the nasal tampons and balloon catheters appear to be less time consuming and easier to insert. 
  2. Most patients discharged with nasal packing should follow-up with an  ENT physician within 48-72 hours to reduce potential complications. Most patients with anterior nasal packing do not require antibiotic prophylaxis as the incidence of Toxic shock syndrome is very low.
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Spinal stabilisation of adult trauma patients

A strong recommendation against spinal stabilisation of patients with isolated penetrating trauma; a weak recommendation against the prehospital use of a rigid cervical collar and a hard backboard for ABCDE-stable patients; and a weak recommendation for the use of a vacuum mattress for patient transportation. Finally, our group recommends the use of our clinical algorithm to ensure good clinical practice.

The Sickle Cell Patient in the ED – Management of Acute Complications

Evidence-based guidelines and expert panels recommend the following in the management and treatment of pain crisis:

  • Initiate analgesia within 30 minutes of triage. (Consensus – Panel Expertise)
  • Employ individualized prescribing and pain monitoring protocols. (Consensus – Panel Expertise)
  • If no contraindications, give NSAIDs as adjuvant pain therapy. (Moderate Recommendation, Low-Quality Evidence)
  • Avoid meperidine (pethidine) (normeperidine, the active metabolite of meperidine, is excreted by the kidneys, and is associated with an increased incidence of seizures in the setting of renal dysfunction – common in occlusive crisis)