Prophylactic Antibiotics for Anterior Nasal Packing in Epistaxis

Are Prophylactic Antibiotics Necessary for Anterior Nasal Packing in Epistaxis? There are some discussion regarding toxic shock syndrome and infections(otitis media, sinusitis) in case we do not prescribed antibiotic, but we have to take into account the risk of antibiotics side effects including, C-diff, anaphylaxis, allergic reaction, GI irritation and STS. I had a patient with questionable diagnosis of dental pain and was  prescribed Clindamycin and came to our ED with diarrhea and was diagnosed with c-diff, a young 20 years old. We have to be a little bit more conscious regarding our diagnosis and treatment in acute setting.

Link to article in annals

ACEP Clinical Policy on Nontraumatic Aortic Dissection

In adult patients with suspected acute nontraumatic thoracic aortic dissection, is a negative serum D-dimer sufficient to identify a group of patients at very low risk for the diagnosis

of thoracic aortic dissection?
Level C recommendations. In adult patients with suspected nontraumatic thoracic aortic dissection, do not rely on D-dimer alone to exclude the diagnosis of aortic dissection.

Ongoing challenge regarding the role of D-Dimer in TAD, and some assurance to back up our discussion to not rely on D-Dimer in case of suspicious for TAD

 

Link To Clinical Policy

 

 

 

Oxygen, Good or bad!

OXYGEN! Please put  patient on NC 2 -4. This is one of our critical action in mock oral board questions, but is it really a critical action, how much oxygen do we need for a pt w/o hypoxemia? we discuss this in COPD and Sickle cell crisis, but there are more growing in the filed of cardiology related hyperoxia can harm. Intensive Care Medicine published an article “The association between hyperoxia and patient outcomes after cardiac arrest: analysis of a high-resolution database” in Jan 2015! Pao2 > 300 was associated with significant worse outcome, The conclusion is severe hyperoxia was independently associated with decreased survival to hospital discharge.

Link to article

How to handle a Laryngoscope!

It is interesting that you teach a concept and try to back it up with some literature, but sometimes you do not have a simple tools to show it. Canadian Journal of Anesthesia published an article Laryngoscope manipulation by experienced versus novice laryngoscopists in December 2014. This is exactly what I’m talking about! how to grab a laryngoscope and how to manipulate it. There are some pictures that will help our interns to practice more professional. Remember to hold laryngoscope with your palm not your fingers and also have your handle angles less than 45 degrees.

Link to article