What I’m Watching in September Podcasts. Maryland cc project, blood conservation. Sickle cell emergencies, basics of fluid resuscitation, pain management and sepsis care in this vulnerable group of patients. Pearls of the management of the critically ill obese patient. St Emlyn’s discuss breaking bad news. Hero worship strikes again, Levitan on [...]
There are a number of great FOAM resources that have helped me develop as an independent cardiac practitioner. It is very hard to pick a favourite but thinking more laterally and choosing a person rather than an individual website or blog it has to be the work of Dr Ken Grauer and his ECG resource. [...]
The post Dr Ken Grauer- Fabulous ECG resource- by Charles Spencer appeared first on Critical Care Practitioner.
Thoracic aortic dissections (TAD) are a bit of a nightmare. They are difficult to diagnose clinically, which is annoying as an Emergency Department (ED) clinician, but it gets even worse when you consider it from the patients perspective…… Half of all patients who dissect will die within 48 hours if its not diagnosed, compounded by [...]
National Confidential Enquiry into Patient Outcome and Death (NCEPOD) Just Say Sepsis – An overview of the report Sepsis is a leading cause of avoidable death in the UK, and kills more people than breast, bowel and prostate cancer combined. The condition occurs when the body is overwhelmed by an infection. In severe sepsis organs [...]
This week (after a very long break) we get back to business. We’ll take you through the diagnosis, management and investigation of acute menorrhagia.
Take Home Messages:
- Acute Menorrhagia can be severe enough to create haemodynamic instability, assess for shock first.
- Always perform a B-hCG to exclude pregnancy/miscarriage
- Be sure to exclude a pelvic infection in your work-up
- Consider inherited platelet dysfunction or coagulopathies in the adolescent with new menorrhagia
- Consider endometrial hyperplasia or cancer in the woman over 35
- Medical management may include NSAIDs, high-dose Progesterone, Tranexamic Acid
- Surgical management may include Dilation & Curettage
References & Resources:
Adolescent Gynaecology – Menorrhagia Clinical Practice Guidelines, Royal Children’s Hospital Melbourne (Australia)
Menorrhagia (PDF) Australian Doctor Magazine ‘How To Treat’ (2009)
Heavy Menstrual Bleeding NICE Guideline UK (2007, updated 2013)
Bradshaw et al.5
RCT- double blinded
Performed in United Kingdom
IV Morphine + placebo (n = 136)
IV Morphine + metoclopramide 10 mg (n = 123)
N/V between the two groups was not statistically significant (p = 0.3).
Overall incidence of N/V was low in both treatment groups (3.7% in placebo and 1.6% metoclopramide)
Determined pre-treating patients with metoclopramide was not necessary.
Overall N/V associated with IV morphine was very low and recommended using antiemetics for patients who develop N/V
Bhowmik et al. 8
RCT- double blinded
Performed in India
IV Morphine + placebo (n = 53)
IV Morphine + promethazine (n = 54)
IV Morphine + ramosetron (n = 54)
IV Morphine + metoclopramide (n=54)
Overall incidence of N/V was low in all treatment groups (9.4% ramosetron, 18.5% metoclopramide, 10.2% in promethazine and 6.2% in placebo)
Rate of N/V was not statistically significant between any of the groups.
Incidence of N/V in patients was low in all treatment groups. Trial concluded that patients should receive antiemetic therapy only if experience N/V and not as a prophylactic agent with IV opiates.
Per results patients that received placebo + morphine had less N/V compared to other treatment groups; however, NOT statistically significant.
Sussan et al 9
Randomized Double masked multicenter trial
Performed in 9 countries
Investigated 2574 patients that received IV opiates and randomized 520 patients that developed N/V associated with IV opiates.
Group 1: placebo (n = 94)
Group 2: ondansetron 8 mg (n = 214)
Group 3: ondansetron 16mg (n = 211)
Resolution of N/V was statistically more significant (p < 0.001) when comparing ondansetron therapy with placebo.
Group 1: 45.7% N/V resolved
Group 2: 62.3% N/V resolved
Group 3: 68.7% N/V resolved
Concluded the best practice would be to treat patients’ N/V after development in patients that receive IV opiates.
Trial determined the prevalence of N/V is minimal and exposing patients to medication they do not need puts them at risk for additional adverse drug reactions.
Peer reviewed by Craig Cocchio, PharmD, BCPS (@iEMPharmD) and Nadia Awad, PharmD, BCPS (@Nadia_EMPharmD)