Author Archive for: Rick Pescatore

Is Macrobid Safe in 1st Trimester Pregnancy?

23 Jul
July 23, 2018

Background: In 2011, the American College of Obstetricians and Gynecologists (ACOG) released a committee opinion warning against the use of nitrofurantoin (Macrobid) during the first trimester of pregnancy due to the perceived risk of an increased rate of congenital abnormalities with its use (Committee Opinion 2017). While the committee continued to recommend that nitrofurantoin be used as a first-line agent during the second and third trimesters, they stated that it should only be considered appropriate in the first trimester when no other suitable alternative antibiotics were available. While this recommendation seems to have been slow to permeate into the emergency medicine community, growing awareness has led to clinical trepidation in the provision of nitrofurantoin. Read more →

REBEL Cast Ep53 – GeriKet – Ketamine Analgesia in Older Adults

13 Jun
June 13, 2018

Background: The provision of safe and judicious analgesia is an important task for the emergency physician. Recent literature has demonstrated the effectiveness of sub-dissociative ketamine (SDK) in the emergency department (ED) setting (Motov 2015), however concerns regarding increased rates of hemodynamic and psychoperceptual adverse effects have limited application of this analgesic strategy in older populations. As awareness of geriatric oligo-analgesia has risen along with efforts to limit opioid utilization, interest in identifying a data set specific to this population has grown. The authors of this study sought to distinguish the performance and shortcomings of SDK in this unique patient group. Read more →

D-Dimer and Pregnancy: The DiPEP Study

19 Mar
March 19, 2018

Background: Pulmonary embolism is the leading cause of death in pregnancy and the puerperium – accounting for nearly 20% of maternal deaths in the United States – making rapid and accurate diagnosis critically important for emergency physicians, OB/GYNs, and all who take care of these women on a regular basis. Unfortunately, typical diagnostic pathways and approaches may not apply in pregnancy, and are made more complicated by the frequency of concerning and suggestive signs and symptoms in this population, particularly dyspnea (a common symptom in pregnancy related to an increase in progesterone levels) and tachycardia (as resting heart rate is typically expected to increase by up to 25% in normal pregnancy). Read more →

Should You Prescribe Oral Thiamine for Chronic Alcoholics?

07 Sep
September 7, 2017

Background: Alcoholism is a chronic disease with a staggering impact on society, costing the nation approximately 100 billion dollars per year, an expenditure greater than the costs associated with all cancers and respiratory diseases combined (Whiteman 2000). Large public hospital emergency department studies have demonstrated the enormous strain of alcohol use on resources, and the disproportionate burden that the care of the alcohol abusing patient places on the emergency medical system and the ED (Zook 1980). In one observational cohort, 24% of adult patients brought to the ED by ambulance were determined to likely suffer from alcoholism, further underscoring the tremendous frequency of this disease (Whiteman 2000). Read more →

Perichondritis: Not Just Simple Cellulitis

20 Jul
July 20, 2017

Background: Perichondritis is an infection of the connective tissue of the ear that covers the cartilaginous auricle or pinna, excluding the lobule (Caruso 2014). The term perichondritis is itself a misnomer, as the cartilage is almost always involved, with abscess formation and cavitation (Prasad 2007). Perichondritis can be a devastating disease, and if left improperly treated, the infection can worsen into a liquefying chondritis resulting in disfigurement and/or loss of the external ear (Noel 1989) (Martin 1976). Unfortunately, misdiagnosis and mistreatment is common. In one small retrospective review, the overwhelming majority of patients presenting to a large general hospital were prescribed antibiotics without appropriate antimicrobial coverage, resulting in a significant number of patients developing chondral deformities or “cauliflower ear” (Liu 2013). Read more →

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