Archive for category: Mythbuster

Medical Expulsion Therapy in Ureteral Colic: An Update

06 Aug
August 6, 2015

Back in August 2014, we posted an in depth review on medical expulsion therapy (MET) with tamsulosin in patients with renal colic. The summary of that post was: “Clearly, there is disagreement in the literature. None of the studies are ideal. We continue to lack a large, RDCT done on patients presenting to the Emergency […]

Morphine Kills in Acute Decompensated Heart Failure

08 Jun
June 8, 2015

Background: Intravenous morphine use has been reported in nearly one of seven patients hospitalized with acute decompensated heart failure (ADHF). I have anecdotally, even seen physicians giving morphine as a “first-line” agent: Nitroglycerine, Non-Invasive Positive Pressure Ventilation (NIPPV), and Morphine. There is surprisingly little evidence supporting routine use of morphine in ADHF, and no major […]

Mythbuster: Administration of Vasopressors Through Peripheral Intravenous Access

28 May
May 28, 2015

Background: Vasopressors are frequently used in critically ill patients with hemodynamic instability both in the emergency department (ED) as well as intensive care units (ICUs). Typically, vasopressors are given through central venous catheters (CVCs) as opposed to peripheral intravenous (PIV) access due to the concerns about adverse events (i.e. tissue ischemia/necrosis) associated with extravasation through […]

Do Patients with Posterior Epistaxis Managed by Posterior Packs Require ICU Admission?

13 Apr
April 13, 2015

This post is part 2 of epistaxis dogma. In the first post, we discussed the (dis)utility of prophylactic antibiotics in patients with epistaxis who require nasal packing. Here, we will take on dogma #2: Dogma #2: Patients with posterior packs for epistaxis should be admitted to the ICU for continuous monitoring due to the risk […]

Lidocaine + Bupivacaine vs Bupivacaine Alone for Digital Nerve Blocks

09 Apr
April 9, 2015

When I first learned digital nerve blocks in the late 1990’s I was taught to mix Lidocaine and Bupivacaine 50/50 to provide faster onset (Lidocaine) and a longer duration of action (Bupivacaine). My use of two agents for digital nerve blocks was recently questioned by one of my colleagues. Any time additional medications are drawn […]

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