7 Jun 2021

June 7, 2021

Written by REBEL EM
Background: Droperidol came onto the market in 1967 and, over time, became a frequently employed treatment of headache, nausea, agitation, acute pain, chronic pain, pain in the context of opioid-tolerance and refractory abdominal pain.  Unfortunately, in December 2011, the US Food and Drug Administration placed a black box on droperidol due to surveillance data showing increased prevalence of QT prolongation.  Most of these cases were due to high doses of droperidol ranging from 50 to 100 mgs. It’s also important to point out that QTc prolongation is not a patient centered outcome. A trial published by Nuttall et al of over 20,000 patients found ZERO cases of polymorphic VT or death at low doses of droperidol (0.625mg) [3].  Additionally, the Clinical Guidelines Committee of the American Academy of Emergency Medicine (AAEM) reviewed the literature in 2014 and found no evidence that low dose droperidol (under 2.5mg) was unsafe for use [4].
Medical Categories: Toxicology
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3 Jun 2021

June 3, 2021

Written by REBEL EM
Background: Oral sweet solutions have been used for some time as a pain-reducing agent for procedures in the neonatal population.  However, there has been some mixed results in its effectiveness, especially in the <12 months of age group. Nasopharyngeal aspiration (NPA) is a common procedure performed especially during seasonal upper respiratory tract infection. A study performed in 2005 by Macfarlane et al [2], demonstrated that NPA had a Face, Legs, Activity, Cry, and Consolability pain scale (FLACC) score of 6 out of 10.
Medical Categories: Pediatrics
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31 May 2021

May 31, 2021

Written by REBEL Covid-19, REBEL EM
Earlier this year, my home shop began administering the Johnson & Johnson COVID-19 vaccine to patients in the emergency department (ED). Thirteen years of experience in emergency medicine has afforded me many opportunities to counsel patients on lifestyle modifications, death and dying, tPA administration, and many other complex medical issues. However, I’ve never experienced a more polarizing topic than the COVID-19 vaccination. My initial attempts were met with a few quick wins. While in fast-track, a middle-aged Hispanic man presented with an injury to his left knee. I suspected a patellar tendon rupture, and while we waited for the orthopedist to evaluate his knee, I offered him the COVID-19 vaccine. He smiled acceptingly and slapped his left shoulder with his right hand, signaling the location he wished to receive his vaccine and said: “Yeah! I’ll take it.” “I want it too!” His wife exclaimed. Though not yet a patient, she sat patiently at her husband’s bedside, awaiting the orthopedists. She was quickly registered and vaccinated. 
Medical Categories: Infectious Disease
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