24 May 2018

May 24, 2018

Written by REBEL EM

Background: Sore throat is among the most common complaints in the emergency department (ED). Sometimes, the etiology is bacterial, and in those cases antibiotics may shorten the duration of disease and provide symptomatic relief. The majority of cases are viral and though most are appropriately treated with symptom management in the forms of NSAIDS and acetaminophen, some are prescribed antibiotics before cultures result in the hopes of alleviating pain. Corticosteroids are another treatment modality with prior studies suggesting their effectiveness. That said, steroids remain an uncommon therapy for a common disease.

Medical Categories: Head, Eye, Ear, Nose, and Throat
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7 Dec 2017

December 7, 2017

Written by REBEL EM

Background: Epistaxis is a common Emergency Department (ED) complaint with over 450,000 visits per year and a lifetime incidence of 60% (Gifford 2008, Pallin 2005). Standard anterior epistaxis treatment consists of holding pressure, use of local vasoconstrictors, topical application of silver nitrate and placement of an anterior nasal pack. ED patients with epistaxis often fail conservative management and end up with anterior nasal packs which are uncomfortable. This is even more common in the group of patients who are taking antiplatelet agents like aspirin or clopidogrel. Recently, the use of topical tranexamic acid (TXA) has been described in patients with anterior epistaxis with shorter time to epistaxis control and shorter ED length of stay (Zahed 2013). However, prior studies have not focused specifically on patients taking antiplatelet agents.

Medical Categories: Head, Eye, Ear, Nose, and Throat
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5 Oct 2017

October 5, 2017

Written by REBEL EM
Corneal abrasions account for 10% of all ocular complaints, and are the most common cause of ocular trauma (Alotaibi 2011, Bhatia 2013).  The diagnosis of corneal abrasions typically involves fluorescein staining of the eye and visualization of the abrasion via slit lamp exam. This review focuses specifically on pain control for corneal abrasions. Although corneal abrasions typically heal within 24-72 hours without complications, the pain in the acute phase is usually significant (Wilson 2004).  Treatments described include patching, topical anesthetics, topical NSAIDS, cycloplegics or oral analgesics.  Utilization of topical anesthetics has been described in a previous post.  Oral analgesics are usually prescribed as a rescue modality when topical treatment is ineffective at managing pain. 
Medical Categories: Head, Eye, Ear, Nose, and Throat
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24 Jul 2017

July 24, 2017

Written by REBEL Cast
Background: Sore throat is a common presentation to the emergency department as well as primary care clinics.  Corticosteroids inhibit transcription of pro-inflammatory mediators in airway endothelial cells responsible for pharyngeal inflammation and symptoms of pain.  They have been used in other upper respiratory tract infections such as acute sinusitis and croup.  In adults, previous studies with dexamethasone are in combination with antibiotics but studies of children have included dexamethasone without antibiotics.  This study is unique as it is evaluating the benefits of oral corticosteroids for acute sore throat in primary care in the absence of antibiotics
Medical Categories: Head, Eye, Ear, Nose, and Throat
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13 Apr 2015

April 13, 2015

Written by REBEL EM
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 of life-threatening bradydysrhythmias. Unfortunately, the literature here is even sparser than with prophylactic antibiotics. An extensive literature search (paging research librarian) turned up two articles that were repeatedly cited.
Medical Categories: Head, Eye, Ear, Nose, and Throat
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