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...Read More
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....Read More
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). Posterior epistaxis is considerably less common than anterior epistaxis and represents about 5-10% of all presentations. Many patients with posterior epistaxis will be managed with a posterior pack and admitted for further monitoring. Traditional teaching argues that:
Patients with nasal packs should be given prophylactic antibiotics to prevent serious infectious complications.
Patients with posterior packs should be admitted to the ICU for cardiac monitoring as they are at risk for serious bradydysrhythmias.
Recently, there has been a lot of buzz about the use of topical tranexamic acid for epistaxis or oral bleeds on multiple social media platforms. Everyone seems so happy that it works so well, but we thought we would look through the literature and see what the evidence for use of topical tranexamic acid (TXA) is and how best to compound it for these clinical dilemma. We performed a PubMed, and Ovid search using the terms "topical" AND/OR "oral solution" AND/OR "intranasal" PLUS "tranexamic acid" to answer our questions at hand....Read More
Patients with corneal abrasions typically come to the emergency department for eye pain. Most physicians treat these with topical antibiotics, oral analgesia, and for those who are lucky enough 48 - 72 hour follow up with ophthalmology. Oral analgesia does a poor job of controlling these patients pain. Tetracaine is an esterase type anesthetic with a onset of action of 10 - 20 seconds and a duration of action of 10 - 15 minutes. Use of topical anesthetics are very effective at reducing pain, but there use is discouraged secondary to poor wound healing of the corneal epithelium. So what is the evidence for topical anesthetic use on corneal abrasions?...Read More