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I walk into the room and see a 3 year old screaming in pain. It’s 3 am and her ear hurts. She couldn’t sleep. I ask her father what he has been using at home for pain. He pulls out a box and my heart sinks. Another parent duped by Shopper’s Drug Mart. Another child […]

The post Pharmacies are hurting my patients and I’m sick of it appeared first on First10EM.

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First10EM by Justin Morgenstern - 1M ago

Here is another collection of the articles I have found interesting in my reading from the last month or so. For this edition of the Research Roundup we have status epilepticus, nocebos, the pink lady, McGyver bias, and so much more. Podcast version over on BroomeDocs. Our ongoing obsession with fever Young PJ, Bellomo R, […]

The post Research Roundup (May 2019) appeared first on First10EM.

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This will be the final post this week about status epilepticus. I have long argued that our current status algorithms leave too many patients seizing for too long. I updated my suggested alternative algorithm this week and added a longer supplemental post explaining the reasons that I suggest early anesthetic agents (specifically propofol). As I […]

The post Phenobarbital second line in status epilepticus (Burman 2019) appeared first on First10EM.

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My approach to status epilepticus is somewhat more aggressive than commonly taught algorithms. It is summarized (overly simply) as “benzo → benzo → propofol”. There have been a number of concerns raised with this strategy recently on twitter. This post outlines the reasoning (and limited evidence) behind my seizure algorithm. This approach is based on […]

The post Aggressive seizure algorithm: why I use propofol early appeared first on First10EM.

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First10EM by Justin Morgenstern - 1M ago

Case EMS arrives with a 39 year old woman in the midst of a generalized tonic clonic seizure. The seizure has lasted at least 12 minutes now, so this is status epilepticus. No information is available about her past history. The paramedics were unable to start an IV, but did administer one dose of IM […]

The post Status Epilepticus: Emergency Management appeared first on First10EM.

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First10EM by Justin Morgenstern - 1M ago

Hemoptysis can be scary. I covered the emergency medicine approach to massive hemoptysis in one of the early posts on First10EM. However, even when the hemoptysis is small volume, it can be quite distressing to patients and clinicians alike. This paper asks whether using nebulized tranexamic acid (or TXA) for hemoptysis results in less bleeding. […]

The post Nebulized TXA for Hemoptysis (Wand 2018) appeared first on First10EM.

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First10EM by Justin Morgenstern - 1M ago

The “pink lady” or “GI cocktail”, a combination of an antacid and viscous lidocaine, is both much loved and much hated in emergency medicine. Some practitioners use it as a matter of routine. Others warn against it, for fear that it can lead to misdiagnosis in the setting of MI. (As an aside, please let […]

The post Pink Lady: What’s your worth? appeared first on First10EM.

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First10EM by Justin Morgenstern - 2M ago

Last week, I discussed the reasons that I believe that tramadol is a bad drug that shouldn’t be prescribed. This week, I will tackle a similarly bad drug: codeine. The argument is essentially the same. Tramadol may be moderately worse, because of the added SNRI effects, but the variable effects of codeine make it a […]

The post Don’t prescribe codeine appeared first on First10EM.

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First10EM by Justin Morgenstern - 2M ago

I have never prescribed tramadol. I was taught that, for a variety of reasons, it’s an awful drug. In Canada, everyone seemed to agree. But then I moved to New Zealand. During my orientation in New Zealand I was told that, unlike North America, very few patients were on opioids. However, over my first few […]

The post Don’t prescribe tramadol appeared first on First10EM.

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Status epilepticus is associated with a high degree of morbidity and mortality. Approximately ⅓ of patients have long term neurologic sequela, and mortality is 3-5%. (Chin 2006; Raspall-Chaure 2006) First line treatment is with benzodiazepines, but benzos will fail approximately 30-40% of the time. (Appleton 2008) Therefore, an effective second line agent is essential. Despite […]

The post Levetiracetam versus Phenytoin in Status Epilepticus (ConSEPT and EcLiPSE) appeared first on First10EM.

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