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Myths in Emergency Medicine

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Christopher Wesselman

on 12 November 2014

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Transcript of Myths in Emergency Medicine

40 yo, trapped under garbage truck, prolonged extracation
29 yo M, arm pain
GW Grad Student
- Drinkin' & Arm Wrestlin'
24 yo F, 10wks preg
- Vaginal bleeding, spotting after MVC
- type O negative

When do we need to give Rhogam?
20 yo F
Vaginal discharge, CMT
30yo M
Flew back from Singapore 4d ago
Crampy abdominal pain
4-5 loose, watery stools
Myths in Emergency Medicine
Sing Sing Prison Warden Wilfred Dinno
- worried a 24hr follow up between would encourage an escape attempt
- made researchers return after 72hrs

Rhogam must be given within 72h
"Rh0 (D) immunoglobulin protects against Rh isoimmunization if given within
72 hours
of fetomaternal hemorrhage."- Tintinalli Ch 253
(aka: Holstein-Lewis Fracture)
give NSAIDs for an acute fracture, it will inhibit bone growth."
Anesthesiology, 2003
When cricoid applied:
-90.5% of cases the oesophagus was displaced
- 66.7% of cases, cricoid resulted in lateral laryngeal compression
-81% resulted in AIRWAY COMPRESSION
Analgesia & Anesthesia, March 2014
-79 pt, could not pass a GT with 30N of CP
- 100% successful???
Combative, you decide to intubate...
Upgrade to trauma yellow...
In rushes the Anesthesia team..
Lancet, 1961
"In the cadaver it was found that when the stomach was filled with water and firm pressure was applied to the cricoid","a steep Trendelenburg tilt did not cause regurgitationof fluid into the pharynx."
2010 ACLS
"Seven randomized studies showed that cricoid pressure can delay or prevent the placement of an advanced airway and that some aspiration can still occur despite application of cricoid pressure."
Emergency Medicine Journal, 2013
Cricoid pressure in emergency rapid sequence induction
60 cc syringe full of air to about the 38 cc mark will equate to about 40 N
"It is concluded that although there is a theoretical advantage to providing cricoid pressure during induction, there is little evidence of any benefit at this time."
"The balance of evidence in the available literature appears to suggest that a short-duration NSAID regimen is a safe and effective supplement to other modes of post-fracture pain control, without a significantly increased risk of sequelae related to disrupted healing"
Kurmis, et al. 2012
The effect of nonsteroidal anti-inflammatory drug administration on acute phase fracture-healing: a review
, Shellfish, Gainful Employment
"There is 10% cross-reactivity between Penicillin and Cephalosporins"
"An investigation of a variety of potential penicillin and cephalosporin antigens by skin prick tests in patients with a history suggesting allergy to penicillin and in control subjects is described. There was an association between skin reactivity to penicillin and cephalosporium mycelial extracts and to A. fumigatus but not to penicillins, cephalosporins or PPL"
Dash, C H . "Penicillin allergy and the Cephalosporins".
Journal of Antimicrobial Chemotherapy (0305-7453), 1 (3 suppl), 107.
PMID: 1201975
Campagna JD, Bond MC, Schabelman E, Hayes BD.
"The use of cephalosporins in penicillin-allergic patients: a literature review".
The Journal of Emergency Medicine (0736-4679), 42 (5), 612
27 Articles
Apter 2006
Retrospective study of 534,810 patients who received a prescription for penicillin followed by cephalosporin; 3920 reported an allergic event to penicillin, and 43 of them also reported a reaction to a cephalosporin
"Is there cross-reactivity between penicillins and cephalosporins?" Am J Med 2006;119: 354:e311–20
64% were first-generation antibiotics
Rx for Cipro

Rx for Loperamide
give antimotility agents to infectious diarrhea. Diarrhea is the body's way of expelling the bacteria. If you give loperamide, it will keep the toxins & badness in and the patient will DIE!!!"
Ann Internal Med, 1993
Ciprofloxacin and Loperamide in the Treatment of Bacillary Dysentery
Gerald S. Murphy, MD; Ladaporn Bodhidatta, MD; Peter Echeverria, MD; Somsit Tansuphaswadikul, MD; Charles W. Hoge, MD; Somchai Imlarp, BSc; and Kazumichi Tamura, MD
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