Drugs that Work and Drugs that Don’t
Ultimately, there is still great latitude to practice the art of medicine. However, my goal is to challenge many commonly accepted practices that are potentially harmful, are expensive, create operational inefficiency, or simply just don’t work - Kevin M. Klauer DO
image by: HWN
HWN Suggests
Myths in Emergency Medicine
As much as we claim to be scientists and practice with evidence as our guide, much of the care that is delivered in emergency departments comes from folklore. We have all—present company included—practiced in ways we absolutely believed to be best practice only to find out later that we may have been wrong. Hey, you don’t know what you don’t know.
There is great value in learning from great educators. However, we can get lost in the “greatness” of our mentors. Many edicts in medical education were taught to those we trust today by those whom they trusted yesterday. Once a learned, respected colleague states a “fact” with confidence, it often becomes unchallenged evidence and is passed…
Articles of Interest
Beta-Blockers for Cocaine and other Stimulant Toxicity
Rather than snow him with benzos, I suggested metoprolol, a lipophilic beta-1 blocker with both peripheral and central nervous system effects. Her response to this was, “Oh no, you can’t do that – what about unopposed-alpha stimulation?” It was at this point I realized the level of misinformation regarding this dogma had become so pervasive, that newly-minted physicians were applying it as an absolute contraindication to beta-blocker treatment for all stimulants.
Calcium, Digoxin Toxicity and ‘Stone Heart’ Theory
Administration of intravenous calcium has traditionally been considered a contra-indication for the treatment of hyperkalemia in the presence of digoxin toxicity.
Drop the Dogma: Is it Time to Use Epinephrine for Digital Nerve Blocks?
If you are like me you have been trained to not use epinephrine in digital nerve blocks. As a matter of fact I was taught NEVER to use epinephrine for regional nerve blocks involving the, “fingers, ears, toes, nose, and hose.” The fear is that the use of epinephrine will cause vasoconstriction and ultimately cause necrosis of tissue distally, due to the lack of collateral blood flow. This belief has been passed down from generation to generation of medical providers and quite honestly been accepted most likely because it makes physiological sense, but needs to be seriously challenged. Using epinephrine in digital nerve blocks may benefit patients by speeding up onset and helping prolong the effect of anesthesia.
EM Drugs that Work and Drugs that Don’t Part 2 – Antiemetics, Angioedema, Oxygen
Justin Morgenstern and Joel Lexchin discuss the evidence for various antiemetics like metoclopramide, prochlorperazine, promethazine, droperidol, ondansetron, inhaled isopropyl alcohol and haloperidol as well as why should not use an antiemetic routinely with morphine in the ED. We then discuss the evidence for various drugs options for a potpourri of true emergencies like angioedema and hyperkalemia, and wrap it up with a discussion on oxygen therapy…
EM Drugs That Work and Drugs That Don’t – Part 1: Analgesics
In this podcast we discuss the key concepts in assessing drug efficacy trials, and provide you with a bottom line recommendation for the use of gabapentinoids, NSAIDs and acetaminophen for low back pain and radicular symptoms, topical NSAIDs and cyclobenzaprine for sprains and strains, caffeine as an adjunct analgesic, why we should never prescribe tramadol, dexamethasone for pharyngitis, calcium channel blockers for hemorrhoids and anal fissures, buscopan for abdominal pain and renal colic and why morphine might be a better analgesic choice than hydromorphone…
Low-Dose Aspirin Late in Life? Healthy People May Not Need It
Taking it did not lower their risks of cardiovascular disease, dementia or disability. And it increased the risk of significant bleeding in the digestive tract, brain or other sites that required transfusions or admission to the hospital.
Mythbusting the Banana Bag
The rationale behind ordering banana bags for these patients is relatively simple–alcoholics are likely to have nutritional deficiencies related to their dietary preferences for alcohol over nutrient-dense foods, putting them at risk for complications. Furthermore, the administration of fluids is conventionally believed to help speed up sobriety. But it seems the combination of these components may be unnecessary, let’s break it down piece by piece:
Phenylephrine Decongestant
Why is oral phenylephrine so useless? It is extensively metabolized, starting in the gut wall. You can find a bioavailability figure of 38% in the literature, but that appears to be the most optimistic number possible, and you can also find studies that show 1% or less.
Physostigmine Doesn't Live Up to Its Unsafe Reputation
The use of physostigmine had virtually disappeared by the 1990s, and the Association of United States Poison Centers reported in 1997 that only two percent of more than 7,000 patients treated that year for anticholinergic toxicity received physostigmine. What happened? First off, the clinical abandonment of physostigmine was somewhat surprising because it is one of the most effective and specific antidotes.
Three Reasons Not to Use Normal Saline or Crystalloids in Trauma
The goal of this article is to illustrate the many deficiencies of administering NS in a trauma patient, and to encourage critical thinking regarding current fluid resuscitation strategies that discuss increasing support for the use of blood components, including whole blood (WB).
Resources
You can’t overdose on fentanyl by touching it
The myth that you can, however, is genuinely dangerous.
