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Paper Chase 5 – A Case of Steroids Not Helping

Sanjay Arora, MD and Mike Menchine, MD
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03:59
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Nurses Edition Commentary

Mizuho Spangler, DO, Lisa Chavez, RN, and Kathy Garvin, RN
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00:44

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EM:RAP 2016 August Written Summary 819 KB - PDF

In patients  with Cryptococcal Meningitis, adjunctive dexamethasone caused worse clinical outcomes compared with placebo

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Steve D. -

I appreciate getting to review this paper, but I'm not sure how much you can extrapolate it to the ED. Is one dose of dexamethasone in the ED similar to 6 weeks of treatment like in this trial? Even if the dexamethasone is continued to 1-2 days waiting for culture results, it still likely doesn't have the same risk profile of 6 weeks of steroids. I'm not an expert in the literature on this topic by any means, but I don't think there has been harm shown in the studies of dexamethasone in patients with presumed bacterial meningitis.

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Can You Pick Your Friend's Nose? Full episode audio for MD edition 260:32 min - 363 MB - M4AEM:RAP 2016 August German Edition Deutsche 78:23 min - 108 MB - MP3EM:RAP 2016 August French Edition Français 35:54 min - 49 MB - MP3EM:RAP 2016 August Aussie Edition Australian 29:08 min - 40 MB - MP3EM:RAP 2016 August Canadian Edition Canadian 26:55 min - 37 MB - MP3EM:RAP 2016 August Spanish Edition Español 73:36 min - 101 MB - MP3EM:RAP 2016 August Board Review Answers 285 KB - PDFEM:RAP 2016 August Board Review Questions 246 KB - PDFEM:RAP 2016 August Written Summary 819 KB - PDFEM:RAP 2016 August Individual MP3 Files 308 MB - ZIPEM:RAP 2016 August El Resumen Escrito en Español 2 MB - PDF

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