Start with a free trial account for free content every month. Already a subscriber? Sign in.

EM:RAP 2018 August Mailbag

Jan Shoenberger, MD and Stuart Swadron, MD, FRCPC
00:00
06:40
Sign in or subscribe to listen

No me gusta!

The flash player was unable to start. If you have a flash blocker then try unblocking the flash content - it should be visible below.

Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
00:00
00:43

No me gusta!

The flash player was unable to start. If you have a flash blocker then try unblocking the flash content - it should be visible below.

EMRAP 2018 08 August Vol.18 Written Summary 658 KB - PDF

To view chapter written summaries, you need to subscribe.

Sign up today for full access to all episodes.

Patrick B. -

Ouch! Shots fired! :P

I am sorry if the listener disliked the poison ivy episode, but let's look at a few points the listener made:

1) the data is of lower quality than what is typically in EMRAP.
I started off by saying the evidence was based off a small study; and while it was not JAMA, there are many topics covered on this program that are not particularly based off much data - only glimpses into the mind of the great podcasters (like, say, Reuben waxing about Morphine IR, or, well, just about everyone talking push dose pressors... or the data on methotrexate toxicity... or even physician wellness!– not great data on any of these things, but they are discussed!) … If EMRAP only discussed items entrenched in solid evidence & well designed trials, this would be a much, much shorter podcast. Likewise, EMA actually discusses "food for thought" papers like this with some regularity.

2) The idea that we should let a disease run its course when potentially better options are available.
Are we not all subscribers to this fine podcast to improve our care across the entire spectrum? If our junk gets poison ivy, do you *really* want to have to come back to the ED more than once? I also get that I probably should have mentioned considering doing a fingerstick prior to starting steroid tapers in select patient populations. One reason I really enjoy recording for EMRAP is to cover the non-resus stuff that we see all the time and thus we can improve the entirety of our EM game, as I'm sure EMRAP has many listeners who cover the spectrum of ED care, from fast track rashes at 2pm to the resus room at 3am plus everything in between. We should take pride in giving our all to each and every one of them, making the best judgements we can make with imperfect data..... thus, I thought it was only fair to provide better care to something we may see regularly during the summer outside of resus.

Also, for what its worth, in two out of three trials looking at steroids vs anti-histamines, steroids won, with the exception of one trial (with that one trial excluding 80% of patients) – and none of these trials explicitly looking at poison ivy.

Ultimately, I probably should have closed with offering some sort of shared decision making to the tune of, “you have a higher chance of resolving this faster without the need for additional medications with longer courses of steroids, but with a theoretical increased risk of side effects like an increased glucose level, etc. …. so tell me sir/madam, how bad is this rash bothering your junk?”

https://www.ncbi.nlm.nih.gov/pubmed/7486360
https://www.ncbi.nlm.nih.gov/pubmed/8869688
https://www.ncbi.nlm.nih.gov/pubmed/28476259

Thanks for the input & thanks for listening!
Patrick

To join the conversation, you need to subscribe.

Sign up today for full access to all episodes and to join the conversation.

To download files, you need to subscribe.

Sign up today for full access to all episodes.
EM:RAP 2018 August Full episode audio for MD edition 211:59 min - 295 MB - M4AEM:RAP 2018 August German Edition Deutsche 92:18 min - 127 MB - MP3EM:RAP 2018 August Aussie Edition Australian 2:27 min - 3 MB - MP3EM:RAP 2018 August Canadian Edition Canadian 14:57 min - 21 MB - MP3EM:RAP 2018 August French Edition Français 26:58 min - 37 MB - MP3EM:RAP 2018 August Spanish Edition Español 79:40 min - 109 MB - MP3EMRAP 2018 08 August Individual MP3 272 MB - ZIPEMRAP 2018 08 August Individual Summaries 935 KB - ZIPEMRAP 2018 08 August Vol.18 Written Summary 658 KB - PDFEM:RAP 2018 August Spanish Written 829 KB - PDFEMRAP Board Review Answers 2018 08 Aug Vol.18 08 284 KB - PDFEMRAP Board Review Questions 2018 08 Aug Vol.18 08 809 KB - PDF

To earn CME for this chapter, you need to subscribe.

Sign up today for full access to all episodes and earn CME.

6 AMA PRA Category 1 Credits™ certified by CEME (EM:RAP)

  1. Complete Quiz
  2. Complete Evaluation
  3. Print Certificate