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Community Medicine Rants – Stuff We Do

Al Sacchetti, MD
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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
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EMRAP 2019 04 April Written Summary 439 KB - PDF

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Dallas Holladay, DO -

I have had similar success with infant LPs. I do not use lidocaine before needle insertion on neonates because the actual introduction of lidocaine into the tissues requires a needle stick comparable to the LP needle followed by the discomfort of the injection. Comparing that to simple introducing the needle and completion of the procedure in the same amount of time it would take me to place anesthetic with half the sticks makes more sense to me. I do use glucose solution which helps immensely.

Alfred S., M.D. -

You are correct it is two needle sticks, however the infant only feels the first one and it is done with a 27 gauge needle. That needle need only be in the general area of the LP site, so it can be inserted quickly. When it comes time to place the spinal needle you can be more precise, enter the skin slowly and the child is not going to squirm as much.

Ross B. -

how many times and for how often do you guys recommend the bleach baths?

Alfred S., M.D. -

I just recommend one bath per infection. Will repeat with each recurrent infection.

Emergency NP -

An inexpensive regimen of dilute bleach baths, intranasal mupirocin, and hygiene education effectively eradicated S. aureus over four months. High rates of recurrent SSTI suggest factors other than endogenous colonization as important determinants of infection.
ref:
Fritz SA, Camins BC, Eisenstein KA, et al. Effectiveness of measures to eradicate Staphylococcus aureus carriage in patients with community-associated skin and soft-tissue infections: a randomized trial. Infect Control Hosp Epidemiol. 2011;32(9):872–880. doi:10.1086/661285

Alfred S., M.D. -

I'll take 4 months without MRSA.

Megan R. -

I cringed a little with the one-size-fits all rocuronium followed by sugammadex if needed to reverse recommendation. Sugammadex binds to rocuronium and, to a lesser, extend, vecuronium. While doesn't cause the muscarinic side effects typically associated with the administration of acetylcholinesterase inhibitors, there are A LOT serious adverse effects: bradyarrythmias (even cardiac arrest), residual/rebound neuromuscular blockade, anaphylaxis and transient anti-coagulant effect, among others. This drug had so many safety concerns it took 8 years and several additional studies to be approved by the FDA. In my humble opinion, it's only role in the ED should be for the "can't intubate, can't ventilate" patient requiring urgent roc reversal.

Megan Rech, PharmD, MS, BCCCP

Alfred S., M.D. -

Rocuronium really should only be needed in the ED for those "can't intubate, can't ventilate" circumstances or possibly in a patient in whom an immediate neuro assessment is needed.

Kenneth D., D.O. -

Thanks for the LET tip. I do use lidocaine with epinephrine the same way, but it takes too long. Hadn't thought about LET.

Alfred S., M.D. -

Thanks, try it, you’ll like it.

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EM:RAP 2019 April Full episode audio for MD edition 224:11 min - 312 MB - M4AEM:RAP 2019 April Spanish Edition Español 90:50 min - 125 MB - MP3EM:RAP 2019 April German Edition Deutsche 98:37 min - 135 MB - MP3EM:RAP 2019 April Canadian Edition Canadian 28:51 min - 40 MB - MP3EM:RAP 2019 April Aussie Edition Australian 25:30 min - 35 MB - MP3EM:RAP 2019 April Farsi Edition Farsi 98:02 min - 135 MB - MP3EM:RAP 2019 April French Edition Français 20:25 min - 28 MB - MP3EMRAP 2019 04 April Board Review Answers 131 KB - PDFEMRAP 2019 04 April Board Review Questions 590 KB - PDFEMRAP 2019 04 April Individual MP3 Files 262 MB - ZIPEMRAP 2019 04 April Individual Summaries 693 KB - ZIPEMRAP 2019 04 April (SPA Summary) 712 KB - PDFEMRAP 2019 04 April Written Summary 439 KB - PDF

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