I really liked the tips for creative uses of nasal cannula. I did want to comment on one use - for drying tissue glue.
As I understand it, cyanoacrylates like Dermabond harden with a chemical reaction that can be accelerated by heat, but in theory not with dry air. I bet the nasal cannula will dry the site effectively before application, which is necessary for the glue to work. Actually, high flow oxygen may cool the site and slow down the reaction while it hardens.
I have heard that you can speed up the hardening reaction by using a warm exam light to warm up the glue immediately after application. One down side is it seems to increase the burning sensation that can happen as the glue hardens.
International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Abstract A Panel of International Experts was convened by the Infectious Diseases Society of America (IDSA) in collaboration with the European Society for Microbiology and Infectious Diseases (ESCMID) to update the 1999 Uncomplicated Urinary Tract Infection Guidelines by the IDSA. Co-sponsoring organizations include the American Congress of Obstetricians and Gynecologists, American Urological Association, Association of Medical Microbiology and Infectious Diseases-Canada, and the Society for Academic Emergency Medicine. The focus of this work is treatment of women with acute uncomplicated cystitis and pyelonephritis, diagnoses limited in these guidelines to premenopausal, non-pregnant women with no known urological abnormalities or co-morbidities. The issues of in vitro resistance prevalence and the ecological adverse effects of antimicrobial therapy (collateral damage) were considered as important factors in making optimal treatment choices and thus are reflected in the rankings of recommendations.
Comment in Trimethoprim-sulfamethoxazole may no longer be acceptable for the treatment of acute uncomplicated cystitis in the United States. [Clin Infect Dis. 2011]
Looking at: International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases.
The first ranked choice for uncomplicated cystitis was nitrofurantoin. Second ranked choice was TMP/SMX if suseptibility to Ecoli was less than 20%
Our local antibiogram showed ecoli with 15% resistance to TMP/SMX, so after hearing your podcast I was surprised to see that our local guide to Antimicrobial therapy for adults recommended nitrofurantoin as first line, and didn't even have TMP/SMX in the top 3. (I am by no means an expert in ID, in fact I am just a lowly medical student interested in EM and would love to hear your thoughts on this topic, and how to weigh this evidence, especially considering the comments about the acceptability of TMP/SMX and its rate of growth in resistance above by Ricky G.)
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Michael B. - December 6, 2013 8:14 AM
I really liked the tips for creative uses of nasal cannula. I did want to comment on one use - for drying tissue glue.
As I understand it, cyanoacrylates like Dermabond harden with a chemical reaction that can be accelerated by heat, but in theory not with dry air. I bet the nasal cannula will dry the site effectively before application, which is necessary for the glue to work. Actually, high flow oxygen may cool the site and slow down the reaction while it hardens.
I have heard that you can speed up the hardening reaction by using a warm exam light to warm up the glue immediately after application. One down side is it seems to increase the burning sensation that can happen as the glue hardens.
Ricky G - January 2, 2014 10:14 AM
International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases.
Abstract
A Panel of International Experts was convened by the Infectious Diseases Society of America (IDSA) in collaboration with the European Society for Microbiology and Infectious Diseases (ESCMID) to update the 1999 Uncomplicated Urinary Tract Infection Guidelines by the IDSA. Co-sponsoring organizations include the American Congress of Obstetricians and Gynecologists, American Urological Association, Association of Medical Microbiology and Infectious Diseases-Canada, and the Society for Academic Emergency Medicine. The focus of this work is treatment of women with acute uncomplicated cystitis and pyelonephritis, diagnoses limited in these guidelines to premenopausal, non-pregnant women with no known urological abnormalities or co-morbidities. The issues of in vitro resistance prevalence and the ecological adverse effects of antimicrobial therapy (collateral damage) were considered as important factors in making optimal treatment choices and thus are reflected in the rankings of recommendations.
Comment in
Trimethoprim-sulfamethoxazole may no longer be acceptable for the treatment of acute uncomplicated cystitis in the United States. [Clin Infect Dis. 2011]
Ricky G - January 2, 2014 10:16 AM
Macrodantin 100bid X 5d was felt to be equally efficacious with less side effects and is recommended for uncomplicated cystitis over bactrim
Casey W. - March 17, 2014 6:09 PM
Looking at: International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases.
The first ranked choice for uncomplicated cystitis was nitrofurantoin.
Second ranked choice was TMP/SMX if suseptibility to Ecoli was less than 20%
Our local antibiogram showed ecoli with 15% resistance to TMP/SMX, so after hearing your podcast I was surprised to see that our local guide to Antimicrobial therapy for adults recommended nitrofurantoin as first line, and didn't even have TMP/SMX in the top 3. (I am by no means an expert in ID, in fact I am just a lowly medical student interested in EM and would love to hear your thoughts on this topic, and how to weigh this evidence, especially considering the comments about the acceptability of TMP/SMX and its rate of growth in resistance above by Ricky G.)