Articles by Kevin Klauer, DO, EJD
Although we used to have any drug we needed at our fingertips
(regulatory interference notwithstanding) today we don’t. So, what has
changed? Have they run out of the rare “zine” compound that is needed to
make Compazine, or the “tron” in ondansetron? Hardly! We can only order
what the pharmaceutical companies are willing and able to produce.
The FDA-approved drug dabigatran is being marketed as a safe alternative
to Coumadin. But without a proven reversal agent available, it has the
potential to create a new set of complications, and send unsuspecting
patients right back to the ED.
At the ACEP Scientific Assembly this year, I spoke to a group of
physician assistants and advanced practice nurses. I gained many
insights into the uniqueness of their role and their place in Emergency
Medicine. The first thing I learned was that terminology is evolving as
their training and scope of practice is evolving.
Rolling in like a Trojan horse, CMS is proclaiming that its new ramped
up benchmarking efforts are primarily motivated by efforts to improve
quality. In reality, they are really focused on cost-reduction.
Managing diabetes, in particular DKA, is a staple in the practice of
emergency medicine. The pancreas hasn’t changed since we discovered that
it secreted insulin. So, the treatment has no reason to change either.
Want to save the healthcare system time and money? Forget the
follow-up and make the emergency department the last stop for a range of
simple injuries. First up: broken toes.
Are you ready for an acute inflammatory mediator for sepsis that is consistent and works just as we’d expect it to? Well, it’s here: procalcitonin. Or is it? It can certainly claim that it works just as well as former acute phase reactants and inflammatory mediators. But these predecessors all suffer from a similar, critical problem - they are somewhat sensitive but not very specific.
A 76-year-old man was diagnosed with appendicitis and placed on
levofloxacin, 300 mg/day for two weeks, post-operatively. At seven days,
he developed bilateral Achilles’ tendon pain. At day 14, the tendons
began to swell, and four days later they both spontaneously ruptured
while putting his pants on.
When contemplating the potential complications of a sore throat, it’s
time to consider more than the usual suspects. Lemierrie’s syndrome
might not be the zebra you thought it was.
If you want to read a medical fairly tale, pick up an older textbook and read the chapter on lumbar punctures. Although you won’t read about unicorns or dragons, some of the recommendations are no less mythical. Let’s take a shot at disproving these myths with a silver bullet of truth.
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