EM:RAP and AIR (Toxicology) (June 2020)
AIR: https://www.aliemu.com/courses/trauma-2020/
EM:RAP for Asynchronous Learning! For credit, first, listen to the entire podcast. Your participation in the discussion board here is your attestation that you have listened and engaged with the content in a meaningful way.
https://www.emrap.org/episode/emrap2019may/emrap2019may2
When you have finished listening to the podcast, answer the following questions:
1. Please list three things you learned from this podcast that you were not aware of before.
2. Are there any areas of your practice that you would change after listening to this podcast? If so, what would you do differently?
3. What topics mentioned in this podcast is considered too “bleeding edge” (ex. too new, lacks enough evidence, not ready for prime time). Are there any practices mentioned in this podcast that you would consider to not be applicable to our practice setting here at BMC?
One comment
1. I hadn’t heard of discharging patients with IR morphine; my practice has been to use oxycodone or oxycodone-APAP typically. Similar to prior segments on high-sensitivity troponin, I learned a lot about how to actually implement them (i.e. 1 negative HS troponin is all that’s required after 3 hours of pain, or a delta trop in 1 hour). I also found the review of pediatric rashes very helpful after the normal/not-normal infant findings from last month’s episode. This is not something we see a lot in our training, and I will be seeing a lot of kids at my new job (and not working under a pediatric-trained physician), so the review is very timely for me.
2. The segment with variceal GI bleeding raised some great points. I will be sure to emphasize antibiotic prophylaxis (after blood product resuscitation) for the mortality benefit. We’re always happy to give a PPI and start an ocreotide infusion, but those interventions do not have patient-centered outcomes or mortality benefit, so it’s important to be clear about the order of precedence of interventions. The part about all of the human-derived products like PCC also being contraindicated by typical Jehovah’s witness patients was a good reminder that not just component blood therapy has to be discussed with the patient and we have to have treatment plans that do not include these other products.
3. Also regarding the GI bleeding segment, I’m not sure about TXA as a recent trial (I believe also released this month) does not support its use in GI bleeding, and I’m also not sure about routinely giving vasopressin based on a theoretical benefit without further research or having exhausted other interventions.