15 04, 2014

Understanding Phenytoin Equivalents

By |April 15th, 2014|Tox & Medications|0 Comments

fosphenytoin image 1 (1)Sometimes, in an effort to make things simpler, we actually make them more confusing. Such is the case with phenytoin equivalents. 

Fosphenytoin is a water-soluble prodrug of phenytoin. After IV administration, much of the fosphenytoin is metabolized to phenytoin within 15 minutes. Advantages over phenytoin include the option for IM administration and less cardiotoxicity allowing for faster infusion rates. Even the potential for hyperphosphatemia from the release of phosphate is generally inconsequential. 

14 04, 2014

Neuraminidase Inhibitors for Influenza – The Truth, The Whole Truth, and Nothing But the Truth Finally

By |April 14th, 2014|Infectious Disease, Tox & Medications|7 Comments

InfluenzaOver the last 5 years, the use of neuraminidase inhibitors for the treatment of influenza has skyrocketed. Emergency physicians have been pushed to prescribe these medications under the belief that they reduced symptoms, the risk of complications, hospitalizations, and transmission. However, the recommendation for the use of these drugs has never sat on firm evidence-based ground. So what did we know then, and what do we know now?

12 04, 2014

Behaviorism: Is punishment or reward more effective in education?

By |April 12th, 2014|Medical Education|4 Comments|Tags:

Behaviorism_2Every person involved in teaching and learning has a philosophy on how people learn. Implicitly, explicitly, legitimate or not this mental construct of learning affects the way they impart instruction and assess learning. One of the oldest and most commonly used educational theory of learning is behaviorism.

11 04, 2014

PEITHO Trial: Fibrinolysis for Intermediate-Risk Pulmonary Embolism

By |April 11th, 2014|Cardiovascular, Expert Peer Reviewed (Clinical), Pulmonary, REBEL|18 Comments|Tags:

What-is-a-Pulmonary-EmbolismExpertPeerReviewStamp2x200Most of us would agree that massive PE is treated with fibrinolysis and non-massive PE is treated with anticoagulation. The area of great debate has been the optimal treatment for sub-massive PE. The MOPETT Trial was published in January 2013 and although the patient population was small, it did show a huge benefit in pulmonary pressures at 28 months with fibrinolysis. The next study we have all been waiting for is the Pulmonary Embolism Thrombolysis (PEITHO) trial, which was just published yesterday in the NEJM, evaluating fibrinolysis for patients with intermediate-risk PE.

10 04, 2014

Top 10 reasons NOT to order a CT scan for suspected renal colic

By |April 10th, 2014|Expert Peer Reviewed (Clinical), Genitourinary, Radiology|6 Comments

CT_Scanner_01.jpg2d5efea2-a1b7-4c15-848e-4d6c5567eecfLargerExpertPeerReviewStamp2x200It appears that the excitement and utilization of computed tomography (CT) imaging in the emergency department (ED) has far outpaced our concern for the short- and long-term consequences of increased reliance on this technology. CT has greatly supplemented, or even replaced, our clinical decision making for many chief complaints.  Many articles document the dramatic increased CT use in contemporary practice, including a 330% increase in the rate of CT imaging from 1996 to 2007. The likelihood of a CT order being part of any ED encounter now approaches 15%, with no signs of decline (1).