There are some things that we seem to do reflexively in the ED. Giving steroids to a patient with an asthma exacerbation is one of those things. Ask yourself the following question. Why do we do this? What is the evidence behind it? Can you cite any of the studies that lead to this common practice? I couldn’t fully elaborate [...]
Once in a while you'll see a child with a chronic cough. Even in the absence of a compelling history - and let's face it, the history cupboard is often bare - it is important to consider the possibility of an inhaled foreign body. Thinking about the possibility of a bronchial foreign body got me thinking about the indications for [...]
High Flow, High Flow, it's off to work we go. Let's give some CPAP and… stop singing. OK, anyway, as a follow up to yesterday's article on standard oxygen therapy I wanted to dive into High Flow. It entails the delivery of heated and humidified oxygen via special devices (eg, Vapotherm®) providing up to 8 L/min in infants and up to [...]
As a prelude to a more detailed post on high flow (coming tomorrow) I thought that it would be a good idea to brush up on standard oxygen delivery devices and techniques - you know, the ones we use every day. Blow-by Temporary O2 delivery Oxygen tubing, corrugated tubing, or simple mask held at a short distance from the child's face [...]
Ever wonder why we give nebulized albuterol in the ED instead of a metered dose inhaler? Haven't you heard form a colleague that "4 to 6 puffs is equivalent to a neb." Perhaps some of this is convention, but there is evidence behind it. In an oldie but goodie form 1993 Idris et al performed a RCT to compare an [...]
