PEM Review 004 – May 12th 2015

Quite a bit about drugs and prescribing this week – plus plenty more interesting bits and pieces if you don’t want to dive right in with pharmacology 😉

ESR // MEDS IQ // STICKY EYES // OBESITY // TONGUE TIE // TRAUMA // LARYNGOMALACIA

PEMgeek3

@PEMgeek

rouleaux_form               1. ESR: A USER’S GUIDE Archives Education and Practice (@ArchivesEandP) have published this piece (free full text) telling you everything you ever wanted to know about ESR as a blood test (lots of useful facts which will help your clinical practice, plus lots of ‘lab nerd’-level information to satisfy your inner geek). My personal highlights – Why ESR is superior to CRP in monitoring chronic conditions; which rheumatological diseases are NOT associated with a raised ESR; which environmental/sample handling conditions could give you an unreliable result.

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _  Home    2. If you are a UK paeds trainee, you need to know about the MEDS-IQ project, which was unveiled at the recent RCPCH conference. It aims to improve our paediatric prescribing practices and reduce the incidence of drug errors, through providing e-learning and sharing QI project experiences. It’s really worth looking through some of the QI project reports – you might find something to inspire a project of your own… here is one that caught my eye…

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Sticky Eyes Pressure Relief Toy - White + Black (2 PCS)        3. STICKY EYES different ages, different causes (and don’t forget to think about foreign bodies – get the fluorescein out!) St Emlyns (@stemlyns) have a straightforward run-through of how to manage this common problem and as a bonus there is also a short vodcast from Natalie May (@_NMay) to reinforce the key points.

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 fat          4. DRUG DOSING: OVERWEIGHT CHILDREN Clear and concise pointers  from ‘don’tforgetthebubbles’ @TessaRDavis, guiding you on how to adapt your prescribing practices for overweight children. A little bit of basic pharmacology, with explanations of how to prescribe the commonly used categories of drugs (antibiotics, analgesia, anticonvulsants).
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tt        5. TONGUE TIED?  Parents of a newborn baby who is slow to breastfeed are often concerned about the possibility of a tongue-tie, and certainly the midwives I’ve worked with seem to get very concerned if they detect one. But does a tongue-tie really affect a baby’s ability to breastfeed? And if so should it be surgically treated (frenotomy)? This systematic review (@AmerAcadPeds) concluded that there was a low level of evidence to support frenotomy (but it may be associated with a mother-reported improvement in breastfeeding). This OTHER systematic review focused on non-breastfeeding outcomes (speech etc) but again found no conclusive evidence of definite benefit – partly because so little is known about the natural history of untreated tongue-tie.

See also this Fifteen minute consultation in @ADC_BMJ (may need to log in via Athens). Clearly a topical and controversial issue!

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iv        6. VANCOMYCIN – A MISSED OPPORTUNITY? So apparently in critically ill adults, a vancomycin loading dose is commonly given..? (can’t personally vouch for this as it’s been a few years since I treated a regular-sized human). This is not current practice in paediatrics. In this recent post, the folks at ALIEM (@ALIEMteam) review the evidence of the risks and benefits of giving a loading dose of vancomycin to paediatric patients. Practice may yet change, if there is further data to support the PAVED study.

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Blood-                   7. TRAUMA AND TXA: A quick read: this month’s @paedspearls has a useful short article summarising the evidence for using tranexamic acid in major paediatric trauma (TXA has been proven to reduce mortality in adult trauma). The RCPCH has produced a statement which cautiously supports its use.

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ laryn                 8. LARYNGOMALACIA I found these three clips  last week when I looking for videos to show to a new SHO who had never seen laryngomalacia before. (1 – while crying, 2 – while feeding, 3 – at rest) If you are looking for a parent information sheet, this one from Minnesota Childrens Hospital is quite clear and simple.

That’s it for this week – feel free to drop me a line if you have any new #FOAMed/#FOAMped resources that deserve to be shared with the world.

@PEMgeek

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