PEM review 017: ANTIBIOTIC RESISTANCE // CONSENT // INJURIES // H.U.S // NIGHTS

cropped-pemgeek32.jpg

Happy new year! 2015 was a busy one for this new blog – over 15,000 hits from 120 different countries – unbelievable 🙂 Thank you to everyone who has visited, commented, contributed, and welcomed me to the FOAMed community. In 2016 you will be seeing more of the popular PEM Reviews, but also a variety of other posts; always happy to take feedback and suggestions of what you’d like more of. Onwards!

abx       1.  MIND YOUR LANGUAGE

As doctors we know that antibiotic resistance is increasing, and it threatens lives every day. However… the Wellcome Trust’s fascinating (terrifying) report on attitudes to antibiotics shows that patients’/parents’ understanding of ‘antibiotic resistance’ is pretty poor – (commonly patients believe the person – and not the bacteria – becomes resistant, meaning they are less likely to complete a course of antibiotics). After looking at the language doctors use to talk about the problems, and the gap in patient understanding of the issues, the Wellcome Trust has now stopped using the phrases ‘antibiotic resistance’ and ‘superbug’ and instead refers to ‘drug resistant infections’ and focuses on the threat to the individual patient, not the public health effects, in its communications to the general public. Maybe this is a new year’s resolution we could all get on board with.

consent        2.  DEFERRED CONSENT

Deferred consent is a reasonably new concept in the UK, which has made  important paediatric emergency care research possible (e.g. CATCH trial, ECLIPSE trial). But the thought of taking consent from parents ‘after the fact’ instinctively makes many of us feel a bit uncomfortable – so it is really interesting to read the parents’ views in this study.

scalp    3.  ED HACK

A very neat trick from @stemlyns for bandaging the scalp – ideal for protecting scalp sutures and holding dressings in place. Looking forward to seeing if this passes the toddler-test!

 

HUS       4. HAEMOLYTIC-URAEMIC SYNDROME

HUS is diagnosed by a triad of haemolytic anaemia, low platelets and acute renal failure, following a recent E-Coli D+V illness (stools classically bloodstained, but not always). Uncommon, but one not to miss in your differential diagnosis, as the management is supportive but very complex – get nephrology and PICU involved as soon as it is suspected, and think carefully before giving any antibiotics… Thank you for the comprehensive review @drewlong2232 and @long_brit

 

pillbaby.jpg    5. RUNNING ‘AMOX’ WITH ABX?

Continuing with the antibiotic stewardship theme this week – it looks like we might be overusing amoxicillin in suspected sepsis. For an under-3-month-old with suspected sepsis, most hospital guidelines recommend cefotaxime plus amoxicillin (the latter to cover Listeria) However this article finds that there have only been 120 cases of Listeria in infants in the UK in the past TEN years, and over 97% of these are in babies under a month old. Time to think, before blindly giving amoxicillin to babies over a month old?

bump   6. BEEM CASES – HEAD INJURY

I’m excited about this new venture by @first10EM and @EMNerd_ – Best Evidence in Emergency Medicine (BEEM) mixes interactive cases with critical appraisal of evidence. The first case is one so commonly seen in Paeds ED – minor head injury. How does evidence inform our decision as to who gets a CT scan? And how long should children with concussion stay on bed rest?

night%20owl      7. UP ALL NIGHT

Those of us who have done nights for several years all have our little ‘night shift routine’ but it is easy to overlook bad habits we might have got into… Take a look at this useful post on @stemlyns from @baombejp – there might be some worthwhile tweaks you could make to your routine so your next nights are slightly more bearable.

 

 

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s