The diagnosis formerly known as ALTE

The AAP has formally changed the name of ALTE to Brief Unexplained Event (BRUE). The definition has also been formalized with more specific criteria and suggestions to empower the clinician to base the diagnosis on their suspicion rather than relying only on the caregiver’s history.

BRUE is an event occurring in an infant <1 year of age when an observer reports a sudden, brief (<1 min), and now resolved episode of ≥1 of the following without explanation:

  • Cyanosis or pallor
  • Absent, decreased, or irregular breathing
  • Marked change in tone (hyper- or hypotonia)
  • Altered level of responsiveness
  • Must have returned to baseline
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UTox and cross reactivity

Many non illicit drugs cross react with common drugs screened on the traditional urine drug screen.

  • NSAIDs can cause false positive cannabinoid screens
  • Sertraline can cause a benzo false positive
  • Most benzodiazepine screens look for oxazepam which is a metabolite of diazepam and chlordiazepoxide. Therefore, lorazepam, alprazolam, and clonazepam are commonly missed.

What is the detection interval for marijuana on a UDS?Read more

Seeking emergency physicians for the Houston area

EmCare® is seeking emergency medicine physicians for several sites in and around Houston. Come join the country’s most experienced, physician-led practice management company.

Known for its unique structure, EmCare® develops local practices, supports them with regionally-located clinical leadership and operational personnel, while providing them access to unprecedented national resources.

Contact Stacey Harris, EmCare® physician recruiter, at (214) 712-2477 or Stacey.harris@emcare.com

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Support open medicine and become a WikEM Sponsor! Read more

Irrigation of cutaneous abscesses

The treatment of cutaneous abscesses classically involves the incision and drainage procedure. Historically, this procedure involves making a linear incision over the abscess cavity, followed by manual expression of cavity contents, blunt dissection to break up loculations, further irrigation with saline, and packing with gauze. However, a lack of data supports the routine use of irrigation to improve the success of the procedure and treatment of the abscess. In addition, while not typically considered, the routine use of irrigation does include some downsides: extra time and supplies, cost, and the possibility of microbiologic contamination of the patient care area and body fluid exposure to the practitioner.

The authors of this study randomized patients to I&D with or without… Read more

CHEST Recommendations Subsegmental PE

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The wiki has been updated with the recommendations for PE from a new CHEST guideline now that offers the option based on low quality (2C) evidence for clinical surveillance rather than anticoagulation for sub-segmental pulmonary embolism.  This excludes patients with proximal DVTs and those at risk for recurrent VTE (cancer patients, recent surgery, recurrent DVTs, decreased mobility, or hospitalization)

 

 … Read more