Podcast # 450: Probiotics in Gastroenteritis

Author: Sam Killian, MD

Educational Pearls:

  • Viral gastroenteritis alters the gut microbiome and it is theorized that probiotics may help reduce the duration and severity of the disease.
  • Double-blind randomized controlled trial involving almost 900 children with viral gastroenteritis compared 5 days of probiotics to a control group.
  • There was no difference in the rates of severe gastroenteritis between the two groups
  • Probiotics are likely unhelpful for kid with viral gastroenteritis

References:

Freedman SB, Williamson-Urquhart S, Farion KJ, Gouin S, Willan AR, Poonai N, Hurley K, Sherman PM, Finkelstein Y, Lee BE, Pang XL, Chui L, Schnadower D, Xie J, Gorelick M, Schuh S; PERC PROGUT Trial Group.. Multicenter Trial of a Combination Probiotic for Children with Gastroenteritis. N Engl J Med. 2018 Nov 22;379(21):2015-2026. doi: 10.1056/NEJMoa1802597. PubMed PMID: 30462939.

Summarized by Will Dewispelaere, MS3 | Edited by Erik Verzemnieks, MD

Podcast #449:  Banana Bags

Author: Dylan Luyten, MD

Educational Pearls:

  • A “banana bag” is a bag of IV fluid that contains various vitamins and minerals including folate and thiamine
  • IV fluids do not alter intoxicated patients recovery in the emergency department
  • Folate deficiency is rare in the intoxicated patient
  • Some intoxicated patients may be thiamine deficient, and those that would benefit the most need significantly more daily thiamine supplementation than provided in a banana bag

References:

Perez SR, Keijzers G, Steele M, Byrnes J, Scuffham PA. Intravenous 0.9% sodium chloride therapy does not reduce length of stay of alcohol-intoxicated patients in the emergency department: a randomised controlled trial. Emerg Med Australas. 2013 Dec;25(6):527-34. doi: 10.1111/1742-6723.12151. Epub 2013 Nov 8. PubMed PMID: 24308613; PubMed Central PMCID: PMC4253317.

Li SF, Jacob J, Feng J, Kulkarni M. Vitamin deficiencies in acutely intoxicated patients in the ED. Am J Emerg Med. 2008 Sep;26(7):792-5. doi: 10.1016/j.ajem.2007.10.003. PubMed PMID: 18774045.

ay E, Bentham PW, Callaghan R, Kuruvilla T, George S. Thiamine for prevention and treatment of Wernicke-Korsakoff Syndrome in people who abuse alcohol. Cochrane Database Syst Rev. 2013 Jul 1;(7):CD004033. doi: 10.1002/14651858.CD004033.pub3. Review. PubMed PMID: 23818100.

Summarized by Will Dewsipelaere, MS3 | Edited by Erik Verzemnieks, MD

Podcast #448:  Chronic Salicylate Toxicity

Author: Ryan Circh, MD

Educational Pearls:

  • Chronic salicylate (ASA) toxicity can present in elderly patients as altered mental status
  • Consider chronic toxicity in patients with an unexplained anion gap acidosis
  • Treatment for chronic ingestion typically  includes IV fluids and urine alkalinization

References:

O’Malley GF. Emergency department management of the salicylate-poisoned patient. Emerg Med Clin North Am. 2007 May;25(2):333-46; abstract viii. Review. PubMed PMID: 17482023.

Durnas C, Cusack BJ. Salicylate intoxication in the elderly. Recognition and recommendations on how to prevent it. Drugs Aging. 1992 Jan-Feb;2(1):20-34. Review. PubMed PMID: 1554971.

Summarized by Will Dewsipelaere, MS3 | Edited by Erik Verzemnieks, MD

Podcast #447:  IV Tylenol

Author: Dylan Luyten, MD

Educational Pearls:

  • Recent randomized controlled trial compared intravenous to oral acetaminophen in emergency department patients
  • There was no difference in pain relief between the groups
  • While the actual acquisition cost of these drugs are not significant, the cost multipliers that are passed onto patients lead to real dollars
  • With the significant cost of IV acetaminophen, it may not be the best choice given the lack of superiority to other formulations

References:

Furyk J, Levas D, Close B, Laspina K, Fitzpatrick M, Robinson K, Vangaveti VN, Ray R. Intravenous versus oral paracetamol for acute pain in adults in the emergency department setting: a prospective, double-blind, double-dummy, randomised controlled trial.Emerg Med J. 2018 Mar;35(3):179-184. doi: 10.1136/emermed-2017-206787. Epub 2017 Dec 15. PubMed PMID: 29247042.

Summarized by Will Dewsipelaere, MS3 | Edited by Erik Verzemnieks, MD

Podcast #446:  Retinal Detachment

Author: Dylan Luyten, MD

Educational Pearls:

  • 1:500 patients will experience a retinal detachment
  • Consider stroke on your differential (central retinal arterial occlusion)
  • Flashes and floaters are a common complaint with retinal detachments
  • Though patients may report fields of vision loss, visual acuity is often spared
  • Ocular ultrasound is an effective way to diagnosis retinal detachment in the ED
  • These require urgent ophthalmologic consultation for surgical repair

References:

https://www.aliem.com/2014/03/ocular-ultrasound-retinal-detachment-posterior-vitreous-detachment/

Gottlieb M, Holladay D, Peksa GD. Point-of-Care Ocular Ultrasound for the Diagnosis of Retinal Detachment: A Systematic Review and Meta-Analysis. Acad Emerg Med. 2019 Jan 13. doi: 10.1111/acem.13682. [Epub ahead of print] PubMed PMID: 30636351.

 

Summarized by Will Dewsipelaere, MS3 | Edited by Erik Verzemnieks, MD