Urgent Bite 160 – Funded Adrenaline Auto-injectors
As of February 1st, 2023, adrenaline auto-injectors are now funded in New Zealand under Special Authority.
Urgent Bite 159 – Which steroid when the seal barks?
Do you use Prednisone of Dexamethasone for croup?
Terracycle
One of our urgent care fellows working in the Bay of Plenty is passionate about recycling and reducing waste. The healthcare industry creates huge amounts of waste and plastic pollution, but there are ways that we can make our working environments more sustainable.
Tamsin has set up a recycling box in Rotorua Emergency Department to collect flexible cleaning wipe packaging and soap pumps, trigger heads. In just two weeks, 100 plastic packets have been collected. These are sent in to Terracycle using a freepost label where they are recycled into their component parts. Can you set up one in your work place and help divert plastic waste from landfill?
See the steps below for setting one up:
1. Get permission for the recycle box from the in charge / supervisor.
2. Repurpose a cardboard box for collections (as shown). I can send you a poster of the collected items similar to the one below if required.
3. Promote and advertise – inform those working in your area by email / intranet communications about the collections. Discuss with cleaners and HCAs. Put a poster up in a common area. Leave messages on white boards about the collections.
4. Empty collections when full.
5. Download a postage label from Terracycle (or email Tamsin when you need one and she can send it to you).
6. Attach label to packaged items and drop off at post office (freepost label!)
Point of Care Ultrasounds in the Diagnosis of Pulled Elbows
Author: Dr Jin Gao
Type: MLP-research
Date: 16 December 2020
Abstract:
The pulled elbow(PE) is a common childhood injury. In most cases, the clinical management is straight forward, however, the diagnosis and management may be difficult if there is an unclear history, an unwitnessed injury or an atypical mechanism of injury. This medical literature project evaluates the effectiveness of point-of-care ultrasound in the diagnosis of PEs.
Nausea and Vomiting in Pregnancy (NVP)
Nausea and Vomiting in Pregnancy (NVP)
Author: Dr Richard Chen
Abstract:
Aim:
Nausea and Vomiting in Pregnancy (NVP) is a common presentation seen by a wide variety of medical professionals however the evidence around the safety and efficacy of drugs used to treat NVP is often not well understood. This review looks to explore current prescribing practices of drugs used to treat NVP and provide evidence-based recommendations.
Method:
The current New Zealand Guidelines for treatment of NVP was studied and an in-depth literature search into the safety and efficacy of drugs available was conducted.
In addition, a survey of current doctors working in the Urgent Care setting was conducted to determine current prescribing habits.
Results:
Pyridoxine, Doxylamine and Metoclopramide are the medications with the most proven safety profile in pregnancy respectively. There have been significant studies into the Pyridoxine-Doxylamine combination as well as Metoclopramide to demonstrate effectiveness against placebo. However, there is insufficient evidence to suggest any drug is the most effective drug available.
A large proportion of prescribing preferences of the doctors working in Urgent Care surveyed in the context of treating NVP were not supported by the available evidence.
Conclusion:
Considering both safety and efficacy, Pyridoxine and Doxylamine are the recommended initial drugs of choice to manage NVP. This is closely followed by Metoclopramide. More doctors working in the acute medical setting should be aware of the potential teratogenicity of drugs used to treat NVP.
CROUP
Author: Dr Alexander Stapleton
Type: MLP-case study
Date: 2022
ABSTRACT
Background: This literature review was devised to clarify the rationale between the use of
Dexamethasone and Prednisolone for the treatment of paediatric Croup in the community setting.
Methods: A computerised literature search of local and international Guidelines, PubMed and CENTRAL
(Cochrane Central Register of Controlled Trials) was carried out. Fifteen sources were included.
Indications and use of dexamethasone and prednisolone varied across the cited literature. An evidence
based practice viewpoint and appraisal of the literature was undertaken and the results collated.
Results: Analysis of the literature shows a clinical benefit of Dexamethasone in comparison to
Prednisolone when it comes to re-presentation, with a reduction in patient readmission and
re-presentation when using Dexamethasone compared to Prednisolone. Clinical benefit outside of this
parameter has not been proven. There was also a demonstrable effect on caregiver stress levels when
Dexamethasone was given compared to Prednisolone given ease of use. Some benefit with improved
tolerance with Dexamethasone compared to Prednisolone. There is also a potential cost benefit
involved in treating Croup with single dose Dexamethasone but this would need further exploration in
the New Zealand context.
Urgent Bite 158 – Nasal Septal Haematoma
Always look for a nasal septal haematoma in cases of nasal trauma.
Urgent Bite 157 – Needle Expectation
Does expectation influence the experience of receiving an injection?
Cannabinoid Hyperemesis Syndrome
Author: Dr Sandy Crofts
October 2021
Abstract:
Cannabinoid Hyperemesis Syndrome (CHS) is a syndrome of intractable vomiting with severe abdominal pain that is associated with chronic marijuana use. Classically, symptoms are relieved by hot showers and are often unresponsive to traditional acute interventions such as antiemetics.
Patients commonly undergo multiple investigations without diagnosis. Complete resolution of symptoms occurs with abstinence from cannabis.
The following Medical Literature Project gives an overview of Cannabinoid Hyperemesis Syndrome and review of current management.
Point of care ultrasound for the diagnosis of paediatric distal radius buckle fractures
Author: Dr Alice Mason
March 2022
Abstract:
Paediatric forearm fractures are a common presentation seen in Urgent Care, often occurring from a fall onto an outstretched hand. Currently, best practice is for an x-ray when there is suspicion of a fracture.However, this comes with exposure to ionising radiation and can be associated with prolonged waiting times, pain, and further cost. This review aims to investigate whether point of care ultrasound (POCUS) could be used as an alternative or preferred option for suspected distal radius fractures in children.