Croup: are patients safe to discharge following nebulised adrenaline? Is ‘rebound phenomenon’ a myth?

MLP-research

Author: Dr Gareth Norton

Date: August 2022

Abstract:

Croup, or laryngotracheobronchitis, is an extremely common presentation of respiratory
disease in the paediatric population. The mainstay of treatment is oral corticosteroids and in moderate/severe cases nebulised adrenaline. Concerns exist around the possibility of a rebound effect where their are increased symptoms when the effect of a drug has passed. If a drug produces a rebound effect, the condition it was used to treat may return with an
increased severity. Or is there no rebound effect and the return of symptoms, even at an
increased severity is due to the natural course and progression of the treated condition?

Guideline for Management of Severe Asymptomatic Hypertension in Urgent Care

MLP-guideline

Author: Dr Gustav Fourie

2019

Abstract:

Hypertension is a common presentation but there is no New Zealand based guideline for the management of severe asymptomatic hypertension (greater than 180 systolic or 110 diastolic) in urgent care. Definitions have varied in both naming ( hypertensive emergency, hypertensive urgency, hypertensive crisis ,malignant hypertension,accelerated hypertension, severe asymptomatic hypertension) and parameters.

Method:

A review of recent literature was conducted.

Rivaroxaban as bridging agent for suspected DVT

MLP-research

Author: Dr Gary Mitchell

Abstract:

Rivaroxaban is well established as a treatment for deep vein thrombosis and pulmonary embolism, but there has been hesitation in using it as a bridging agent in clinical situations where DVT is suspected but not yet confirmed by definitive ultrasound scan. The evidence for the safety and efficacy of this approach is explored. During this time of research, the use of rivaroxaban began to gain acceptance and usage in New Zealand, leading to a brief analysis of factors involved in trying to introduce up to date guidelines into a small health organisation in New Zealand prior to widespread acceptance and definitive guidelines at District Health Board level.

Diverticulitis: the role of antibiotics in urgent care

MLP-research

Diverticulitis: the role of antibiotics in urgent care

Author: Dr Eleri Clissold

Abstract:

Our understanding of this common and painful disease is evolving. What was thought to be a predominantly infective process is postulated to be inflammatory and self-limiting in the majority of cases. Over several decades multiple high quality studies have emerged questioning the role of antibiotics in the management of acute diverticulitis without perforation, sepsis or other complications. No study has demonstrated the superiority of any antibiotic strategy in any one of multiple outcomes assessed. This literature search seeks to examine the evidence in-depth and place it in context for urgent care practitioners.

Terracycle

General news

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

MLP-research

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)

MLP-research

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

MLP-case study

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.

Cannabinoid Hyperemesis Syndrome

MLP-research

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

MLP-research

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.