Morning Report: 3/21/2012

by Jay Khadpe MD • March 21, 2012 • Comments Off

The Dr. Audrey Tan Advice Column (Actually Morning Report from 3/20/2012)

Practical Advice. Not so sexy but definitely necessary.

ABSCESSES

To pack or not to pack to prevent recurrent/repeat infection?

7 prior controlled studies suggesting that packing prolongs wound healing times without decreasing abscess recurrence rates BUT poor studies and most compared packing with primary closure (?!)
theNNT.com

100% saw no benefit
0% were helped by preventing need for secondary intervention (eg repeat I&D)
0% were helped by prevention of recurrent abscess

What are your aftercare instructions?

Do not disturb dressing until 1st follow up visit (usually within 48 hrs although in facial abscesses, packing should be removed after 24 hrs)

When do you stop packing and start warm soaks?

Once healthy granulation tissue has developed through the wound and well-established drainage tract is present
Soaks with warm, clean water for 20-30 minutes once a day

I FEEL LIKE S*&T!

Symptomatic relief of coughing?

Expectorant (eg guaifenisin) thins the mucus and makes it easier to cough, relieving chest congestion and making breathing easier
Cough suppressant (eg dextromethorphan) for dry hacking coughs; they should not be used for productive wet coughing
Caution in age < 6 yo
Tessalon (benzonatate) 100 mg PO TID PRN; anesthesizes respiratory passage, lungs and pleural stretch receptors reducing cough reflex
Honey? May be better than no treatment in symptomatic relief of cough but not better than dextromethorphan (Cochrane 2012)

Seasonal allergy season is coming. What do you give? (National Guidelines Clearinghouse, Oct 2007)

Avoidance of allergens
Non-sedating antihistamine loratidine (Claritin) should be tried initially. Will provide relief in most cases.
If symptoms persist, consider:

Intranasal corticosteroids to control itching, sneezing, rhinorrhea, stuffiness. Adults – fluticasone (Flonase), flunisolide (Nasarel). Children – mometasone (Nasonex AQ) preferred.
Oral nonsedating antihistamines – less effective for nasal congestion. Fexofenadine (Allegra).
Oral decongestant (eg phenylephrine, pseudoephedrine) – lots of side effects! CI for those on MAOI, HTN, CAD.
Less effective – LT inihibitor, intranasal cromolyn, intranasal antihistamine

Thanks for the advice Dr. Tan!

What other tips for managing these common problems does everyone have. Leave your thoughts in the comment section below.

Thanks,

The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.

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Jay Khadpe MD

Editor in Chief of "The Original Kings of County" Assistant Professor of Emergency Medicine Assistant Residency Director SUNY Downstate / Kings County Hospital