Boring Question: Does my patient require admission for IV antibiotic administration?

In Clinical Questions by Patrick Bafuma8 Comments

We have all had a patient or two request admission for intravenous antibiotics. Usually, the argument is that IV administration is better because it ‘gets into the blood more quickly’. In fact, many of us have made that argument ourselves, or heard it from our peers. But, what if I told you that many of your favourite antibiotics have similar pharmacokinetic properties regardless of the route of administration? What if I also showed …

Boring Questions: Do you even dip?

In Clinical Questions by Eve Purdy2 Comments

Urine is boring so we are doing a follow up post to Brent’s first ever post on BoringEM “Urinalysis Voodoo”. Less voodoo, more evidence. The case: Jane, a 23-year-old, sexually active female presents to the emergency department with a two day history of dysuria and urinary frequency. She has not experienced vomiting, fevers or changes in vaginal discharge. Her abdominal review of systems is negative. Her LMP was one week ago and she …

Boring Question: Is this patient seeking opioids for non-medical use?

In Clinical Questions by Chris Byrne2 Comments

Clinical Scenario  A 35-year-old woman presents to the emergency department with severe, generalized abdominal pain. She has had two prior visits in the past ten days with discharge diagnoses of “abdominal pain, not yet diagnosed”. As you try to clarify the history, the patient begins screaming in apparent severe pain. The patient’s vital signs are: T 36.4, HR 75, BP 121/84, RR 20, SpO2 99% on room air. You have already reviewed the …

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Boring Question: Steroids for Tinea?

In Clinical Questions by Eve Purdy3 Comments

The Case An otherwise healthy 30-year-old woman presents to the emergency department with a pruritic rash on her upper thigh that she has had for nine days. Thinking it was poison ivy, she had been using topical corticosteroids on the area. When the rash didn’t improve, she decided to seek care. She is otherwise well; she reports no fevers, joint pain, or tick exposure. On exam she has two lesions each about 2 …

Boring Question: Which low risk C-spine rule is best?

In Clinical Questions by Alana Hawley9 Comments

A Case: A 32-year-old female was the driver in a simple rear-end motor vehicle collision at about 40km/h.  She was wearing a seatbelt and her airbags did not deploy.  She extricated herself from the car.  When EMS arrived, she was walking. On examination by paramedics, the young woman denied paraesthesias. She did complain of midline C-spine tenderness; as a result, she was boarded and collared prior to transport. She is now on a …

Boring Question: Does this medication cause long QT? (with Bonus: Tiny Tips!)

In Clinical Questions, Tiny Tips by Jatin Kaicker7 Comments

The Clinical Case A 70-year-old female presents to the emergency department with new palpitations and 2 syncopal episodes, witnessed by her son. These episodes have started within the past 10 days. Her past medical history includes diabetes, hypertension, depression, dyslipidemia and atrial fibrillation. She is a long-standing diabetic and is followed by a nephrologist for her diabetic nephropathy. Her medications included: metformin, atorvastatin, aspirin, warfarin and sertraline. She was recently seen in hospital …