Comments for Pediatric EM Morsels http://pedemmorsels.com Pediatric Emergency Medicine Education Thu, 22 Jan 2015 10:30:15 +0000 hourly 1 http://wordpress.org/?v=4.1 Comment on Spleen Injury by Low Risk for Intra Abdominal Trauma http://pedemmorsels.com/splenic-injury/#comment-1031 Fri, 16 Jan 2015 12:01:02 +0000 http://pedemmorsels.com/?p=3287#comment-1031 […] have discussed pediatric trauma several times within the PedEM Morsels (Splenic Injury, Head Injury, Pneumothorax, etc), because it is often a source of trepidation, confusion and […]

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Comment on Lactate Level in Kids by Research and Reviews in the Fastlane 064 - LITFL http://pedemmorsels.com/lactate-level-kids/#comment-1029 Wed, 31 Dec 2014 00:20:31 +0000 http://pedemmorsels.com/?p=3229#comment-1029 […] More: Lactate Level in Kids (Pediatric EM […]

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Comment on Dexamethasone for Asthma by LITFL Review 162 - LITFL http://pedemmorsels.com/dexamethasone-asthma/#comment-1028 Sun, 28 Dec 2014 23:41:15 +0000 http://pedemmorsels.com/?p=3249#comment-1028 […] Fox at PED EM Morsels discusses the question of which steroids are better for asthma – dex or pred? […]

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Comment on Tonsillolith by Tonsil And Adenoid Removal Ear Pain | Tonsil Stone Treatment http://pedemmorsels.com/tonsillolith/#comment-1027 Sun, 28 Dec 2014 12:33:53 +0000 http://pedemmorsels.com/?p=2117#comment-1027 […] the techniques they can be changed within your eating habits. Tonsil And Adenoid Removal Ear Pain The guide furthermore covers why medicines and surgical procedures fail to give an satisfactory answer to the issue. Banish Tonsil Stones […]

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Comment on Dexamethasone for Asthma by Sean Fox http://pedemmorsels.com/dexamethasone-asthma/#comment-1026 Sun, 28 Dec 2014 01:40:15 +0000 http://pedemmorsels.com/?p=3249#comment-1026 Dr. Leetch,
I appreciate your comments and patronage!

I agree that ordering the home dose of Dexamethasone can be tricky. We also typically use the IV formulation of the medicine given in an oral manner. This allows for a much smaller amount to be given (which is generally appreciated by the kids).

Naturally, this is only an issue with respect to prescribing to patients who won’t take pills. I have been surprised at how many times I have incorrectly judged this (on both sides of the equation).

While prednisolone may taste better than prednisone, the issue is still in that it has to be taken for several days. Personally, I’d rather not have to prescribe any medication that has to be taken after the patient leaves, as this allows too many variables to enter into the equation of compliance.

So, the real question is, if you can achieve good results with one dose, than why choose 5? The literature supports a single dose (or two doses of dexamethasone).

Personally, I choose the longer duration of prednisolone if the child has a more difficult and complicate history and may, in the end, need a steroid taper.

Thank you again!
Have a Great New Year,
sean

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Comment on Dexamethasone for Asthma by Aaron Leetch http://pedemmorsels.com/dexamethasone-asthma/#comment-1025 Sun, 28 Dec 2014 01:31:51 +0000 http://pedemmorsels.com/?p=3249#comment-1025 Excellent morsel this month, Sean. I have this discussion a fair amount with my residents as I have seen many give Dex instead of pred. I’ll be honest that I’m on the pred side for a couple of reasons:

-I use prednisolone as it’s equipotent and tastes like cherries
-We use the IV form of dex (1mg/0.1mL?) orally in the ED but have no similar option to give outpt for the second dose. In fact, the only liquid option I have is 0.5mg/5mL. And trying to get a kid to take a crushed up pill? That’s why we invented liquid medicine.

Curious of your thoughts. I haven’t reviewed the articles about single dose dex but I’ll be sure to do so.

Aaron

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Comment on Dexamethasone for Asthma by Aaron Leetch http://pedemmorsels.com/dexamethasone-asthma/#comment-1024 Sun, 28 Dec 2014 01:27:48 +0000 http://pedemmorsels.com/?p=3249#comment-1024 Excellent morsel this month, Sean. I have this discussion a fair amount with my residents as I have seen many give Dex instead of pred. I’ll be honest that I’m on the pred side for a couple of reasons:

-I use prednisolone as it’s equipotent and tastes like cherries
-We use the IV form of dex (1mg/0.1mL?) orally in the ED but have no similar option to give outpt for the second dose. In fact, the only liquid option I have is 0.5mg/5mL. And trying to get a kid to take a crushed up pill? That’s why we invented liquid medicine.

Curious of your thoughts. I haven’t reviewed the articles about single dose dex but I’ll be sure to do so.

Aaron

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