Episode Chapters
- Introduction: Heimlich Maneuver9:35The History of Heimlich2:05Paper Chase 1: Benefits of Strict Rest After Acute Concussion6:17Heat Illness Part 1Free Chapter10:17Point Of Care - Testing: Troponin9:57Diverticulitis Part 116:06Paper Chase 2: Single-Dose Oral Dexamethasone Versus Multidose Prednisolone5:45What Do I Do Next? 41yo Woman with HA and Visual Change16:15Tinea14:49Heat Illness Part 224:27Paper Chase 3: ED Visits Among Children Admitted With Meningitis or Septicemia7:12Contributor Profiles: Matthieu DeClerck, MD4:07Diverticulitis Part 212:23Paper Chase 4: Acute Otorrhea in Children With Tympanostomy Tubes6:09Answering Your Clinical Question with Medical Literature17:22Paper Chase 5: Postural modification for SVT6:04The Summary24:05
A single dose of dexamethasone was NOT inferior to an oral steroid course.
Death By Peppermint Patty Full episode audio for MD edition 185:25 min - 87 MB - M4AHippo Urgent Care RAP September 2016 Summary 638 KB - PDF
Mike W., MD - September 26, 2016 9:50 AM
Question from a listener:
I am wondering about the Paper Chase 2 - it was not discussed, but I am curious....do you know if the first dose of the Prednisolone was given in the ED. If the Decadron dose was given in the ED, and the Prednisolone was given as a prescription, it could have been seriously delayed, and that may have accounted for the "non-inferiority". I am not a big fan of Prednisolone, so I am all in for the single dose of Decadron, but was wondering about that detail. Once again...keep it up...
Answer from Nate Finnerty, MD (paper chaser):
Great question! A delay in prednisolone administration relative to decadron would have seriously confounded the results. Fortunately this was not the case and both interventions were initiated prior to ED discharge:
"After randomization and administration of the day 1 dose (day 1.day of enrollment), and before discharge from the
ED, the parents or legal guardians of patients randomized to the PRED group were instructed on how to appropriately
store the remaining study drug. Patients who vomited the medication in the ED within 30 minutes of administration
received a second dose.”
Kevin M., PA-C - September 26, 2016 11:05 AM
I have been using the one time dose of dexamethasone in my pediatric patients. I had a younger patient with a higher BMI and when doing the calculation I felt like the mg dosage was rather high. What is the max dose of dexamethasone that can be given?
Mike W., MD - September 26, 2016 1:54 PM
I typically max out at 10mg - the additional benefit of higher doses (if at all..) would be outweighed by the increased side effect profile
stacie o., 9692404 - February 1, 2017 7:54 AM
I have not had consistent results with the single dose dexamethasone with bounce back with persistent wheezing. I have had very good results with using a new formulation of oral prednisolone in an ODT, Orapred ODT if you can get insurance to cover. Parents with kids who have tried steroids previous have had very little problems giving the ODT tablet.