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Clinical Conundrums: How Long Should We Monitor After Giving IM Epinephrine for Anaphylaxis?

RebelEM

The risk of a biphasic reaction is what keeps patients in the ED while being observed for a set period of time. The overall incidence of biphasic reactions is unknown with rates quoted from < 0.5% up to 23% ( Lieberman 2005 , Rohacek 2014 , Tole 2007 , Grunau 2014 ). The Journal of Allergy and Clinical Immunology.

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Cetirizine Vs Diphenhydramine For the Treatment of Acute Urticaria in the ED

RebelEM

Background: Diphenhydramine, a first-generation antihistamine, is the most common pharmacologic agent used to treat acute allergic reactions. Diphenhydramine versus nonsedating antihistamines for acute allergic reactions: a literature review. 2007 Jul-Aug;28(4):418-26. Resources: Banerji A, Long AA, Camargo CA Jr.

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Nephrotic Syndrome

Mind The Bleep

Steroid resistance Failure to achieve complete remission after 8 weeks of prednisolone at 60mg/m2/day Differentials Heart failure – would present with oedema, shortness of breath, cyanosis Allergic reaction – presents with facial oedema, pruritus. Fronteirs in Immunology. Moroni G, P. Secondary Membranous Nephropathy.

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Subcutaneous Rehydration

Pediatric Emergency Playbook

The idea is not to tape on the growing mound itself, because the mound may pull at the anchored skin and set a nuclear chain reaction of annoyance and restlessness – and potentially a failed procedure. in 2007 compared subcutaneous administration of lactated ringer’s solution by gravity with and without hyalurondase. J Am Geriatr Soc.