By Josh Faucher, MD, JD // Edited by Michael Barrie, MD
A 24 year-old male presents to your rural ED’s fast-track area with purulent penile discharge and dysuria. These have been present for the past week, and he recently began intercourse with a new female sexual partner. They have not used barrier contraception. He denies hematuria, fevers, genital lesions, or other associated symptoms; his physical exam is within normal limits other than purulent penile discharge. Rapid urine testing is positive for Neisseria gonorrhea infection; the patient is treated empirically in the ED with one-time doses of ceftriaxone and azithromycin. He denies any other recent sexual partners. The patient’s sexual partner works full time but is uninsured, and in your rural area there are no local STD clinics that are easily accessible for partner follow-up. Your patient asks if he can have a prescription to conveniently treat possible infection in his female partner at home, saving the time and cost of an additional ED visit or delayed outpatient follow-up. Can you provide the sexual partner any treatment without seeing her directly as a patient?
By Michael Barrie, OSU EM Assistant Professor
A great emergency medicine study in this month’s JAMA: Friedman et. al “Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for treating acute low back pain: A randomized clinical trial.” This was a randomized, double-blind controlled trial to see if adding narcotics or cyclobenzaprine to naprosyn helps improve symptoms in patients with lumbar back pain compared to those that received naprosyn plus placebo. They showed there was NO benefit.
Conclusions and Relevance Among patients with acute, nontraumatic, nonradicular LBP presenting to the ED, adding cyclobenzaprine or oxycodone/acetaminophen to naproxen alone did not improve functional outcomes or pain at 1-week follow-up. These findings do not support use of these additional medications in this setting.
Written by Michael Barrie @MikeBarrieMD, OSU EM Assistant Professor
It’s clear that when a patient presents with sudden onset of a rash, wheezing, vomiting and hypotension every emergency physician knows that epinephrine is life saving. But evidence is mounting against the routine administration of steroids in our patients with anaphylaxis.
Should we abandon corticosteroid administration in anaphlaxis? This month’s issue of Annals of Emergency starts that discussion with Grunau et al “Emergency Department Corticosteroid Use for Allergy or Anaphylaxis is Not Associated with Decreased Relapses.”