Journal Jam 6 – Outpatient Topical Anesthetics for Corneal Abrasions

This is EM Cases Journal Jam Podcast 6 - Outpatient Topical Anesthetics for Corneal Abrasions. I’ve been told countless times by ophthalmologists and other colleagues NEVER to prescribe topical anesthetics for corneal abrasion patients, with the reason being largely theoretical - that tetracaine and the like will inhibit re-epithelialization and therefore delay epithelial healing as well as decrease corneal sensation, resulting in corneal ulcers. With prolonged use of outpatient topical anesthetics for corneal abrasions, corneal opacification could develop leading to decreased vision. Now this might be true for the tetracaine abuser who pours the stuff in their eye for weeks on end, but when we look at the literature for toxic effects of using topical anesthetics in the short term, there is no evidence for any clinically important detrimental outcomes. Should we ignore the dogma and use tetracaine anyway? Is there evidence that the use of topical anesthetics after corneal abrasions is safe and effective for pain control without adverse effects or delayed epithelial healing? To discuss the paper "The Safety of Topical Anesthetics in the Treatment of Corneal Abrasions: A Review" by Drs. Swaminathan, Otterness, Milne and Rezaie published in the Journal of Emergency Medicine in 2015, we have EM Cases’ Justin Morgenstern, a Toronto-based EM Doc, EBM enthusiast as well as the brains behind the First10EM blog and Salim Rezaie, Clinical Assistant Professor of EM and Internal Medicine at University of Texas Health Science Center at San Antonio as well as the Creator & Founder of the R.E.B.E.L. EM blog and REBELCast podcast. In this Journal Jam podcast, Dr. Morgenstern and Dr. Rezaie also discuss a simple approach to critically appraising a systematic review article, how to handle consultants who might not be aware of the literature and/or give you a hard time about your decisions and much more...

Episode 61 Whistler’s Update in EM Conference 2015 Highlights Part 1

This EM Cases episode is Part 1 of The Highlights of The University of Toronto, Divisions of Emergency Medicine, Update in EM Conference from Whistler 2015 with Paul Hannam on Pearls and Pitfalls of Intraosseus Line Placement, Anil Chopra on who is at risk and how to prevent Contrast Induced Nephropathy, and Joel Yaphe on the Best of EM Literature from 2014, including reduction of TMJ dislocations, the TRISS trial (on transfusion threshold in sepsis), PEITHO study for thrombolysis in submassive PE, Co-trimoxazole and Sudden Death in Patients Receiving ACE inhibitors or ARBs, the effectiveness and safety of outpatient Tetracaine for corneal abraisons, chronic effects of shift work on cognition and much more...