Migraine treatment with….propofol?

http://academiclifeinem.com/on-the-horizon-propofol-for-migraines/                              Image

The link above shows a summary of a few studies showing some effectiveness for propofol in treatment of migraines..

An interesting idea, with apparently a decent amount of evidence behind it.  I’ve always been curious about trying it with some of our chronic migraine patients, but I have not used it.  Has anyone had any experience with this?

Also, I’m curious whether people have a certain “migraine cocktail” they prefer using.  Please post in the comments section.

Also don’t forget to vote in the poll!

What patients should receive oseltamivir (tamiflu)?

I’m pretty sure there are varying opinions on this topic.  Do you prescribe it for everyone who just has symptoms?  Do you only give it those who present within 48 hours, as the indication states?  Do you only give it to those patients who test positive?  below is a quick read about on ED physician’s opinion.

http://www.epmonthly.com/departments/columns/in-my-opinion/tamiflu-a-drug-looking-for-an-indication/

please click on the “reply” button to share your thoughts!

Don’t forget to vote in the poll below!

Should beta blockade be part of the ED protocol for patients with Acute Coronary Syndrome?

I’m pretty sure everyone agrees beta blockade has significant benefit on patients with heart disease.  However, when is the best time to give the beta blocker?  Within the first hour?  24 hours?  Month?  Should beta blockade be given intravenously?  or orally?

UpToDate’s summary recommends: “For all patients with acute MI, we recommend initiation of oral beta blockers within the first 24 hours, as long as no contraindications are present. (Grade 1B). ”

The 2013 ACCF/AHA STEMI Management Guidelines give a Class 1 recommendation to starting oral beta blockers within 24 hours of presentation, but a class 2a recommendation to give IV beta blockade at time of presentation to those “who are hypertensive and have ongoing ischemia.”  (https://circ.ahajournals.org/content/127/4/e362.full)

Please post your thoughts below by clicking on the “reply” button.

Link

http://media.blubrry.com/emcrit/p/traffic.libsyn.com/emcrit/EMCrit-Podcast-20140127-116-tPA-Cage-Match.mp4

 

Dr. Andy Jagoda and Dr. Swaminathan debate the pros and cons of tPA for acute stroke.  Please vote in the poll below

tpa pro and con debate from EMcrit website