EM Quick Hits 3 – Kawasaki Disease, Suturing Dog Bites, BVM in RSI, Anticraving Meds for Alcohol Misuse, ED Violence

Topics in this EM Quick Hits podcast

Natalie May on Kawasaki disease clues to diagnosis (1:25)

Justin Morgenstern on suturing dog bites: the evidence (7:52)

Anand Swaminathan on BVM prior to laryngoscopy (11:51)

Michelle Klaiman on anticraving medications for alcohol use disorder  (18:39)

Howard Ovens on managing ED violence with compassionate care (24:31)



Podcast production, editing and sound design by Anton Helman

Podcast content, written summary & blog post by Natalie May, Justin Morgenstern, Anand Swaminathan and Michelle Klaiman, edited by Anton Helman

Cite this podcast as: Helman, A. May, N. Morgenstern, Swaminathan, A. Klaiman, M. Ovens, H. EM Quick Hits 3 - Kawasaki Disease Clues to Diagnosis, Suturing Dog Bites: The Evidence, BVM Prior to Laryngoscopy, Anticraving Medications for Alcohol Use Disorder and Managing ED Violence Humanely. Emergency Medicine Cases. March, 2019. https://emergencymedicinecases.com/em-quick-hits-march-2019/. Accessed [date].

Kawasaki Disease clues to diagnosis



* Know the diagnostic criteria and ask yourself - could this be Kawasaki disease or incomplete Kawasaki Disease

* Consider Kawasaki disease particularly in children re-presenting with fever or with fever for more than five days: specifically document the diagnostic criteria and their presence or absence, especially if discharging these patients

* In children who present with cardiac ischemia or dysrhythmia, consider Kawawaki as the inciting cause

* For the stable patient with a suspected diagnosis of Kawasaki disease, refer for coronary artery echocardiogram and consideration of prompt IV immunoglobulin +/- high dose ASA.



Expand to view reference list



* Anderson, M. S., J. K. Todd, et al. (2005). Delayed Diagnosis of Kawasaki Syndrome: An Analysis of the Problem. Pediatrics 115(4): 428-433.

* Baumer, J., S. Love, et al. (2009). Salicylate for the treatment of Kawasaki disease in children [review]. Cochrane Database of Systematic Reviews(4).

* Burns, J. C., H. Shike, et al. (1996). Sequelae of Kawasaki disease in adolescents and young adults. Journal of the American College of Cardiology 28(1): 253-257.

* Furusho, K., T. Kamiya, et al. (1991). Intravenous γ-Globulin for Kawasaki Disease. Pediatrics International 33(6): 799-804.

* Kato, H., T. Sugimura, et al. (1996). Long-term Consequences of Kawasaki Disease: A 10- to 21-Year Follow-up Study of 594 Patients. Circulation 94(6): 1379-1385.

* Newburger, J. W., M. Takahashi, et al. (2004). Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease. Circulation 110(17): 2747-2771.





Suturing dog bites: the evidence



* Routinely suturing dog bites does not seem to cause an increased rate of infection, but this is only based on two small RCTs

* Based on one of the RCTs, suturing may result in better cosmetic outcomes



Expand to view reference list



* Maimaris C, Quinton DN. Dog-bite lacerations: a controlled trial of primary wound closure. Archives of Emergency Medicine. 5(3):156-61.