Diagnosing and treating undifferentiated shortness of breath is usually an easy task, but sometimes the etiology can be difficult to determine. Other times, there may be multiple causes. Here are a list of "C's" to keep in mind in patients with shortness of breath.
Neonates (<28 days of age) are a fragile population that can present in life-threatening distress that requires immediate evaluation and treatment. As such, utilizing a systematic approach can help identify and treat the most common causes of neonatal distress. As more hospital nurseries discharge patients earlier, emergency departments must be ready to evaluate, diagnose, and treat neonatal emergencies.
For more information; ACEP "The Misfits"
The Misfits is a useful mnemonic for neurologic changes in the neonate, and can be expanded to neonatal distress in general to aid in a systematic approach to all neonates in distress. Keep in mind that neurologic changes in the very young may be subtle and difficult to diagnose.
According to this new article from JAMA, the addition of Percocet or Flexeril to Naproxen does not improve functional outcomes in acute low back pain. The article compared functional outcomes in lower back pain at 1 and 3 weeks between Naproxen, Flexeril, and Percocet. Via a randomized, double-blind study in NYC, 323 patients were randomized to Naproxen + Placebo, Naproxen + Flexeril, and Naproxen + Percocet. Using an improvement in the Roland-Morris Disability Questionnaire (RMDQ), the study found that 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.