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That language and attitude sets an impossibly high bar for evidence based
medicine. In fact, it is tantamount to rationalizing that parachutes aren't
needed because there is no published RCT supporting their use.
Three people spouted dogma. Dr. Wilkerson cited a reference. At this point,
as a disinterested party, I would say the preponderance of evidence favors
early discharge if the 2 hr level is not detectable.

Kevin Powell MD PhD FAAP
Pediatric hospitalist
Saint Louis, MO

-----Original Message-----
From: Pediatric Emergency Medicine Discussion List
[mailto:[log in to unmask]] On Behalf Of Doc Holiday
Sent: Sunday, February 15, 2015 4:17 PM
To: [log in to unmask]
Subject: Re: Possible Acetaminophen ingestion - level timing

From: [log in to unmask]
> That is exactly the argument that I remember.  Based on logic and
physiology rather than studies, I suspect. I would also love some
toxicologist input.

--> While I accept that there is a low enough reading at 2 hours which would
allow a discharge, we still go for 4 hours. Reduces the number of patients
in whom more than one hole is made.
Still, for my own interest, I would appreciate reading any good quality
stuff (child or adult) which provides solid evidence for which level at 2
hours is 100% certain to exclude the possibility of a toxic reading at 4
hours and that it makes no difference what the stomach contents were at the
time.
Thanks in advance.


 		 	   		  
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