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So, what's your personal practice on this?
Personal?
If I got a bad abrasion, I'd use drops.
I mean, do you discharge patients with the remainder of the Tetracaine bottle?
I went to one of those CMEs that Rick Bukata runs, and one of the speakers said they had a colleague that gave out the bottle, and the pt used it so liberally, they eroded away their cornea, and needed a transplant. Doc got sued, and lost. Yet, he still does that - leaves the bottle there with a wink.I don't prescribe it but for patients with a legit abrasion who seem smart enough to follow basic instructions I explain how its used, the theoretical risks, why I will not be giving them a prescription for it, and then I leave the rest of the little bottle at bedside and tell them "I can't send you home with this but no one is going to come looking for the rest of it, wink wink". Small sample size but no one has returned with an ulcer yet and I would certainly use it personally if I had an abrasion.
Regardless of the above using topical anesthetics for 24 hrs provides significant pain relief and has essentially zero chance of causing corneal damage.
The key is to only give a 24 hr supply (3cc of 0.5% or 0.o5% proparacaine).
Topical Anesthetic Use on Corneal Abrasions - R.E.B.E.L. EM - Emergency Medicine Blog
From the reddit legal advice sub-forum:
There's no reason to do this. There are other ways to control this pain that have zero risk. I'm not saying corneal abrasions can't hurt, because they do, but let's face it, it's a scratch. A scratch. That's it.So, what's your personal practice on this?
To be fair, if you read the comments on the reddit thread, basically everyone is telling the original poster he's an idiot with no standing to sue.That Reddit thread sealed the deal for me. I will never let them take it home!
To be fair, if you read the comments on the reddit thread, basically everyone is telling the original poster he's an idiot with no standing to sue.
We just had an *adverse event* with this.
Doc says it's cool to take home the tetracaine. "Heres the literature!" Homeboy takes it home. Uses several drops every hour and ulcerates his cornea.
Big kerfuffle. Good doc. Not playing this game.
Any idea how long the patient used the drops for? I suppose that's the unaccounted for variable that we don't pay attention to - patient stupidity. Will come back to bite you every time.
Never suppress the urge to face palm. Don't suppress any urges. Ever.hah, i'm sure anyone who just reads that has to instantly suppress the urge to facepalm.