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It is not recommended to prescribe opioid analgesics or combination analgesics containing opioids or barbiturates as first line therapy for the treatment of migraine.
Choosing Wisely Canada
Canadian Headache Society
Non-steroidal anti-inflammatory drugs and triptans are recommended first line treatments for acute migraine therapy. Opioids may produce increased sensitivity to pain and increase the risk that intermittent headache attacks will become more frequent and escalate to a chronic daily headache syndrome (medication overuse headache), particularly when opioids are used on 10 days a month or more. Opioids may impair alertness and produce dependence or addiction syndromes.
ver más ... 2018It is not recommended to order neuroimaging or sinus imaging in patients who have a normal clinical examination, who meet diagnostic criteria for migraine, and have no “red flags” for a secondary ...
Choosing Wisely Canada
Canadian Headache Society
Red flags for a secondary headache include thunderclap onset, fever and meningismus, papilloedema, unexplained focal neurological signs, unusual headache attack precipitants, and headache onset after age 50. The yield of neuroimaging in patients with typical recurrent migraine attacks is very low. Any imaging study, particularly MRI, can identify incidental findings of no clinical significance which may lead to patient anxiety and further unnecessary investigation. For patients with typical ...
ver más ... 2018It is not recommended to order ankle and/or foot X-rays in patients who have a negative examination using the Ottawa ankle rules
Choosing Wisely Canada
Canadian Association of Emergency Physicians
Foot and ankle injuries in children and adults are very common presentations to emergency departments. The Ottawa Ankle Rules (OAR) have been validated in both children (greater than 2 years old) and adult populations, and have been shown to reduce the number of X-rays performed without adversely affecting patient care. In alert, cooperative and sensate patients with blunt ankle and/or foot trauma within the previous ten days and who are not distracted by other injuries, only those who fulfill ...
ver más ... 2018It is not recommended to routinely use antibiotics in adults and children with uncomplicated sore throats
Choosing Wisely Canada
Canadian Association of Emergency Physicians
Adults and children frequently present to the emergency department with sore throats (pharyngitis). The vast majority of cases of pharyngitis are caused by self-limiting viral infections that do not respond to antibiotics. The benefit of antibiotics for the approximately 10% of cases in adults (25% in children), caused by bacteria (principally Group A Streptococcus (GAS)) is modest at best, although is associated with fewer complications and a slightly shorter course of illness. Inappropriate ...
ver más ... 2018It is not recommended to order CT pulmonary angiograms or VQ scans in patients with suspected pulmonary embolism until risk stratification with a clinical decision rule has been applied and when ...
Choosing Wisely Canada
Canadian Association of Emergency Physicians
Many adults present to the emergency department with chest pain and/or shortness of breath. The majority of adult patients with these symptoms do not have a pulmonary embolism (PE) that requires investigation with a CT pulmonary angiogram (CTPA) or ventilation perfusion (VQ) lung scan. CTPAs or VQ scans expose patients to ionizing radiation that has the potential to increase patients’ lifetime risk of cancer. CTPAs also place patients at risk for potential allergic reaction and acute kidney ...
ver más ... 2018