About William Paolo, MD

Residency Program Director
Assistant Professor of Emergency Medicine
SUNY-Upstate Medical Center

Vomiting in Kids After Head Trauma: To CT or Not to CT?

A 6-year-old male is brought to the emergency department (ED) after falling from the monkey bars at a local playground. Physical examination reveals no scalp hematoma, and the child appears alert and well oriented. You decide to observe him over the next 30 minutes hours to determine if he develops any disconcerting symptoms. After 15 minutes of observation within the ED the patient has an episode of vomiting witnessed by the nurses. The patient’s mother wants to know if this means he has failed his observation period and needs to receive a head CT. Your answer? (more…)

By William Paolo, MD|2016-12-16T12:06:29-08:00Sep 18, 2014|Pediatrics, Trauma|

Anxiolytics and Hypnotics: Are They Doing Harm?

A patient presents to the emergency department complaining of increasing insomnia due to anxiety. She states that she is not actively suicidal nor homicidal but she has trouble “turning off her brain” at night in order to sleep and her insomnia is worsening her anxiety. She has a history of morbid obesity and smokes 1 pack of cigarettes per day. In order to help you consider writing her a prescription for 5 mg of zolpidem as you presume it to be a benign way to deal with her current sleep disorder. But what does the evidence say about these drugs and the risks of harm? (more…)

By William Paolo, MD|2016-11-11T19:21:16-08:00Jul 2, 2014|Psychiatry, Tox & Medications|

Ondansetron: Has it reduced need for IV rehydration in vomiting kids?

A 3-year-old male presents to the emergency department (ED) complaining of vomiting and diarrhea that has been occurring for 2 days. The mother states that the child has had fewer wet diapers today but has made tears when crying. On physical examination you note no rebound or guarding of the abdomen and determine that the child is moderately dehydrated. Your initial plan is to administer ondansetron and rehydrate the child orally. This is what you have been taught but is it actually efficacious? A just published 2014 JAMA Pediatrics article attempted to answer this question.

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By William Paolo, MD|2016-11-11T19:20:56-08:00May 22, 2014|Gastrointestinal, Pediatrics|

Deep Vein Thrombosis (DVT): Wells criteria and D-dimers happy together

You are evaluating a 45-year-old male who is complaining of calf pain. He has a history of cancer however he has never had a clot in the past. The leg is neither swollen nor warm but he notes a cramping sensation in the posterior portion of his calf. You are concerned for a deep vein thrombosis (DVT) and consider the multiple means to reliable exclude the diagnosis: Wells score, D-dimers, ultrasound? What works?

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By William Paolo, MD|2016-11-11T19:46:08-08:00Apr 24, 2014|Cardiovascular|

Article: Hypotonic maintenance IV fluids in pediatrics

A 6-month-old male presents to the emergency department with diarrhea and vomiting. Despite antiemetic therapy, the the child is unable to tolerate oral intake in the ED and so you opt to admit him to the hospital for IV fluids. The pediatric hospitalist requests that you write maintenance fluids prior to admission to the floor. Utilizing the 4-2-1 rule you calculate maintenance needs and choose D5 ½NS as your fluid. This is what you had been taught to utilize in children. It seems appropriate… but is it?

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By William Paolo, MD|2016-11-11T19:19:57-08:00Apr 9, 2014|Endocrine-Metabolic, Pediatrics|

Article: Elevated INR May Overestimate Coagulopathy in Trauma and Surgical Patients

A 55 year old woman presents as the driver of a motor vehicle collision. She has moderate abdominal tenderness diffusely and a seat belt sign, but has a negative abdominal/pelvis CT. Her INR, however, was noted to be 2.1. She is not on any vitamin K antagonists. The surgeons admit her to the hospital to observe for a potential hollow viscus injury and requests that you order 2 units of FFP for her. Seems reasonable… or is it? What is the logic?

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By William Paolo, MD|2016-11-11T19:19:39-08:00Mar 17, 2014|Heme-Oncology, Trauma|