Keto....

Our Chief of Admin approached me 2 days ago in the ED. She showed me a case note and asked me about the details of consultation. The case was a 5 yrs boy who had fever. He was seen by one of our locum doctor during the weekend. The boy had developed allergy after ketoprofen was given parenterally - yes "parenterally", his allergy was managed and discharge withour observation, the family was not happy with it of coz.....The family had come to our hospital the next day and asking for explaination. They had posted a few question : was the drug suitable ? , did the staff given an overdose and leading to the allergy ? I explained to the family and pacified the mother and she went home.
I had a discussion with our Chief of Admin - well, the management was in-appropriate definitely... ketoprofen was suposed to given intramuscularly and not parenterally. Luckily no anaphylaxis was noted. I told the Chief of Admin I would discuss with Lem and set up a protocol. Since my return to this hospital, I had pushed very hard about the ketoprofen IV issue. In the past, we had tended to give ketoprofen parenterally(including me) , but later we learnt that it was a very dangerous act  - indeed we had encountered various case who developed severe reaction. Now most of us are giving the drug intramuscularly but it would be difficult to restrict locum doctor if no written protocol is set.
This locum doctor is a ED certified physician who was previously trained in family medicine. He had stepped on several tails in our hospital. Han had a peritonitis case who was referred out instead of calling our own surgeon to manage it. I had case who was diagnosed as UTI and given moxifloxacin....But we have to tolerate him as locum doctor would need time to coup and get use with the tempo of the hospital.
After the discussion with the Chief of Admin, the nurse who overheard the discussion had come to me and told me that the locum doctor L had some opinion about my management... Opinion means "against" of coz... I asked them about the detail - he had told the family and nurse that I did not give "adequate" medicine to the paeds patient for URI...He likes to give multiple drug for antipyretic, and 2 antihistamine at least compare to my "all syrup" regimen. (usually 2 bottles - paracetamol and a multiple component antihistamine+ bromhexine+ antitussive mixture). That was what I gave my children....as the ancient taiwanese proverbs said, "there are endless children(other peoples of coz) to die"
I had this colleague back in my ex-hospital - he is a plastic surgeon turned ED physician. He is not internal medicine trained and his management for medicine case is criticized by most of the attending physician especially the cardiologist. However the chief of staff managed to "calm" everyone down with this - " since everyone of you are not satisfy with him , I will fire him then - but the left over of 15 ED night shift will be left over to you guys ..." . Since then no one made any complaint ....
Well, we had this similiar condition at the moment - our hospital superintendent had not only once hinted us that he wanted us to cover the weekend call - and we denied his pledge of coz...  nothing to shout about with this locum doctor at the moment....
I had reminded the ED nurses that no IV ketoprofen in the future - if any doctor orderded it make sure he pushes the drug himself....
maybe we should introduced Ketorolac - but it is far more expansive NT 10 vs NT 55....