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These mechanisms can potentially reduce secondary injuries and enhance clinical outcomes (Fernndez-Gajardo, Matamala, Carrasco, Gutirrez, Melo and Rodrigo, 2014)

Acetaminophen is contraindicated in patients with severe hepatic impairment or severe active liver disease and should be used with caution in patients with hepatic impairment or active liver disease [see Warnings and Precautions (5.1) and Clinical Pharmacology (12)]

Routine ERCP should be avoided in patients with low to intermediate suspicion of retained bile duct stones, who are planned to have cholecystectomy

PMID: 111 DuschaAHegelmaierTDrholzKDeselCGoldRZaissMMet al

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Advertisement This protocol is an extension of the widely accepted PEN-FAST (penicillin allergy reported by patient, five years or less since reaction, anaphylaxis or angioedema, severe cutaneous adverse reaction, and treatment required for reaction) clinical decision tool that has been used to identify patients with reported penicillin allergy who are appropriate for DOC rather than immediate hypersensitivity skin testing, which recent data suggest has poor positive predictive value in low-risk patients