Blog
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Apr 12 2024
When “Calm Down” Doesn’t Work…New ACEP Severe Agitation Policy
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This systematic review was conducted to answer the clinical question: Is there a superior parenteral medication or combination of medications for acute management of adult out-of-hospital or emergency department patients with severe agitation? These recommendations do not apply to pediatric, elderly (>65 years), pregnant, or out-of-hospital patients. For these groups, additional studies are needed given unique risk profiles.Source
Clinical Policy: Critical Issues in the Evaluation and Management of Adult Out-of-Hospital or Emergency Department Patients Presenting With Severe Agitation: Approved by the ACEP Board of Directors, October 6, 2023. Ann Emerg Med. 2024 Jan;83(1):e1-e30. doi: 10.1016/j.annemergmed.2023.09.010. PMID: 38105109. -
Apr 11 2024
What Are the New Duke ISCVID Criteria?
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Yesterday, we covered an article demonstrating the superior diagnostic accuracy of the new Duke-International Society for Cardiovascular Infectious Diseases Diagnostic (Duke-ISCVID) criteria. Today, we cover what the new criteria actually are.Source
The 2023 Duke-International Society for Cardiovascular Infectious Diseases Criteria for Infective Endocarditis: Updating the Modified Duke Criteria. Clin Infect Dis. 2023 Aug 22;77(4):518-526. doi: 10.1093/cid/ciad271. Erratum in: Clin Infect Dis. 2023 Oct 13;77(8):1222. -
Apr 10 2024
Should We Use New Duke Criteria for Infective Endocarditis?
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This external validation compared the 2023 Duke-International Society for Cardiovascular Infectious Diseases Diagnostic (ISCVID) Criteria against various other criteria for diagnosing infective endocarditis (IE) and found the 2023 Duke-ISCVID Criteria had the best test characteristics. Tomorrow, we'll dive into the new criteria. -
Apr 09 2024
STOP RCT – Duration of Antibiotics for Pediatric Febrile UTI
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The Short-Course Oral Antibiotic Therapy of Acute Pyelonephritis (STOP trial) demonstrated that a 5-day course of amoxicillin-clavulanate was noninferior to the standard 10-day course with regard to recurrence of infection.Source
STOP Trial Group. Short Oral Antibiotic Therapy for Pediatric Febrile Urinary Tract Infections: A Randomized Trial. Pediatrics. 2024 Jan 1;153(1):e2023062598. doi: 10.1542/peds.2023-062598. -
Apr 08 2024
New AHA Statement on Cardiac Cath Lab Activation After OHCA
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The goal of invasive management in the cardiac catheterization laboratory (CCL) is to identify and treat culprit coronary lesion or additional resuscitative measures (such as mechanical circulatory support (MCS) or interventions for massive pulmonary embolism). This is a scientific statement from the American Heart Association (AHA) which provides an update on the role of CCL in the management of resuscitated patients or those with ongoing cardiac arrest.Source
Cardiac Catheterization Laboratory Management of the Comatose Adult Patient With an Out-of-Hospital Cardiac Arrest: A Scientific Statement From the American Heart Association. Circulation. 2024 Jan 30;149(5):e274-e295. doi: 10.1161/CIR.0000000000001199. Epub 2023 Dec 19. PMID: 38112086. -
Apr 05 2024
New Meta-analysis – Should We Do Bougie-First Intubations?
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In this systematic review and meta-analysis to evaluate the use of a bougie versus non-bougie approach (ie. stylet) in intubations of adult patients, a bougie-first approach significantly increased the rate of first-attempt success compared to controls. But what does this say about your intubation strategy?Source
Effect of Bougie Use on First-Attempt Success in Tracheal Intubations: A Systematic Review and Meta-Analysis. Ann Emerg Med. 2024 Feb;83(2):132-144. doi: 10.1016/j.annemergmed.2023.08.484. Epub 2023 Sep 19. -
Apr 04 2024
Do Preemies Have Higher Rate of Serious Bacterial Infection?
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There was no difference in rates of bacteremia or meningitis between term and preterm infants with fever. Preterm infants had lower rates of urinary tract infection (UTI) compared to term infants.Source
Rate of Urinary Tract Infections, Bacteremia, and Meningitis in Preterm and Term Infants. Pediatrics. 2024 Mar 13. doi: 10.1542/peds.2023-062755. Epub ahead of print. -
Apr 03 2024
The Top Cardiac Arrest RCTs of 2023
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This review article discusses four randomized clinical trials (RCT) focusing on interventions for out-of-hospital-cardiac-arrest (OHCA) that were published in 2023, all of which showed negligible impact on survival for the interventions studied. -
Apr 02 2024
Trypanophobes Rejoice! Big IVs Hurt No More Than Little Ones
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This single centre RCT investigated the link between IV cannula diameter and how painful it will be to insert. 18G cannulas were not more painful nor more difficult to place than 20G cannulas across the spectrum of experience levels. Pain and insertion success rates being equal, patients are better off with cannulas that can accommodate higher flow rates.Source
Spiced RCT: Success and Pain Associated with Intravenous Cannulation in the Emergency Department Randomized Controlled Trial. J Emerg Med. 2024;66(2):57-63. doi:10.1016/j.jemermed.2023.10.008. -
Apr 01 2024
Dogma Bust – Paperclips in Penetrating Trauma
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The use of radiopaque markers (ROM) in penetrating trauma is based on expert opinion and historical clinical practice; however, there is no high-quality evidence to support their routine use in clinical practice.Source
The use of radiopaque markers is medical dogma. Acad Emerg Med. 2024 Feb;31(2):193-194. doi: 10.1111/acem.14858. Epub 2024 Feb 6.