September 2017 EM Articles

*NNR THIS MONTH = 109

You'd have to read 2510 articles to find these 23 gems from the journals.

*NNR - number needed to read

Pre-hospital Supraglottic Airway was Associated with Good Neurological Outcome in Cardiac Arrest Victims Especially Who Received Prolonged Cardiopulmonary Resuscitation.  Acad Emerg Med. 2017 Sep 12. doi: 10.1111/acem.13309. [Epub ahead of print]
Spoon Feed: Use of a supraglottic airway (SGA) was associated with improved survival with a good neurological outcome.

 

Using Press Ganey Provider Feedback to Improve Patient Satisfaction: A Pilot Randomized Controlled Trial.  Acad Emerg Med. 2017 Sep;24(9):1051-1059. doi: 10.1111/acem.13248. Epub 2017 Aug 16.
Spoon Feed: Patient satisfaction is important.  But the most commonly used metric in the US, the Press Ganey survey, may not be a good measure of individual emergency physician and clinician performance.  Giving emergency clinicians feedback on their Press Ganey scores, ostensibly so they could take steps to improve, did not lead to appreciable score improvements.

 

Why Do People Choose Emergency and Urgent Care Services? A Rapid Review Utilizing a Systematic Literature Search and Narrative Synthesis.  Acad Emerg Med. 2017 Sep;24(9):1137-1149. doi: 10.1111/acem.13220. Epub 2017 Jun 19.
Spoon Feed: Why do people seek emergency or urgent care?  This quick systematic review of the literature identified the following reasons.

  1. limited access to or confidence in primary care
  2. patient perceived urgency
  3. convenience
  4. views of family, friends, or other health professionals
  5. belief that their condition required the resources and facilities offered by a particular healthcare provider.

 

Critical Appraisal of Emergency Medicine Educational Research: The Best Publications of 2015.  Acad Emerg Med. 2017 Aug 31. doi: 10.1111/acem.13305. [Epub ahead of print]
AUTHORS' CONCLUSIONS: This installment in this critical appraisal series reviews twelve of the highest quality EM-related medical education research manuscripts published in 2015. This article is protected by copyright. All rights reserved.

 

The Effect of Head Position on the Cross-sectional Area of the Subclavian Vein.  Anesth Analg. 2017 Aug 31. doi: 10.1213/ANE.0000000000002446. [Epub ahead of print]
Spoon Feed:  For better success at subclavian central venous catheter placement, have the patient turn their head 30 degrees toward the side of insertion to increase the cross sectional area of the vein.

 

Push-Alert Notification of Troponin Results to Physician Smartphones Reduces the Time to Discharge Emergency Department Patients: A Randomized Controlled Trial.  Ann Emerg Med. 2017 Sep;70(3):348-356. doi: 10.1016/j.annemergmed.2017.03.021. Epub 2017 May 9.
Spoon Feed: Push alerts for troponin results to a physician's smartphone decreased time to disposition by 26 minutes, but it didn't affect total length of stay.

 

Update: D-dimer Test for Excluding the Diagnosis of Pulmonary Embolism.  Ann Emerg Med. 2017 Sep;70(3):e31-e32. doi: 10.1016/j.annemergmed.2016.12.012. Epub 2017 Mar 25.
Spoon Feed: Coming soon from Alex Chen


How Accurate Is Rapid Antigen Testing for Group A Streptococcus in Children With Pharyngitis?  Ann Emerg Med. 2017 Aug 31. pii: S0196-0644(17)30918-6. doi: 10.1016/j.annemergmed.2017.07.018. [Epub ahead of print]
Spoon Feed: The diagnostic accuracy of rapid streptococcal antigen testing is such that a negative test rules out disease and should not be treated; a positive test rules it in and should be treated.

 

Diagnostic Accuracy of Novel and Traditional Rapid Tests for Influenza Infection Compared With Reverse Transcriptase Polymerase Chain Reaction: A Systematic Review and Meta-analysis.  Ann Intern Med. 2017 Sep 19;167(6):394-409. doi: 10.7326/M17-0848. Epub 2017 Sep 5.
Spoon Feed: Diagnostic accuracy of the digitally interpreted rapid influenza A and B antigen tests (DIA) was better than the traditional rapid flu tests, 77-80% sensitive vs. 53-54% sensitive.  In children compared to adults, the sensitivity was 18.5 points higher for flu A and 32 points higher for flu B with the traditional rapid test; 12 and 25 points higher for the DIA respectively; 19.5% points higher for NAAT.  The nucleic acid amplification tests (NAATs) were overall about 95% sensitive.  All tests had specificity of about 98%.

 

Corticosteroids for treatment of sore throat: systematic review and meta-analysis of randomised trials.  BMJ. 2017 Sep 20;358:j3887. doi: 10.1136/bmj.j3887.
Spoon Feed: In patients age 5 years through adulthood with sore throat of any cause, use of a single, low-dose steroid (most often dexamethasone 10mg or 0.6mg/kg for children, max 10mg; most given orally) were twice as likely to have pain relief at 24 hours.

 

A multicenter, randomized trial of a checklist for endotracheal intubation of critically ill adults.  Chest. 2017 Sep 13. pii: S0012-3692(17)32685-5. doi: 10.1016/j.chest.2017.08.1163. [Epub ahead of print]
Spoon Feed: Calling out a verbal, pre-intubation checklist to make sure equipment was present and the intubation plan (and backup plan) was in place did not result in improved lowest oxygen saturation.

 

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association.  Circulation. 2017 Sep 18. pii: CIR.0000000000000525. doi: 10.1161/CIR.0000000000000525. [Epub ahead of print]
Spoon Feed: This 50 page AHA guideline is very concisely but completely summarized in this post.  Save some time and get the pearls.  Table 5 is fantastic, and this article is available in free full text (see Source below), so take advantage and look at this.

 

Long-Term Prognostic Value of Gasping During Out-of-Hospital Cardiac Arrest.  J Am Coll Cardiol. 2017 Sep 19;70(12):1467-1476. doi: 10.1016/j.jacc.2017.07.782.
Spoon Feed: Gasping during cardiac arrest was associated with improved neurologically intact survival.  The practical take-home is to avoid premature cessation of CPR if any signs of gasping or agonal respirations are present and to avoid suppression of spontaneous gasping during CPR.

 

Negative CT can Safely Rule out Clinically Significant Intra-abdominal Injury in the Asymptomatic Patient After Blunt Trauma: Prospective Evaluation of 1193 Patients.  J Trauma Acute Care Surg. 2017 Sep 20. doi: 10.1097/TA.0000000000001705. [Epub ahead of print]
Spoon Feed: Asymptomatic blunt trauma patients over age 14 with a negative CT abdomen/pelvis (CTAP) did not have delayed missed injuries.

 

Accuracy of Complete Blood Cell Counts to Identify Febrile Infants 60 Days or Younger With Invasive Bacterial Infections.JAMA Pediatr. 2017 Sep 11:e172927. doi: 10.1001/jamapediatrics.2017.2927. [Epub ahead of print]
Spoon Feed: Coming soon from Alex Chen.

 

Oxygen Therapy in Suspected Acute Myocardial Infarction.  N Engl J Med. 2017 Aug 28. doi: 10.1056/NEJMoa1706222. [Epub ahead of print]
Spoon Feed: Coming soon from Alex Chen

 

Outcome after stroke thrombolysis in patients >80 years treated within 3 hours vs >3-4.5 hours.  Neurology. 2017 Sep 8. pii: 10.1212/WNL.0000000000004499. doi: 10.1212/WNL.0000000000004499. [Epub ahead of print]
Spoon Feed: Elderly stroke patients over age 80 who received tPA >3 - 4.5 hours from time of onset were more likely to have symptomatic intracranial hemorrhage (SICH), 10% vs 8% in the <3-hour group, but overall mortality and percentage with good neurological outcome was the same in the delayed group as patients who received it in under 3 hours.

 

A critique of phrenology in Moby-Dick.  Neurology. 2017 Sep 5;89(10):1087-1090. doi: 10.1212/WNL.0000000000004335.
AUTHORS' CONCLUSION: Thus, Moby-Dick illustrates the diffusion of phrenology in Western culture, but may also reflect Melville's skepticism and criticism toward its main precepts.  My comment - OK, this is one weird article... 
 

Direct oral anticoagulant- vs vitamin K antagonist-related nontraumatic intracerebral hemorrhage.  Neurology. 2017 Sep 12;89(11):1142-1151. doi: 10.1212/WNL.0000000000004362. Epub 2017 Aug 16.
Spoon Feed: Coming soon from Alex Chen]

 

Utility of Blood Culture Among Children Hospitalized With Community-Acquired Pneumonia.  Pediatrics. 2017 Sep;140(3). pii: e20171013. doi: 10.1542/peds.2017-1013. Epub 2017 Aug 23.
Spoon Feed: In children without other comorbidities with moderate to severe community acquired pneumonia requiring hospitalization, the yield of blood culture was very low, and most isolated organisms were Streptococcus pneumoniae, 82% of which were penicillin sensitive.

 

Reliability of Examination Findings in Suspected Community-Acquired Pneumonia.  Pediatrics. 2017 Sep;140(3). pii: e20170310. doi: 10.1542/peds.2017-0310.
Spoon Feed: Substantial agreement on clinical exam findings in children with suspicion of pneumonia was only present for wheezing and retractions.  All other clinical exam findings had poor to moderate agreement between clinician examiners.

 

Prehospital Intubation is Associated with Favorable Outcomes and Lower Mortality in ProTECT III.  Prehosp Emerg Care. 2017 Sep-Oct;21(5):539-544. doi: 10.1080/10903127.2017.1315201. Epub 2017 May 10.
Spoon Feed: Outcome in patients with traumatic brain injury (TBI) was better in patients with prehospital intubation (PHI), but most of the intubations were performed by air transport crews.

 

Delayed return of spontaneous circulation (the Lazarus phenomenon) after cessation of out-of-hospital cardiopulmonary resuscitation.  Resuscitation. 2017 Sep;118:107-111. doi: 10.1016/j.resuscitation.2017.07.022. Epub 2017 Jul 24.
Spoon Feed: Delayed ROSC may occur after cessation of CPR - the so called Lazarus phenomenon.  The incidence is around 6/1000 cases and usually occurred within 3-8 minutes after CPR cessation.  All patients eventually died; 4 of 5 had PEA. It may be wise to allow 10 minutes before pronouncing death (or 4 days if the patient is actually named Lazarus).
 

Effectiveness of different compression-to-ventilation methods for cardiopulmonary resuscitation: A systematic review.  Resuscitation. 2017 Sep;118:112-125. doi: 10.1016/j.resuscitation.2017.05.032. Epub 2017 Jun 2.
Spoon Feed:  According to this large systematic review, in adults a 30:2 compression to ventilation ratio was better than 15:2.  For kids, either ratio was better than compression only CPR, except under 1 year in which ventilations did not improve outcome beyond compression-only.

Member Login
Welcome, (First Name)!

Forgot? Show
Log In
Enter Member Area
My Profile Sign up to get full access. Log Out