1. Whelan DB, Kletke SN, Schemitsch G et al. Immobilization in External Rotation Versus Internal Rotation After Primary Anterior Shoulder Dislocation: A Meta-analysis of Randomized Controlled Trials. Am J Sports Med. 2015 Jun 26. pii: 0363546515585119. [Epub ahead of print]
CONCLUSION: Immobilization in external rotation is not significantly more effective in reducing the recurrence rate after primary anterior shoulder dislocation than immobilization in internal rotation. Additionally, this review suggests that there is minimal difference in patients' perceptions of their health-related quality of life after immobilization in internal versus external rotation. PMID: 26116355
Comments: Some studies have shown reduced recurrence of anterior shoulder dislocation if immobilized in external rotation post reduction. This meta-analysis did not bear this out. Routine slinging in internal rotation is adequate post reduction.
2. Sloan BK, Kraft EM, Clark D et al. On-site treatment of exertional heat stroke. Am J Sports Med. 2015 Apr;43(4):823-9. doi: 10.1177/0363546514566194. Epub 2015 Jan 28.
CONCLUSION: On-site treatment of athletes who develop exertional heat stroke appears to be both safe and effective. On-site treatment may decrease the local burden of critically ill patients to emergency departments during large athletic events. PMID: 25632055
Comments: I have always been taught "wet and windy" for heat related illness. That is, cool mist and fans provide rapid evaporative cooling. But the most rapid cooling method is cold water immersion CWI. This is logistically challenging in the ED, as there are few 50 gallon horse troughs laying around, certainly not enough large containers for multiple patients to undergo CWI. In the large Indianapolis Mini-Marathon (a half marathon, 13.1 miles), they used numerous 50 gallon horse troughs for CWI with great success. Over 8 years, there were 32 heat stroke patients, of which 22 were treated on site and released. All had a good outcome. The other 10 were transported to local EDs. No patients died. Here is the protocol they used. They used iStat electrolytes and a rectal temperature probe.
1. Wright AA, Hegedus EJ, Lenchik L et al. Diagnostic Accuracy of Various Imaging Modalities for Suspected Lower Extremity Stress Fractures: A Systematic Review With Evidence-Based Recommendations for Clinical Practice. Am J Sports Med. 2015 Mar 24. pii: 0363546515574066. [Epub ahead of print]
CONCLUSION: MRI was identified as the most sensitive and specific imaging test for diagnosing stress fractures of the lower extremity. When MRI is available, NS is not recommended because of its low specificity, high dosage of ionizing radiation, and other limitations. Conventional radiographs are likely to result in false negatives upon initial presentation, particularly in the early stages of stress fracture, and in some cases may not reveal an existing stress fracture at any time. A diagnostic imaging algorithm was developed with specific
recommendations for cost-efficient imaging of low-risk and high-risk suspected stress fractures. PMID: 25805712
Comments: Here is the evidence-based algorithm they came up with. The only time I would consider emergent MRI in the ED (if x-ray negative) would be in the case of a high-risk locations as described in the article: femoral neck, anterior cortex of the tibia, tarsal navicular, and base of the fifth metatarsal.
Clinical Prediction Rules