Why We Use NEXUS for C-Spine Clearance

Why We Use NEXUS for C-Spine Clearance

The NEXUS criteria can be used to determine which patients do not need c-spine x-rays.  Since this was published, we have shifted to predominantly CT imaging, which is more sensitive.  Also, we have learned that NEXUS is not as sensitive in elderly patients.

Should We Ditch Preintubation Checklists?

Should We Ditch Preintubation Checklists?

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.  Read on to see why we shouldn't ditch the checklist just yet.

CBC Misses Invasive Bacterial Infection in Febrile Infants Under 60 Days

CBC Misses Invasive Bacterial Infection in Febrile Infants Under 60 Days

The CBC is not a very good test for identifying invasive bacterial infections in febrile infants ≤60 days. If you used common normal ranges of WBC count (5000-14900) and absolute neutrophil count <10k, you would have missed 63% and 82% of invasive bacterial infections, respectively.

How Accurate Is Your Rapid Flu Test?

How Accurate Is Your Rapid Flu Test?

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; 2.7% points higher for nucleic acid amplification tests (NAATs).  NAATs were about 95% sensitive overall.  All tests had specificity of about 98%.

Absorbable Suture vs Nylon in Pediatric Lacerations

Absorbable Suture vs Nylon in Pediatric Lacerations

There was no difference in cosmetic outcome with use of absorbable vs. nonabsorbable suture for pediatric lacerations, though there was a nonsignificant trend to absorbable being superior.  There was also no difference in dehiscence or infection rate between the two.

Hey, Press Ganey - You Can't Improve What You Can't Control

Hey, Press Ganey - You Can't Improve What You Can't Control

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.

Does POCUS Degrade CPR Quality?

Does POCUS Degrade CPR Quality?

Point of care ultrasound may be very useful during CPR, but it should not get in the way of chest compressions.  If you're going to use it, get in there quick and get out of the way or choose a view that allows continuous chest compressions (i.e. subxiphoid).