LR - When NOT to Use It

LR - When NOT to Use It

With all the talk of using balanced, lower chloride solutions for volume in the ED and ICU, we thought it might be a good idea to discuss the potential downsides of LR.

Value of "Red Flag" Questions for Back Pain

Value of "Red Flag" Questions for Back Pain

Positive responses to "red flag" screening questions for back pain warranted further investigation, though the positive predictive value was poor.  Negative responses to screening "red flag" questions were useless as a screening tool for ruling out serious disease, such as fracture, infection, malignancy, or cauda equina.

Self-Reduction of Shoulder Dislocation - Like a Boss

Self-Reduction of Shoulder Dislocation - Like a Boss

The Boss-Holzach-Matter (aka Davos, self-reduction) technique was less painful than the physician-driven Spaso technique and just as successful and efficient.

SMART Trial - Balanced Crystalloids vs NS in Critically Ill Adults

SMART Trial - Balanced Crystalloids vs NS in Critically Ill Adults

In patients admitted to the ICU, use of balanced fluids resulted in a lower rate of major acute kidney events (MAKE) at 30 days compared to normal saline (14.3% vs 15.4%). This is a NNT of 94 to avoid one MAKE.

SALT-ED Trial - Balanced Crystalloid vs NS

SALT-ED Trial - Balanced Crystalloid vs NS

In non-critically ill patients that received IV fluids in the ED, there was a lower incidence of major adverse kidney events in the balanced crystalloid group compared to saline (4.7% vs 5.6%) with a NNT of 111. There was no difference in terms of hospital-free days between the groups.

Fluoroquinolones - Risk of Aortic Aneurysm and Dissection

Fluoroquinolones - Risk of Aortic Aneurysm and Dissection

Fluoroquinolone use was associated with increased risk of developing newly diagnosed aortic aneurysm or dissection.

Just Drunk or Critically Ill?

Just Drunk or Critically Ill?

One percent of patients presenting with acute alcohol intoxication eventually needed critical care admission.  Be wary of abnormal vital signs, hypoglycemia, or the need for additional chemical sedation, as these were associated with an increased odds of needing the ICU in such people.

MRSA - I&D Only or Add Antibiotics?

MRSA - I&D Only or Add Antibiotics?

This meta-analysis of 4 RCTs found anti-MRSA antibiotics in addition to I&D led to a far better cure rate than I&D alone.

Should We Anticoagulate Subsegmental PE?

Should We Anticoagulate Subsegmental PE?

This systematic review suggested that we don't know if treating subsegmental PE harms or helps.  But this may inform decision making in patients in whom it would be very dangerous to anticoagulate.  It suggests a state of equipoise.

Hydrocortisone + Fludrocortisone in Septic Shock - APROCCHSS Trial

Hydrocortisone + Fludrocortisone in Septic Shock - APROCCHSS Trial

In patients with septic shock, those treated with hydrocortisone + fludrocortisone had a lower 90-day mortality compared to placebo (43% vs 49.1%, NNT 17). They also had significantly more vasopressor-free and organ-failure free days, in addition to having a shorter time to weaning from vasopressors and mechanical ventilation.

How to Change Opiate Prescribing Habits

How to Change Opiate Prescribing Habits

Emergency clinicians who underestimated their own opiate prescribing were impacted more profoundly to reduce prescriptions by being shown their opiate prescribing data compared to their peers.

Metro Is So Retro - C. diff Guidelines

Metro Is So Retro - C. diff Guidelines

If you're still reaching for metronidazole in patients with suspected or confirmed C. difficile colitis, it's time to get up to speed with this summary.

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