Chloride poisoning – too much is bad
For every 100 meq of increased chloride load in patients needing large amounts of isotonic fluid, hazard for death increased 5.5% even after controlling for potential confounders.
October 2016
RINSE but don’t repeat
Prehospital cold saline during CPR did not improve outcome and may have caused harm.
NSAIDs increase risk of CHF admission
NSAIDs increase the risk of hospitalization for heart failure and should be avoided in at-risk patients.
PCC reverses warfarin for LP
PCC is an effective way to reverse warfarin for emergent LP.
Tamsulosin helps pass larger stones
Tamsulosin helps pass larger stones but is of no benefit for smaller (<5 mm) stones, according this this meta-analysis of 8 RCTs.
Buccal O2 in obese patients – 12.5 min of apnea
Buccal O2 allowed 12.5 minutes of apnea without hypoxia in obese patients.
ABEM ConCert exam – does it make a difference
This ABEM study found that we reinforce old info and learn some new by taking the ConCert exam, but a more important question is if this expensive process improves patient outcomes.
CT vs TTE for RV strain in PE
CTPA has good sensitivity for detecting RV strain but is not specific and is a poor sole predictor of bad outcome if TTE does not confirm RV strain.
Sending fever and neutropenia home
Using validated risk scores, like MASCC, some patients with fever and neutropenia can be safely treated at home on oral antibiotics.
Ketamine safe to use in kids outside the OR
Ketamine use outside the OR was safe in kids, with adverse events about 7%, serious events <2%.