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Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage. N Engl J Med. 2016 Jun 8. [Epub ahead of print] Spoon Feed: This RCT called ATACH-2 was stopped early due to futility. There was no difference in intensive BP lowering, and this group had increased adverse renal outcomes. Read More
Radiograph-Negative Lateral Ankle Injuries in Children: Occult Growt
h Plate Fracture or Sprain? JAMA Pediatr. 2016 Jan 4;170(1):e154114. doi: 10.1001/jamapediatrics.2015.4114. Epub 2016 Jan 4. Spoon Feed: We routinely splint kids with lateral malleolar tenderness and no fracture in case an occult Salter-Harris 1 (SH1) injury is present, but only 3% of kids had SH1 fractures at follow up. All recovered just as quickly as kids with sprains. It looks like an ankle brace and self-determined return to activity is OK for these kids. Read more
Early Volume Expansion and Outcomes of Hemolytic Uremic Syndrome. Pediatrics. 2016 Jan;137(1):1-9. doi: 10.1542/peds.2015-2153. Epub 2015 Dec 7. Spoon Feed: Too much IV fluid in HUS causes volume overload, but judicious early volume expansion (10% baseline weight) drastically improved the clinical course for these patients. Read more
Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants. Pediatrics. 2016 May;137(5). pii: e20160590. doi: 10.1542/peds.2016-0590. Epub 2016 Apr 25. Spoon Feed: Apparent Life Threatening Event (ALTE) has undergone a name change and redefinition. The new name for this is BRUE – Brief Resolved Unexplained Events. A BRUE consists of: “sudden, brief, and now resolved episode of ≥1 of the following: (1) cyanosis or pallor; (2) absent, decreased, or irregular breathing; (3) marked change in tone (hyper- or hypotonia); and (4) altered level of responsiveness. A BRUE is diagnosed only when there is no explanation for a qualifying event after conducting an appropriate history and physical examination.” Read more
Duration of Prehospital Resuscitation Efforts After Out-of-Hospital Cardiac Arrest. Circulation. 2016 Apr 5;133(14):1386-96. doi: 10.1161/CIRCULATIONAHA.115.018788. Epub 2016 Feb 26. Spoon Feed: This suggests prehospital resuscitation efforts in adults should be continued for at least 40 minutes to have a >99% sensitivity for 30-day neurologically intact survival. Survival rates declined with longer resuscitation times. Read more
Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest. N Engl J Med. 2016 May 5;374(18):1711-22. doi: 10.1056/NEJMoa1514204. Epub 2016 Apr 4. Spoon Feed: Neither amiodarone nor lidocaine made an impact on survival or neurological outcome for out-of-hospital arrest due to v-fib or pulseless v-tach. Read more
Evaluation of Cervical Spine Clearance by Computed Tomographic Scan Alone in Intoxicated Patients With Blunt Trauma JAMA Surg. 2016 Jun 15. doi: 10.1001/jamasurg.2016.1248. [Epub ahead of print] Spoon Feed: C-spine CT had a “negative predictive value of 99.8% for ruling out CSIs that required immobilization or stabilization.” In patients with no gross motor deficits and normal c-spine CT, it appears safe to remove the collar, even if intoxicated. Read more
Spoon FeedRegistry study data finds the criteria to start extracorporeal cardiopulmonary resuscitation (ECPR) of age <75, time from emergency call to hospital arrival within 45 minutes and initial shockable rhythm to be predictive of good neurological outcomes and survival at one month. SourceClinical outcomes among out-of-hospital cardiac arrest patients treated by extracorporeal cardiopulmonary resuscitation: The CRITICAL study in Osaka. Resuscitation.…
Spoon FeedIn the omicron era, nirmatrelvir/ritonavir (Paxlovid) is highly effective in reducing the risk of severe COVID-19 and mortality. SourceEffectiveness of Paxlovid in Reducing Severe COVID-19 and Mortality in High Risk Patients. Clin Infect Dis. 2022 Jun 2;ciac443. doi: 10.1093/cid/ciac443. Online ahead of print.
Spoon FeedChildren with functional abdominal pain and irritable bowel syndrome taking an open-label placebo reported significantly less pain and took fewer rescue pain medications. SourceEffect of Open-label Placebo on Children and Adolescents With Functional Abdominal Pain or Irritable Bowel Syndrome: A Randomized Clinical Trial. JAMA Pediatr. 2022 Apr 1;176(4):349-356. doi: 10.1001/jamapediatrics.2021.5750. Erratum in: doi: 10.1001/jamapediatrics.2022.0359.
Spoon FeedThis review article highlighted some of the pivotal pediatric emergency medicine literature in 2021. It is a great update on commonly seen pathology in the pediatric population.