August 2017

Meningitis was a very rare cause of status epilepticus (SE) in this retrospective single-center review.

Idarucizumab reverses anticoagulation 100% due to dabigatran in the test tube. It seemed to stop active bleeding in patients in about 2.5 hours, and reported operative hemostasis was good.  But since this was an open label trial with no control group, we don't know how the outcomes would have compared with patients who were treated with other procoagulants or who were not treated.

Supine position to improve cerebral blood flow in ischemic stroke patients did not impact outcome positively or negatively compared to head-of-bed elevation 30 degrees.

Even small abscesses, <5cm, benefitted from antibiotics.  This is contrary to some prior studies' findings that I&D alone was adequate for small abscesses.

Non-invasive ventilation (NIV) in patients with acute exacerbation of COPD decreased the need for intubation and reduced in-hospital mortality.

ED stress testing, in addition to standard workup with ECG and biomarkers, led to more downstream testing (angiography) and more interventions (PCI or CABG), but this didn't translate into fewer acute myocardial infarctions at one year.

If clinical gestalt for PE is low, use PERC to rule out PE.  If not ruled out, use a validated tool to determine pretest probability of PE: Wells, Revised Geneva, or simplified versions of either score.  If non-high or "unlikely" pretest probability, order D-dimer, adjusting for age (<500 or <age x 10).  If D-dimer is negative, PE is ruled out.  If positive, order CT pulmonary angiogram.

A negative c-spine CT had 99.9% NPV for clinically significant c-spine injury in intoxicated patients.  The Western Trauma Association recommends c-spine clearance, even in intoxicated patients, if gross motor function is normal, no neurologic complaints, and negative c-spine CT per experienced radiologist.  Be careful out there, and get institutional buy-in if you plan to put this into practice.

A simplified Geneva Score is safe to use in place of the Geneva score and is straightforward, with each criterion being worth one point.  Low to Intermediate pretest probability plus negative D-dimer with the simplified Geneva ruled out PE as well as the regular Geneva score.

This was a fun article that searched the literature and dispensed with 10 myths about cellulitis.