Compared with vitamin K antagonist (VKA)-related non-traumatic intracerebral hemorrhage (ICH), direct oral anticoagulant (DOAC)-related ICH had less disability, smaller bleeds, and the meta-analysis showed lower in-hospital mortality rates.
In children without other comorbidities, with moderate to severe community acquired pneumonia requiring hospitalization, the yield of blood culture was very low. Most isolated organisms were Streptococcus pneumoniae, 82% of which were penicillin sensitive.
Spinal cord injury without radiographic abnormality (SCIWORA) was very rare, 27/34069 (0.08%). Although NEXUS enrolled 3000 patients <18 years, down to age 1, all patients with SCIWORA were adults in this cohort.
Elderly stroke patients over age 80 who received tPA >3 – 4.5 hours from time of onset were more likely to have symptomatic intracranial hemorrhage (SICH), 10% vs 8% in the <3-hour group, but overall mortality and percentage with good neurological outcome was the same in the delayed group as patients who received it in under 3 hours.
In patients age 5 years through adulthood with sore throat of any cause, use of a single, low-dose steroid (most often dexamethasone 10mg or 0.6mg/kg for children, max 10mg; most given orally) were twice as likely to have pain relief at 24 hours.
Asymptomatic blunt trauma patients over age 14 with a negative CT abdomen/pelvis did not have delayed missed injuries.
Substantial agreement on clinical exam findings in children with suspicion of pneumonia was only present for wheezing and retractions. All other clinical exam findings had poor to moderate agreement between clinician examiners.
Gasping during cardiac arrest was associated with improved neurologically intact survival. The practical take-home is to avoid premature cessation of CPR if any signs of gasping or agonal respirations are present and to avoid suppression of spontaneous gasping during CPR.
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.
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.
