November 2017

Consider testicular torsion a surgical emergency even if it is past the usual 6-8 hour mark, which is traditionally taught as the outer limit of testicular viability.  This study found that the testicle could still be salvaged over half the time from 13-24 hours from onset.

Sonographically occult perineal abscess in children was surprisingly common, 28% (61/217).  More than half had I&D within 4 hours of a "negative" radiology-obtained ultrasound.  Symptoms < 4 days, age < 4 years, and history of MRSA were all associated with false negative ultrasound.

After using ketamine for pediatric procedural sedation, 22% of children experienced negative behavioral symptoms measured 1-2 weeks after ED discharge. The most common symptoms were apathy/withdrawal and separation anxiety. Pre-procedural anxiety was the greatest predictor of negative behavioral changes.

Treatment with lytics for acute PE (mostly massive or with arrest) in pregnancy out to 6 weeks postpartum was associated with 94% overall maternal survival and 88% fetal survival.  Major bleeding occurred in 17% of pregnant women and 58% of those in the postpartum period.

Sudden-onset, severe ("worst-ever"), sharp chest pain was the hallmark type A and B aortic dissection.  Ripping or tearing pain was present in only half of patients.  Classic features of aortic regurgitation murmur and pulse deficit were frequently lacking.

There was no mortality difference based on which stress test was done, coronary CTA (CCTA) or functional stress testing.  But CCTA led to more downstream testing.  Either test is fine, but know that tests may have unintended consequences.

Early sepsis treatment with protocolized IV fluid, pressors, and transfusions vs usual care was undertaken in Zambia, and resulted in much higher mortality.  Most patients had HIV.  This is yet another strike against a form of early goal-directed therapy (EGDT) vs. usual sepsis care.

Prophylactic ondansetron given with IV opiates did not decrease the rate of nausea or vomiting.

The primary outcome (quick and sustained headache relief) was achieved in 60% of the IV prochlorperazine + diphenhydramine group vs 31% in the IV hydromorphone group with a NNT of 4. As a result, the study was stopped early.

Adding the magnitudes of the deepest S wave anywhere in the ECG to the deepest S wave in lead V4 (SD + SV4) was the most sensitive ECG test for LVH (62%) while maintaining specificity above 90%.