November 2017
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Nov 30 2017
Testicular Torsion Salvage at 24 Hours?
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.
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Nov 29 2017
Ultrasound For Abscess in Children – The MRSA Era
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.
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Nov 28 2017
Ketamine and Long-term Behavioral Change in Children
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.
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Nov 27 2017
Treatment of Massive PE in Pregnancy
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.
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Nov 25 2017
How Aortic Dissection Presents
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.
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Nov 24 2017
Coronary CTA vs Functional Stress – Which Is Better?
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.
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Nov 23 2017
Better Sepsis Care in Resource-Limited Settings
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.
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Nov 22 2017
Myth Bust – Ondansetron and IV Opiate-Induced Nausea
Prophylactic ondansetron given with IV opiates did not decrease the rate of nausea or vomiting.
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Nov 21 2017
IV Prochlorperazine + Diphenhydramine vs Hydromorphone for Migraines
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.
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Nov 20 2017
A New Better Way to Detect LVH on ECG
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%.