February 2018
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Feb 14 2018
Cephalexin for Pediatric UTI
A push to use cephalexin vs cefixime for uncomplicated pediatric UTI was successful at this medical center. Whether this is an improvement in prescribing depends upon local E. coli resistance.
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Feb 13 2018
Platelet Transfusion Triggers
Transfusion of platelets prophylactically may do more harm than good.
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Feb 12 2018
DEFUSE 3 – A New DAWN in Extending the Stroke Window?
Patients beyond the 6-hour invasive stroke treatment window benefitted from endovascular treatment of proximal MCA or ICA occlusion up to 16 hours from onset if there was a large ischemic penumbra on perfusion imaging that had not yet infarcted.
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Feb 09 2018
Evidence for the Epi-Spritzer (aka Push-Dose Pressor)
Low-doses of IV epinephrine in unstable, hypotensive pediatric patients temporarily increased heart rate and mean arterial pressure.
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Feb 08 2018
Higher DBP In Arrest Impacts Survival
Maintaining a diastolic blood pressure (DBP) of >/=25mm Hg in infants and >/= 30mm Hg in children over age 1 during CPR was associated with improved survival to discharge and improved neurologically intact survival. This is possible only if a child arrests and has invasive BP monitoring in place but is a good reminder that high quality CPR in all patients drastically impacts survival.
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Feb 07 2018
Private to Public ED Dumps Hurt Patients
Failure of private hospitals to care for the uninsured resulted in informal ED to ED referrals, which meant up to 20% increased volume in public EDs for certain diagnoses, particularly orthopedic issues. This led to duplicate testing, increased cost, complications, delays in care, and poor treatment of the most vulnerable patients.
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Feb 06 2018
Fluid Bolus in Asthma – Helpful or Harmful?
Too much fluid in pediatric asthma is a bad thing, leading to worse clinical outcomes and increased interstitial lung water. For each 1% fluid overload, patients spent 7 additional hours in the hospital.
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Feb 05 2018
Prevalence of PE in Syncope
This large, retrospective study found the prevalence of PE in hospitalized patients discharged with a diagnosis of syncope was 0.15% to 2.1%; 0.35% to 2.63% at 90-day follow up. This was much lower than the PESIT trial, at 17.3%.
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Feb 02 2018
Contrast Nephropathy Is Real
There are good data to support contrast-associated acute kidney injury (CA-AKI). With the use of low osmolar contrast agents, the risk may be lower. However, none of the myth-busting studies are good enough to exclude the risk of CA-AKI, especially in the most vulnerable patients.
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Feb 01 2018
Contrast Nephropathy Is a Myth
There is increasing literature that supports the notion that radiocontrast administration does not increase the risk of developing acute kidney injury.