Metro Is So Retro – C. diff Guidelines
If you’re still reaching for metronidazole in patients with suspected or confirmed C. difficile colitis, it’s time to get up to speed with this summary.
March 2018
HEART Score vs EDACS for Chest Pain
In this head-to-head comparison between HEART and EDACS, EDACS identified 10% more patients as low risk with a nearly identical negative predictive value for major adverse cardiac events at 60 days.
Is 15 WBC in CSF Normal? Age-Specific Norms
Normal CSF looks different in neonates and infants 29-60 days. Here are the reference values.
Supply of Opiates – Who’s Prescribing Them?
Episodic prescribers (most prescribers in the ED) contributed to less than 3% of the total morphine milligram equivalents prescribed, compared to the top 5% of prescribers who were responsible for 48.8%. Efforts to curb the opioid supply may be better served by targeting high-quantity prescribers.
Fast PEA | Slow PEA – Survival Difference
There is a difference between PEA rhythms. Slow rates of electrical activity had the usual dismal prognosis. But those with electrical rates >60 had survival and favorable neurological outcome comparable to VF/VT, 22% and 15% respectively.
Gastric Button Battery – Emergent Scope?
This single-center series found button batteries (BB) lodged in the esophagus all caused mucosal injury, but those in the stomach also caused mucosal injury in 6 out of 12. We may need to rethink the urgency of retrieving gastric BB.
People Are Not Using EtCO2 for ETT Confirmation?
This study showed 7% of doctors intubating children were not using any form of EtCO2 detection to confirm placement: waveform capnography or colorimetric. This is appalling. The point of the article was to encourage use of capnography, but a more important message is you must use some form of EtCO2 detection.
Fix Leaks | Then Fill Bucket – Hypotensive Resuscitation
Allowing penetrating or blunt trauma patients to remain temporarily hypotensive in the field vs giving volume resuscitation prior to definitive surgical repair improves mortality and seems to decrease blood loss and need for transfusion of blood products.
Does Diphenhydramine Help EPS with Prochlorperazine?
Prophylactic diphenhydramine reduces extrapyramidal symptoms in patients receiving bolus anti-emetic therapy (given over 2 minutes), but not when the anti-emetic is given as an infusion over 15 minutes.
People Die When ICUs Deny Admissions
Lack of a MICU bed doesn’t mean the ED patient is not critically ill. The longer patients whom the ED determined needed ICU care boarded in the ED before being moved to the ICU, the greater the odds of mortality.