March 2018
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Mar 16 2018
Hyperoxia Post-arrest, NNH = 8
This study gives high quality evidence that hyperoxia post-arrest is harmful. For each hour of hyperoxia (PaO2 >300), risk of poor neurological outcome rose by 3%. Number needed to harm was 8.
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Mar 15 2018
High Sensitivity Troponin and Renal Disease
In patients with renal disease (GFR <60) presenting with possible acute coronary syndrome, high-sensitivity troponin (hs-TN) can still be used to identify those who are low-risk. But the overall percentage deemed low risk was much lower, as was specificity, in patients with renal impairment.
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Mar 14 2018
ACEP Update – Minors in the ED
This is a needed update to the 1993 ACEP statement on the Evaluation and Treatment of Minors in the ED.
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Mar 13 2018
ICH in NOAC vs Warfarin and Mortality
Among patients with ICH, those on non-vitamin K oral anticoagulants had a lower in-hospital risk of mortality compared to warfarin (26.5% vs 32.6%). Compared to warfarin, those on NOACs were more likely to be discharged home (+3.3%), be functionally independent (+2.5%), and have the ability to ambulate independently at discharge (+1.8%).
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Mar 12 2018
Trimethoprim and Risk of Hyperkalemia and AKI in Elderly
Trimethoprim (TMP) was associated with increased risk of hyperkalemia and acute kidney injury (AKI) in adults over age 65.
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Mar 09 2018
Opiates and Risk of Invasive Pneumococcus
Opiate use was associated with invasive pneumococcal disease.
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Mar 08 2018
PECARN – Only 1 in 500 Infants Have Bacterial Meningitis at 29-60 Days
Bacteremia and bacterial meningitis occurred in 3.1% and 1.3% of infants </=28 days, respectively; 1.1% and 0.2% of infants 29-60 days, respectively. With a 1/500 chance of bacterial meningitis in infants 29-60 days, reasonable physicians may disagree on the merits of the lumbar puncture in this group.
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Mar 07 2018
ACEi-ARBs and Hypotension After Induction
Hold ACE-inhibitors (ACEi) or angiotensin receptor blockers (ARBs) in patients you know will need surgery. These drugs are not associated with mortality but are associated with, at times, profound, sustained hypotension after induction.
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Mar 06 2018
PROPER RCT – PERC Stands the Test
In low-risk patients with suspected PE, PERC was not inferior to a conventional strategy. The PERC group underwent 10% fewer CTPA studies, had a decreased ED length of stay of 36 minutes, and a decrease in hospital admission of 3.3%.
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Mar 05 2018
Dry Drowning – Stop the Myth
Children with a non-fatal drowning event who present to the ED with normal vital signs and normal SpO2 very rarely deteriorated. The 3% (2/62) who had delayed complications did so within one hour of arrival.