June 2018
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Jun 19 2018
Battle of the Lytics – Tenecteplase vs Alteplase Prior to Thrombectomy
Tenecteplase was superior to alteplase when given for acute ischemic stroke prior to thrombectomy.
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Jun 18 2018
MRI-Guided Alteplase for Wake-Up Stroke
For patients with unknown time of stroke onset, MRI characteristics may be able to discern the timing of the stroke and allow for thrombolytic therapy. Overall, outcomes were better with thrombolysis but at the possible cost of higher mortality and risk of intracranial bleed.
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Jun 16 2018
Five Fun Ways to Fight Burnout
Burnout is a huge problem among physicians, especially those of us in the ED. I have been through it and still battle that feeling from time to time. I don't have any simple answers. But I do have five fun, simple things you can do to take your mind off work and give you a respite.
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Jun 15 2018
LP on Dual Antiplatelet Therapy?
Lumbar puncture (LP) in this small cohort of patients taking dual antiplatelet therapy was not associated with an increased risk of complications. I would still proceed with caution in such patients.
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Jun 14 2018
Nitrofurantoin Beats Fosfomycin for UTI in Women
Nitrofurantoin was clearly superior to fosfomycin for uncomplicated UTI in adult women.
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Jun 13 2018
NPO Status – No Correlation With Sedation Outcomes
In this cohort of thousands of pediatric ED sedation patients who didn't meet the American Society of Anesthesiologists (ASA) fasting guideline, none had aspiration nor was there any correlation of fasting time with any adverse events or vomiting. It is time to change hospital NPO policies for the ED.
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Jun 12 2018
Syncope/Pre-syncope and Outcome in PE Patients
Syncope or pre-syncope in patients with PE was associated with an increased risk for 30-day mortality (43% vs 6%) and was an independent predictor of 30-day mortality when accompanied by hemodynamic instability on admission. Don't try to treat them as an outpatient.
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Jun 11 2018
Start Strong, Finish Weak – Attending Shift Productivity
Attending physician productivity peaks at the beginning of the shift, starting with about 3 new patients in the first hour and decreases as the shift progresses. This has important implications for staffing models. Assuming a simple, uniform average over the shift won't work.
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Jun 09 2018
When Learning Just Clicks
This week on one of my favorite podcasts, Hidden Brain, the host, Shankar Vedantam presented something I had never considered in education. I highly recommend you listen to this podcast for yourself, but I will briefly summarize, because this could have a profound impact on those we teach in Emergency Medicine.
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Jun 08 2018
Stop Anticoagulants for Nuisance Bleeding?
Nuisance bleeding in patients with atrial fibrillation on oral anticoagulants did not portend subsequent major bleeding or increased risk for stroke/systemic embolism.