July 2018

In women with confirmed first trimester pregnancy loss, the combination of mifepristone 200mg orally and misoprostol 800μg vaginally at 24 hours vs misoprostol 800μg alone resulted in improved complete expulsion at day 8 (NNT = 6) and decreased need for surgery: 9% vs 24%.

This is amazing! UTICalc is an online tool that can both reduce unnecessary testing and missed UTIs.

This large RCT found tamsulosin was of no benefit for kidney stone passage at 28 days, regardless of size or location.

There was no patient safety benefit to having attending internal medicine physicians physically join rounds on established (not new) inpatients.  My application of this to the ED is to make sure I give our residents enough autonomy to learn.

I recently read an article entitled The Mid-Career Demon.  Finding myself in mid-career, and with such a provocative title, my curiosity was piqued.  The concept of acedia, the “mid-career demon,” intrigued me.  I had felt this way too. Here is how I am making it through mid-career.

Oral fluconazole is safe to use in pregnancy.

Most strokes from blunt cerebrovascular injury (BCVI) occurred at a median time of 48 hours.  If other injuries allow it, the earlier antithrombotic therapy can be started, the better for preventing stroke.

Combining Klein's line for the AP view and the new S-sign for the frog-leg lateral view increased the diagnostic accuracy for detecting slipped capital femoral epiphysis (SCFE).

Paired head and c-spine CT scans had low yield for detecting clinically significant injury (CSI) on both, 0.5%.  This suggests a selective scanning, rather than a shotgun approach, may be better.

Midazolam 5mg IM beat haloperidol 5 mg, ziprasidone 20 mg, olanzapine 10 mg, and haloperidol 10 mg (all also given IM), with 71% sedated at 15 minutes.  Olazapine came in second.