Best Articles of 2018
December 31, 2018
Top Articles – 2018
Airway/Anesthesia
Bougie vs Stylet – The BEAM Trial – A bougie-first approach improved first-pass success.
NPO Status – No Correlation With Sedation Outcomes – Nearly half these >6000 children did not meet fasting guidelines, yet there were no aspiration events.
Cardiology
HEART Score vs EDACS for Chest Pain – EDACS seemed to beat HEART for chest pain risk stratification.
NSTEMI – New ACEP Clinical Policy – This is the latest official statement on key NSTEMI issues in the ED.
New AHA Bradycardia Guidelines – Critical diagnosis and management pearls are covered in this summary.
Critical Care
ADRENAL – Hydrocortisone In Septic Shock – Patients with septic shock who received hydrocortisone had no mortality improvement, though shock resolved faster.
Hydrocortisone + Fludrocortisone in Septic Shock – APROCCHSS Trial – Patients with septic shock who received hydrocortisone+fludrocortisone had improved mortality.
SALT-ED Trial – Balanced Crystalloid vs NS – Balanced fluids reduced major adverse kidney events (MAKE) in ED patients.
SMART Trial – Balanced Crystalloids vs NS in Critically Ill Adults – Balanced fluids reduced MAKE in critical care patients.
Surviving Sepsis Update – Insane or Just Crazy? – The new 1-hour bundle stoked controversy and was eventually shot down.
IOTA – Oxygen, Less Is More – Supplemental oxygen in patients who didn’t really need it was associated with increased mortality in critically ill patients.
Medicine/ID/Pulmonary
Metro Is So Retro – C. diff Guidelines – Oral vancomycin was favored over metronidazole as well as more changes in management of C. diff.
Alcohol Pad Aromatherapy vs. Ondansetron – Sniffing an alcohol pad was better than ondansetron for nausea.
Inhaled Tranexamic Acid for Hemoptysis? – Inhaled TXA reduced bleeding from hemoptysis.
Drinking More Water Prevents Cystitis – Simply drinking more water reduced the frequency of UTIs in susceptible patients.
Neurology/Stroke
DEFUSE 3 – A New DAWN in Extending the Stroke Window? – Endovascular stroke treatment beyond 6 hours was still beneficial in select patients.
New 2018 AHA Stroke Guidelines – Key issues in stroke care were reviewed.
Does Diphenhydramine Help EPS with Prochlorperazine? – It did if prochlorperazine was given as a bolus but didn’t if given over 15 minutes.
The 10/20 Rule | Seizure vs Syncope – Less than 10 jerking movements was syncope; > 20 was seizure in this study.
Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage – This is a comprehensive table of reversal agents for various anticoagulant medications.
Pain/Procedure
Opioids Not Better Than Non-Opioids for Back, Hip, Knee Pain – Once again, opiates were no better and were associated with more adverse events.
Atraumatic Needles Drastically Reduce Post-LP Headache – The atraumatic needle markedly reduced post-LP headache.
Acetaminophen + Ibuprofen = Opiate – Well, the title says it all.
Drip Lidocaine On Skin Before Injection to Reduce Pain – The cooler liquid modified pain pathways without direct anesthesia and made injection hurt less.
Pediatrics
Paradigm Shift – Cuffed ETT for Children – Cuffed tubes improved ventilation and reduced complications.
PECARN – Only 1 in 500 Infants Have Bacterial Meningitis at 29-60 Days – Meningitis was extremely rare in this large prospective study in infants 29-60 days.
Does Pan-Scan Benefit Pediatric Trauma Patients? – Whole body CT didn’t reduce mortality in this retrospective study.
New S-Sign for SCFE + Klein’s Line – Check the images on this post for a new way to pick up subtle SCFE.
Amazing Tool, UTICalc – When to Check UA in Kids – This validated online tool reduced unnecessary testing and missed UTI.
Brain Injury in DKA | Fluid Rate or Type RCT by PECARN – Neither fluid rate or type affected risk of brain injury in DKA.
Scheduled Acetaminophen and Febrile Seizure – Scheduled rectal acetaminophen reduced recurrent febrile seizure in this small RCT.
Chest CT Risk vs. Aortic Injury Risk In Children – The risk of cancer from radiation exposure exceeded the chance of detecting aortic injury.
Can We Risk Stratify Febrile Infants 29-60 Days? – The modified Philadelphia criteria performed well in this age range.
Resuscitation
Hyperoxia Post-arrest, NNH = 8 – Risk of poor neurological outcome rose 3% for every hour of hyperoxia.
BVM or ETT in Arrest – New RCT – BVM equalled ETT for 30-day neurological outcome during arrest.
PARAMEDIC2 – Epinephrine in Arrest RCT – Epi in arrest improved overall survival but not 30-day survival with good neurological outcome.
EMS ETT or LT for OHCA? Answers in PART – Use of a King LT over ETT improved 72-hour survival and likely good neurological outcome.
AIRWAYS-2 – SGA vs ETT for Out-of-Hospital Cardiac Arrest – The supraglottic i-gel was equal to ETT for OHCA for 30-day neurological outcome post-arrest. But paramedics seemed to prefer the SGA.
Do Antiarrhythmic Drugs Help In Cardiac Arrest? – They didn’t in this metaanalysis.
Trauma
CT and Discharge Abdominal Stab Wounds? – Don’t do it. Nine percent with negative CT needed ex-lap.
PAMPer – Prehospital Plasma for Hemorrhagic Shock Saves Lives – A plasma-first strategy for hemorrhagic shock in trauma patients saved lives during air transport.
COMBAT – Plasma First During Ground Transport – With the shorter ground transport times, a plasma-first strategy for trauma patients with hemorrhagic shock did not reduce mortality.
WEST Guidelines – Stab Wounds, Avoid Pitfalls – This is a sensible algorithm, but you need to know the pitfalls or this will bite you.
Venous Thromboembolism
New PE Guidelines From ACEP – Critical questions are addressed.
PROPER RCT – PERC Stands the Test – PERC was once again validated as a good PE rule-out option.
Should We Anticoagulate Subsegmental PE? – This systematic review found a state of equipoise.
Treating Low Risk PE at Home – The LoPE Study – Following this protocol identified patients who were safe to treat at home.
PE Workup in Pregnancy – New Evidence – This is one of the first PE rule-out protocols I have ever seen dedicated to pregnant patients. It performed well.