Top Articles - 2018
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.