Best Articles of 2018

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.

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.


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.

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.

Member Login
Welcome, (First Name)!

Forgot? Show
Log In
Enter Member Area
My Profile Sign up to get full access. Log Out