Best Articles of 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.

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