April 2019

Hyperlactatemia appears to arise from impaired oxygen utilization more often than decreased O2 delivery but doesn’t cause acidemia unless there is impaired renal function. The novel “alactic base excess” may give us an early way to tell when the kidneys are failing to compensate.

Risk of repeat visit with subsequent admission was not increased in children <2 years with UTI treated at home with oral antibiotics vs those initially admitted.

In patients ≥60 years, abnormal orthostatic vital signs (OVS) did not predict 30-day serious outcomes.

Thunderclap headache (TCH) is a concerning symptom and requires diagnostic evaluation. Initial head CT w/o contrast can help detect SAH with negative LR of 0.01 if performed within 6h of headache onset. However, a head CT w/o contrast can miss other causes of TCH and may require advanced imaging and LP.

A 250mg/kg, 12-hour N-acetylcysteine (NAC) protocol was as effective as the usual 300mg/kg, 20-hour protocol in patients at lower risk for hepatotoxicity.

Evidence for the 1-hour bundle release by the Surviving Sepsis Campaign is weak. Yet, this is the new standard we are held to, despite ACEP, AAEM, and thousands of physicians, EM and non-EM alike, voicing concern that this is a very bad idea.

There was no statistical difference in inadequate vascular filling for CT pulmonary angiogram (CTPA) if the IV catheter was smaller than 20 gauge (ga) or if it was not in the antecubital fossa (AC) or forearm. Read on for the caveats.

Removal of the ARISTOTLE study (known to contain falsified data) from 22 subsequent meta-analyses led to a change in the conclusion of these meta-analyses nearly half the time. Research misconduct hurts people.

Eyewitness accounts describing an event with loss of consciousness are helpful in differentiating seizure vs syncope or true seizure vs psychogenic nonepileptic seizure (PNES) but may not be as helpful in determining syncope vs PNES.

There was no difference in 90-day survival or other outcomes with immediate vs delayed cardiac catheterization in patients who were post-cardiac arrest and had no STEMI criteria on ECG.