June 2019

Combining a Δ1h high-sensitivity troponin (hsTn) with the HEART score in a diagnostic algorithm helped decrease admission rates (59% to 33%) and median health-care costs ($1,748 to $1,079) with no significant difference in clinical outcomes. It is important to realize that this study was not randomized and was underpowered to detect differences in clinical outcome.

Use of insulin/glucose to treat hyperkalemia works, but hypoglycemia is a common side effect. Here are some pearls to give this treatment more safely.

Intranasal tranexamic acid with nasal compression was as effective as Merocel nasal packing for bleeding cessation in anterior epistaxis, had a lower rebleeding rate, and was better tolerated than nasal packing.

The CDC no longer recommends* annual TB screening of health care providers in the absence of a known exposure or ongoing transmission.

Mortality was higher when door-to-antibiotic time was > 3 h. However, there was no difference when comparing mortality in those given antibiotics within the first hour to those after the first hour.

Learn how to avoid frying one defibrillator with the other if you use dual-sequential defibrillation as well as the most effective pad placement and inter-shock timing.

Early use of a paralytic infusion with deeper sedation did not reduce 90-day mortality in patients with ARDS compared to patients managed with lighter sedation and no paralytics.

Use of virtual reality (VR) in children who need venipuncture or an IV reduced pain. Kids, caregivers, and proceduralists said they would use or recommend VR again.

There is large practice variation in performance of a lumbar puncture (LP) in infants 29-60 days old, with overall LP rate of 69.5%, but a range across centers from 35-90%.

Trauma team activation (TTA) for age ≥70 with traumatic mechanism (vs standard TTA criteria) resulted in overtriage in 39.6% of these patients. Omitting the TTA for age only would have resulted in significant undertriage.