June 2019
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Jun 14 2019
Can You Spot Hyper-K on ECG?
ECG can’t be used to rule out hyperkalemia. It may be present and electrocardiographically silent. But if you see the changes, ECG can be used to rule it in. Sensitivity was 19%; specificity 97%.
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Jun 13 2019
Resident Patients Per Hour – What’s Normal?
Want to see how many patients per hour you should be seeing, according to resident data from this single center? Plug in your number of months as a resident. Patients/hour = (0.018 × month of training) + 1.113.
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Jun 12 2019
Tramadol Isn’t Addictive, Right?
Use of tramadol post-op was associated with an increased risk of prolonged use compared with other short acting opiates.
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Jun 11 2019
ACEP Unscheduled Sedation Guidelines
This guideline for unscheduled sedation is based on good evidence and authoritatively states some key aspects of emergency sedation that apply to our patients and fit the needs of our setting.
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Jun 10 2019
Can We Discharge More Older Syncope Patients?
This study suggests that we may be able to admit fewer patients ≥60 years old with unexplained syncope than we do currently. Incidence of serious adverse events was still alarmingly common in patients who were hospitalized; so, this won’t change my practice.
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Jun 07 2019
Ethics Week – COI and Stroke Guidelines
There is some concern for financial conflict of interest among guideline authors for the AHA stroke guidelines. However, just 6% (2/34) of the authors for the 2013 or 2018 AHA guidelines had industry ties related to alteplase in the year of publication. Be sure to read the more nuanced discussion.
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Jun 06 2019
Ethics Week – COI And EM Journal Editors
Almost one third of prominent US-based EM journal editors have financial conflicts of interest, yet only one of those journals publicly disclosed this.
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Jun 05 2019
Ethics Week – Emergent Dialysis for Undocumented Immigrants
Once insured, undocumented immigrants with end-stage renal disease (ESRD) who were then able to get scheduled vs emergency-only hemodialysis (HD) has a drop in 1-year mortality (NNT = 7) and saved almost $6,000/person/month in healthcare costs.
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Jun 04 2019
Ethics Week – Lost Evidence, Unpublished RCTs
Nearly 90,000 patients were enrolled in randomized trials that were never published. These patients were enrolled in good faith that their participation would benefit future patients. The key issue: “Large unreported trials threaten the credibility of the available, published evidence.”
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Jun 03 2019
Ethics Week – How to Spot Spin in RCTs
Spin is common (>40%) in emergency medicine RCTs. Watch out. Here’s how to spot spin.