July 2019

Physicians who wrote for the most antibiotics were also the ones who diagnosed sinusitis most often.  To justify writing for an antibiotic, there was a coding bias to call it “sinusitis” when in fact, it probably was just a cold.

When faced with an equivocal appendix on ultrasound (US), use of secondary findings such as appendix diameter ≥ 7mm, presence of appendicolith, associated inflammatory changes, and WBC count greater than 10,000/mL can increase diagnostic certainty.

Contrast-associated acute kidney injury is a controversial subject. The available evidence is reassuring that significant acute kidney injury, death, and need for renal replacement therapy are rare after IV contrast administration.

Fluoroquinolone (FQ) antibiotics were associated with an increased odds of serious arrhythmic event (SAE) from 7 up to 90 days after taking them.

Current or past substance abuse, mental health diagnosis, younger age, and male sex increased risk of subsequent opiate misuse after an initial opiate prescription.

ED crowding was associated with markedly increased odds of 10-day mortality in lower acuity patients who were discharged home.

Dual sequential defibrillation (DSD) was ineffective overall in refractory ventricular fibrillation (v-fib) in terminating v-fib to return of spontaneous circulation (ROSC). The subgroup in which DSD was performed earlier (shocks 4-8) had improved ROSC.

Prehospital personnel made frequent pediatric drug dosing errors in several critical scenarios. A drug reference that reduced calculations helped, but the error rate was still dangerously high.

Showing compassion to patients in the ED with a life threatening emergency reduced the odds of PTSD at one month.

Rapid sequence intubation in the prehospital setting was associated with an increase in mortality for stroke patients.