April 2022

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The European Society of Cardiology (ESC) has generated a position detailing optimal follow-up of patients following acute pulmonary embolism (PE). They advocate for a holistic approach with consideration of both short- and long-term events encountered by patients diagnosed with acute PE.

Source
Optimal follow-up after acute pulmonary embolism: a position paper of the European Society of Cardiology Working Group on Pulmonary Circulation and Right Ventricular Function, in collaboration with the European Society of Cardiology Working Group on Ather. Eur Heart J. 2022 Jan 25;43(3):183-189. doi: 10.1093/eurheartj/ehab816.

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There is some evidence that bolus treatment in critically ill pediatric patients (28 days old to 18 years old) with balanced fluids (such as LR) versus unbalanced fluids (such as NS) results in improved serum bicarbonate and blood pH values. However, it's not clear if this is clinically beneficial.

Source
Balanced Versus Unbalanced Fluid in Critically Ill Children: Systematic Review and Meta-Analysis. Pediatr Crit Care Med. 2022 Mar 1;23(3):181-191. doi: 10.1097/PCC.0000000000002890.

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Peripheral nerve blocks may help achieve symptomatic improvement in our primary headache patients, but we are still far off with research supporting it as a first line intervention.

Source
Effectiveness of Peripheral Nerve Blocks for the Treatment of Primary Headache Disorders: A Systematic Review and Meta-Analysis. Ann Emerg Med. 2022 Mar;79(3):251-261. doi: 10.1016/j.annemergmed.2021.08.007. Epub 2021 Oct 28.

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For outpatients with mild-to-moderate Covid-19 at risk of progression to severe disease, treatment with nirmatrelvir and ritonavir within 5 days of symptom onset reduced 28-day hospitalization or death.

Source
Oral Nirmatrelvir for High-Risk, Nonhospitalized Adults with Covid-19. N Engl J Med 2022 Apr 14; 386(15): 1397-1408. Doi: 10.1056/NEJMoa2118542. Epub 2022 Feb 16.

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Computed tomography pulmonary angiography (CTPA) yields an alternative diagnosis to pulmonary embolism (PE) in ~40% of patients with a negative PE study. Alternative diagnoses are more likely to occur in patients with increased age and in patients referred from the hospital setting (ICU or inpatient unit).

Source
Prevalence and significance of incidental findings on computed tomography pulmonary angiograms: A retrospective cohort study. Am J Emerg Med. 2022 Apr;54:232-237. doi: 10.1016/j.ajem.2022.01.064.

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This is a spoon-feed version on how to manage the worst asthmatic patients. Here are the pearls to manage these life-threatening cases.

Source
Management of Life-Threatening Asthma: Severe Asthma Series. Chest. 2022 Feb 23;S0012-3692(22)00395-6. doi: 10.1016/j.chest.2022.02.029. Online ahead of print.

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Home scalp staple removal by a parent is largely successful. Parent education and loss to follow up are some challenges to this approach.

Source
Scalp Staples Placed in a Pediatric Emergency Department: Feasibility and Benefits of Home Removal. Pediatr Emerg Care. 2022 Mar 1;38(3):e1143-e1146. doi: 10.1097/PEC.0000000000002213.

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Reusing personal protective equipment risks contamination for healthcare workers and should be eliminated as much as possible. See image of contamination below.

Source
Reuse of Personal Protective Equipment: Results of a Human Factors Study Using Fluorescence to Identify Self-Contamination During Donning and Doffing. J Emerg Med. 2022 Mar;62(3):337-341. doi: 10.1016/j.jemermed.2021.12.010. Epub 2022 Feb 4.

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Among patients with symptomatic PE who are low risk by sPESI, the addition of right ventricular assessment predictors (echo, CT, troponin, and BNP) significantly improved prognostication for clinical deterioration within 5 days. 

Source
Can right ventricular assessments improve triaging of low risk pulmonary embolism? Acad Emerg Med. 2022 Mar 15. doi: 10.1111/acem.14484. Online ahead of print.

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This is a spoon-feed version of the management of massive and submassive PE in children.

Source
Acute Management of High-Risk and Intermediate-Risk Pulmonary Embolism in Children: A Review. Chest. 2022 Mar;161(3):791-802. doi: 10.1016/j.chest.2021.09.019. Epub 2021 Sep 26.