April 2022
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Apr 15 2022
Finger (or is that…probe) on the Pulse | Doppler vs Manual Palpation During Arrest
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Use of pulsed-wave Doppler ultrasound by a trained emergency medicine physician to detect any femoral pulse was more accurate than manual palpation but did not necessarily confer an adequate blood pressure (i.e. SBP ≥ 60 mmHg). Calculation of peak systolic velocity of ≥20 cm/s had a stronger correlation with a SBP ≥ 60 mmHg.Source
Femoral artery Doppler ultrasound is more accurate than manual palpation for pulse detection in cardiac arrest. Resuscitation. 2022 Feb 4;S0300-9572(22)00032-6. doi: 10.1016/j.resuscitation.2022.01.030. Online ahead of print. -
Apr 14 2022
Should EMS “Scoop and Run” or “Stay and Play” for Trauma?
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In the prehospital setting, prolonged on-scene times were associated with increased 24-hour and 30-day mortality for moderately or severely injured, undifferentiated trauma patients.Source
The impact of prehospital time intervals on mortality in moderately and severely injured patients. J Trauma Acute Care Surg. 2022;92(3):520-527. doi:10.1097/TA.0000000000003380 -
Apr 13 2022
Clear as Mud – Is Your Management of Diverticulitis Evidence-Based?
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There are few studies that address the overall diagnosis and management of acute left sided colonic diverticulitis; many, over the past 3 decades, have poor strength of evidence or are largely inconclusive.Source
Diagnostic Imaging and Medical Management of Acute Left-Sided Colonic Diverticulitis : A Systematic Review. Ann Intern Med. 2022 Mar;175(3):379-387. doi: 10.7326/M21-1645. Epub 2022 Jan 18. -
Apr 12 2022
Is Delayed Admission Deadly?
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This large study shows that all-cause 30-day mortality increases with delayed hospital admission from the ED, starting at 5 hours after patient arrival.Source
Association between delays to patient admission from the emergency department and all-cause 30-day mortality. Emerg Med J. 2022 Mar;39(3):168-173. doi: 10.1136/emermed-2021-211572. Epub 2022 Jan 18. -
Apr 11 2022
Can You Spot a Ruptured AAA? Accuracy of Symptoms, Signs, CTA, and POCUS
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Symptoms and signs of ruptured abdominal aortic aneurysm (rAAA) are frustratingly insensitive. CTA is essential and is accurate. POCUS can accurately tell you a AAA is present but is not meant to diagnose rupture.Source
Accuracy of Presenting Symptoms, Physical Examination, and Imaging for Diagnosis of Ruptured Abdominal Aortic Aneurysm -Systematic Review and Meta-Analysis. Acad Emerg Med. 2022 Feb 27. doi: 10.1111/acem.14475. Online ahead of print. -
Apr 08 2022
ECG Interpretation – Never Trust the Computer
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Changes from STEMI-negative occlusion myocardial infarction can be subtle, yet lethal, and are easily missed by computerized ECG interpretation.Source
Alexander Bracey, H. Pendell Meyers, Stephen W. Smith. Emergency physicians should interpret every triage ECG, including those with a computer interpretation of “normal”. Am J Emerg Med, PubMed -
Apr 07 2022
Does NOAC Use Preclude tPA for Acute Stroke?
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There was no significant difference in intracranial hemorrhage, serious systemic hemorrhage, or inpatient mortality for patients who used non-vitamin K oral anticoagulants in the seven days prior to receiving alteplase for acute ischemic stroke.Source
Association of Recent Use of Non-Vitamin K Antagonist Oral Anticoagulants With Intracranial Hemorrhage Among Patients With Acute Ischemic Stroke Treated With Alteplase. JAMA. 2022 Feb 22;327(8):760-771. doi: 10.1001/jama.2022.0948. -
Apr 06 2022
Answering the Question? IV Vitamin C for the Critically Ill
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IV Vitamin C administration appeared to be safe and reduced overall mortality in this meta-analysis of critically ill patients, when given in higher doses and as monotherapy.Source
IV Vitamin C in Critically Ill Patients: A Systematic Review and Meta-Analysis. Crit Care Med. 2022 Mar 1;50(3):e304-e312. doi: 10.1097/CCM.0000000000005320. -
Apr 05 2022
They Catch on Fire – Electrocautery Trephination with Acrylic Nails
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Electrocautery trephination of acrylic nail products attached to simulated digits was associated with a high likelihood of ignition (83/200; 41.5%). Based on this limited data, electrocautery trephination of acrylic nails should be avoided to reduce risk of further patient harm.Source
Up in Flames: The Safety of Electrocautery Trephination of Subungual Hematomas with Acrylic Nails. West J Emerg Med. 2022 Feb 23;23(2):183-185. doi: 10.5811/westjem.2021.10.53567. -
Apr 04 2022
Not so FAST! POCUS vs CXR – A Rebuttal Letter
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A recent publication, cheekily titled Not so FAST-Chest ultrasound underdiagnoses traumatic pneumothorax, concluded ultrasound for traumatic pneumothorax should be considered with caution. This response letter breaks down the main reasons why this article is likely a red herring.Source
Daniel J Kim, Nik Theyyunni, Rachel B Liu Ultrasound is superior to supine chest x-ray for the diagnosis of clinically relevant traumatic pneumothorax. J Trauma Acute Care Surg. 2022 Mar 14. doi: 10.1097/TA.0000000000003575. Online ahead of print.