Month: July 2022

Frostbite | Spoon Feed Version – In a Heat Wave :)

Spoon Feed
The incidence of frostbite is shifting from exploration to urban environments and requires prompt recognition and often presents with other disease processes. Standard treatment is supportive and conservative, but new therapies including direct and systemic thrombolysis, and anticoagulation may be the future.

Source
Diagnosis and Treatment of Frostbite. NEJM. 2022;386(26):2213-2220. Doi:10.1056/NEJMra1800868

A Real Pain in the Neck – C-Collar Adherence in Children After PED Discharge

Spoon Feed
Many children discharged from the emergency department with minor traumatic cervical spine injury do not adhere to recommendations for cervical immobilization or outpatient follow-up, with no significant clinical consequences observed.

Source
The Fate of the Cervical Collar: An Observational Pilot Study Investigating Follow-up Care After Emergency Department Discharge in Children With Mild Traumatic Neck Injuries. Pediatr Emerg Care. 2022 May 25. doi: 10.1097/PEC.0000000000002755. Online ahead of print.

NOR-TEST 2 – What’s the Right Dose of Tenecteplase for Stroke?

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Tenecteplase, at a dose of 0.4 mg/kg, is not safe for patients with moderate to severe ischemic stroke.

Source
Tenecteplase versus alteplase for the management of acute ischaemic stroke in Norway (NOR-TEST 2, part A): a phase 3, randomised, open-label, blinded endpoint, non-inferiority trial. Lancet Neurol. 2022 Jun;21(6):511-519. doi: 10.1016/S1474-4422(22)00124-7. Epub 2022 May 4.

LOVIT RCT | Vitamin C in Septic Patients – Is There Much to Love?

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A double-blind, international, multi-center RCT of septic adult ICU patients found an increased risk of death or persistent organ dysfunction at 28 days with a high dose IV vitamin C regimen.

Source
Intravenous Vitamin C in Adults with Sepsis in the Intensive Care Unit. N Engl J Med. 2022 Jun 23;386(25):2387-2398. doi: 10.1056/NEJMoa2200644. Epub 2022 Jun 15.

New RCT – Does Uttering the “Q” Word Wreak Havoc in the Emergency Department?

Spoon Feed
Using the word “quiet” in the emergency department (ED) did not increase patient volumes nor did staff perceive there were increased volumes, unless the staff were already superstitious about the word “quiet.”

Source
The use of the word “quiet” in the emergency department is not associated with patient volume: A randomized controlled trial. Am J Emerg Med. 2022 Jun;56:10-12. doi: 10.1016/j.ajem.2022.03.020. Epub 2022 Mar 16.

Don’t Offend the Highly Sensitive Troponin

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A single high sensitivity cardiac troponin T (hs-cTnT) measurement less than the limit of quantitation (the lowest reportable concentration) appears to be sufficient in ruling out acute MI in a low risk population.

Source
Rapid Exclusion of Acute Myocardial Injury and Infarction With a Single High-Sensitivity Cardiac Troponin T in the Emergency Department: A Multicenter United States Evaluation. Circulation. 2022 Jun 7;145(23):1708-1719. doi: 10.1161/CIRCULATIONAHA.122.059235. Epub 2022 May 10.

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