October 2022

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This retrospective single-center study found that hypokalemic patients who received magnesium within 4 hours of their potassium supplementation had no significant difference in time to serum potassium normalization.

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The Effects of Magnesium Coadminstration During Treatment of Hypokalemia in the Emergency Department. J Emerg Med. 2022 Oct 11:S0736-4679(22)00347-X. doi: 10.1016/j.jemermed.2022.06.007. Epub ahead of print.

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Conservative fluid administration in patients with acute pancreatitis can achieve similar clinical outcomes compared with aggressive resuscitation, with less risk of volume overload.

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Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. N Engl J Med. 2022 Sep 15;387(11):989-1000. doi: 10.1056/NEJMoa2202884.

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Hypotonic maintenance IV fluid (MIVF) dropped serum sodium at 24 hours compared with isotonic MIVF in pediatric patients. We should stop using D₅1/2NS for routine MIVF in children.

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0.45% Versus 0.9% Saline in 5% Dextrose as Maintenance Fluids in Children Admitted With Acute Illness: A Randomized Control Trial. Pediatr Emerg Care. 2022 Sep 1;38(9):436-441. doi: 10.1097/PEC.0000000000002621. Epub 2022 Jan 26.

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This is the latest on how to work up possible acute coronary syndrome in the ED.

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There was no statistical difference in 1, 3, or 6 month facial recovery with prednisolone vs placebo for children with Bell's palsy in this underpowered RCT. I plan to keep using steroids, though opinions on this will differ.

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Efficacy of Prednisolone for Bell Palsy in Children: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial. Neurology. 2022 Aug 25;10.1212/WNL.0000000000201164. doi: 10.1212/WNL.0000000000201164. Online ahead of print.

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A novel comprehensive methodized process is presented for the proper disclosure of incidental findings on ED imaging and for ensuring proper follow up and subsequent management.

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Catching Those Who Fall Through the Cracks: Integrating a Follow-Up Process for Emergency Department Patients with Incidental Radiologic Findings. Ann Emerg Med. 2022 Sep;80(3):235-242. doi: 10.1016/j.annemergmed.2022.04.026. Epub 2022 Jun 23.

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Using Tegaderm™ during ocular ultrasound was associated with poorer image quality and had no effect on patient comfort. If you’re using ocular ultrasound as a modality, consider if using a Tegaderm™ will get in the way of a good diagnosis.

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Covered or uncovered: A randomized control trial of Tegaderm versus no Tegaderm for ocular ultrasound. Am J Emerg Med. 2022 Aug 28;61:87-89. doi: 10.1016/j.ajem.2022.08.044. Online ahead of print.

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Fluoroquinolone-resistant (FQR) E. coli was present in 22.1% of UTI pathogens studied at 15 geographically diverse EDs. IDSA guidelines recommend changing empiric treatment if local resistance is >10% and adding a dose of parenteral antibiotic, such as ceftriaxone, prior to discharge home.

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High prevalence of fluoroquinolone-resistant UTI among US emergency department patients diagnosed with urinary tract infection, 2018-2020. Acad Emerg Med. 2022 Sep;29(9):1096-1105. doi: 10.1111/acem.14545. Epub 2022 Aug 5.

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Here are the clinical clues to keep you from missing serotonin syndrome (SS) and pearls to treat it once you make the diagnosis.

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A transfusion threshold of 20 ml/kg of any blood product during the first hour of pediatric trauma resuscitation maximizes sensitivity and specificity for in-hospital mortality, need for intervention, and additional bleeding episodes and may identify children in need of massive transfusion.

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Recognizing Life-Threatening Bleeding in Pediatric Trauma: A Standard for When to Activate Massive Transfusion Protocol. J Trauma Acute Care Surg. 2022 Sep 19. doi: 10.1097/TA.0000000000003784. Online ahead of print.