Month: October 2022

Hypo-K+ Equals Hypo-Mg++…Right??

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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.

Source
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.

What’s the Best Maintenance Fluid for Children – D51/2NS or D5NS?

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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.

Source
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.

Should We Use Steroids for Pediatric Bell’s Palsy?

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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.

Source
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.

Incidental Isn’t Inconsequential – How to Follow Up Incidental Findings on Radiographs

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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.

Source
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.

Quality Versus Comfort: Does Tegaderm Get in the Way of Ocular Ultrasound?

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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.

Source
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.

Fluoroquinolone Resistance in UTI – Is It Time to Change Drugs?

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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.

Source
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.

What’s the Trigger to Activate Pediatric Massive Transfusion

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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.

Source
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.

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