October 2022

Spoon Feed
The most recent IDSA guidelines recommend steroids in most patients who need oxygen. Consider nirmatrelvir or remdesivir in high-risk outpatients, and reserve most other therapies for particular circumstances, if at all.

Source
Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients with COVID-19. Clin Infect Dis. 2022 Sep 5;ciac724. doi: 10.1093/cid/ciac724. Online ahead of print.

Spoon Feed
Febrile infants 29-60 days with a positive UA had no cases of bacterial meningitis. These patients do not need a lumbar puncture.

Source
Serious Bacterial Infections in Young Febrile Infants With Positive Urinalysis Results. Pediatrics. 2022 Sep 13;e2021055633. doi: 10.1542/peds.2021-055633. Online ahead of print.

Spoon Feed
There was no difference in death or discharge with profound disability in patients with high or low PaO2 targets.

Source
Oxygen Targets in Comatose Survivors of Cardiac Arrest. N Engl J Med. 2022 Aug 27. doi: 10.1056/NEJMoa2208686. Online ahead of print.

Spoon Feed
There was no difference in death or discharge with profound disability among comatose patients with out of hospital cardiac arrest (OHCA) randomized to a mean arterial pressure (MAP) goal of 63 or 77 mm Hg.

Spoon Feed
Nirmatrelvir (Paxlovid) use in a population of largely immune outpatients ≥65 years old, during the omicron variant era, was significantly associated with reduction in hospitalization and death.

Source
Nirmatrelvir Use and Severe Covid-19 Outcomes during the Omicron Surge. N Engl J Med. 2022 Sep 1;387(9):790-798. doi: 10.1056/NEJMoa2204919. Epub 2022 Aug 24.

Spoon Feed
Otic quinolones (OQ) were associated with an increased risk of Achilles tendon rupture and all-type tendon rupture, but this was rare. Even with this risk, sometimes an OQ is still the right choice.

Source
Quinolone Ear Drops and Achilles Tendon Rupture. Clin Infect Dis. 2022 Sep 6;ciac709. doi: 10.1093/cid/ciac709. Online ahead of print.

Spoon Feed
Physician burnout has extensive negative effects, not just on individuals, but on hospital systems and on patient safety and satisfaction.

Source
Associations of physician burnout with career engagement and quality of patient care: systematic review and meta-analysis. BMJ. 2022 Sep 14;378:e070442. doi: 10.1136/bmj-2022-070442.

Spoon Feed
Corticosteroid use was associated with a prevention of progression to mechanical ventilation among inpatients with community acquired pneumonia (CAP), but it had no association with the primary outcome of mortality.

Source
Effect of corticosteroids on mortality and clinical cure in community-acquired pneumonia: A systematic review, meta-analysis, and meta-regression of randomized control trials. Chest. 2022 Sep 7;S0012-3692(22)03705-9. doi: 10.1016/j.chest.2022.08.2229. Online ahead of print.

Spoon Feed
This study showed no difference in post-intubation hypotension for endotracheal intubations in the ED between ketamine and etomidate.

Spoon Feed
In this single center cohort of 886 patients, 5 patients had definite awareness during paralysis. However, there were 61 patients determined to have possible awareness, meaning upwards of 7.4% of patients could have been aware.

Source
Recall of awareness during paralysis among emergency department patients undergoing tracheal intubation. Chest. 2022 Sep 08. Doi: https://doi.org/10.1016/j.chest.2022.08.2232