December 2022
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Dec 16 2022
CANARY in the Cath Lab? New RCT Catheter-based Lytics for Intermediate PE
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This underpowered RCT did not find a statistically significant difference between catheter-directed thrombolysis (CDT) and anticoagulation monotherapy for intermediate-high risk pulmonary embolism in its primary outcome but favored CDT in secondary endpoints, without a difference in safety.Source
Catheter-Directed Thrombolysis vs Anticoagulation in Patients With Acute Intermediate-High-risk Pulmonary Embolism: The CANARY Randomized Clinical Trial. JAMA Cardiol. 2022 Oct 19:e223591. doi: 10.1001/jamacardio.2022.3591. Epub ahead of print. -
Dec 15 2022
“Adjust-Unlikely” vs. YEARS – A New Winning Strategy to Reduce CT in Suspected PE
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Assessing pretest probability using a modified, age-adjusted clinical decision tool (“Adjust-Unlikely”) vs YEARS reduces CT imaging in patients with suspected pulmonary embolism (PE). “Adjust-Unlikely” missed no PEs. YEARS had a larger reduction of imaging but missed a few PEs.Source
Comparison of YEARS and Adjust-Unlikely D-dimer Testing for Pulmonary Embolism in the Emergency Department [published online ahead of print, 2022 Nov 10]. Ann Emerg Med. 2022;S0196-0644(22)01118-0. -
Dec 14 2022
Why Are We Still Doing DRE in Trauma Patients?
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Use of the digital rectal exam (DRE) in trauma patients has repeatedly demonstrated poor sensitivity for injuries and has little impact on clinical management, with a high false negative rate in pediatric populations. -
Dec 13 2022
EAST-AFNET 4…RELOADED | Rhythm vs Rate Control for Afib in Low Risk Patients
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Rhythm control, compared to rate control, was associated with reduced mortality and cardiovascular risk in low-risk patients with atrial fibrillation.Source
Early Rhythm Control Therapy for Atrial Fibrillation in Low-Risk Patients : A Nationwide Propensity Score-Weighted Study. Ann Intern Med. 2022 Sep 6. doi: 10.7326/M21-4798. Online ahead of print. -
Dec 12 2022
Transcutaneous Pacing – What’s the Best Pad Placement?
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Placing transcutaneous cardiac pacer pads in the anteroposterior position required less energy to successfully capture.Source
Anteroposterior Pacer Pad Position Is More Likely to Capture Than Anterolateral for Transcutaneous Cardiac Pacing. Circulation. 2022;146(14):1103-1104. doi:10.1161/CIRCULATIONAHA.122.060735 -
Dec 09 2022
When to Use Oseltamivir in Kids (and others…)
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Early administration of oseltamivir in children hospitalized for influenza reduced length of stay, decreased 7-day readmission, need for critical care, and ECMO or death.Source
Association of Early Oseltamivir with Improved Outcomes in Hospitalized Children with Influenza, 2007-2020. JAMA Pediatr. 2022 Nov 1;176(11):e223261. DOI: 10.1001/jamapediatrics.2022.3261. -
Dec 08 2022
How Accurate Is Physical Exam for Pediatric Skull Fracture?
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Physical exam for pediatric skull fracture has poor sensitivity. Avoid overconfidence in exam as a screening tool.Source
Physical Examination Sensitivity for Skull Fracture in Pediatric Patients with Blunt Head Trauma: A Secondary Analysis of the National Emergency X-Radiography Utilization Study II Head Computed Tomography Validation Study. Ann Emerg Med. 2022 Oct 31;S0196-0644(22)01031-9. doi: 10.1016/j.annemergmed.2022.08.442. Online ahead of print. -
Dec 07 2022
Should Medics Clear C-Spine in the Field?
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In this large, single-center prospective cohort implementation study, paramedics were able to apply a modified Canadian C-spine rule to assess low risk trauma patients and transport a large proportion of them to a higher level of care without spinal precautions. -
Dec 06 2022
Old Person + Delirium = Head CT
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Among patients ≥65 years who presented to the ED with delirium, confusion, or altered mental status, 15.6% had an abnormal head CT. Presence of neurologic deficit was a significant predictor for abnormal CT, but anticoagulation was not.Source
Head Computed Tomography Findings in Geriatric Emergency Department Patients with Delirium, Altered Mental Status, and Confusion: A Systematic Review. Acad Emerg Med. 2022 Nov 4. doi: 10.1111/acem.14622. Online ahead of print. -
Dec 05 2022
How to Keep Kids Safer in General Emergency Departments
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This is a joint policy statement by the American Academy of Pediatrics (AAP), the American College of Emergency Physicians (ACEP), and the Emergency Nurses Association (ENA) to optimize safety in the care of pediatric patients in emergency care settings.Source
Optimizing Pediatric Patient Safety in the Emergency Care Setting. Pediatrics. 2022 Oct 3;e2022059673. doi: 10.1542/peds.2022-059673. Online ahead of print.