2023

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While removing low risk amoxicillin allergies in the pediatric ED setting by direct oral challenge (DOC) may be effective, numerous factors play a role in reliable implementation.

Source
Multisite Oral Amoxicillin Challenges During Pediatric Emergency Department Visits. JAMA Pediatr. 2023 Oct 2:e233659. doi: 10.1001/jamapediatrics.2023.3659. Online ahead of print.

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The use of balanced crystalloid (PlasmaLyte A) rather than normal saline (0.9% sodium chloride) reduced acute kidney injury and improved other outcomes in these pediatric patients with septic shock.

Source
Multiple Electrolytes Solution Versus Saline as Bolus Fluid for Resuscitation in Pediatric Septic Shock: A Multicenter Randomized Clinical Trial. Crit Care Med. 2023 Nov 1;51(11):1449-1460. doi: 10.1097/CCM.0000000000005952. Epub 2023 Jun 9.

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Is Guillain-Barre Syndrome (GBS) on your differential for neurologic symptoms? Let’s review this high morbidity/mortality disease.

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Treatment of COVID-19 with nirmatrelvir-ritonavir (N-R) was associated with virologic rebound (VR) in a prospective observational trial. Viral loads are high enough to cause transmission, though it remains unclear if certain patients may require longer insolation periods or how to identify those patients without significant retesting.

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In this spoof BMJ article, some of the delightful Christmas desserts on the Great British Baking show actually have ingredients that might be good for you. The authors' conclusion: "This Christmas, if concerns about the limitations of observational nutrition research are set aside, you can have your cake and eat it too." We wish you a Merry Christmas!

Source
Association of health benefits and harms of Christmas dessert ingredients in recipes from The Great British Bake Off: umbrella review of umbrella reviews of meta-analyses of observational studies. BMJ. 2023 Dec 20:383:e077166. doi: 10.1136/bmj-2023-077166.

Please read this announcement about upgrades to JournalFeed (CME, Amal Mattu, new website)! We also need to do a price increase due to rising costs. Price changes started Dec. 1, 2023 for new subscribers and on Jan 1, 2024 for current subscriber auto-renewals. If cost is a barrier for you, please read the announcement. We want to help! ~Clay Smith

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This was a stratified analysis of patients according to vulnerability to complications from COVID-19; it showed clinical benefit in most extremely vulnerable groups but less benefit for healthier patients, even over age 70.

Source
Nirmatrelvir-Ritonavir and COVID-19 Mortality and Hospitalization Among Patients With Vulnerability to COVID-19 Complications. JAMA Netw Open. 2023 Oct 2;6(10):e2336678. doi: 10.1001/jamanetworkopen.2023.36678.

Please read this announcement about upgrades to JournalFeed (CME, Amal Mattu, new website)! We also need to do a price increase due to rising costs. Price changes started Dec. 1, 2023 for new subscribers and on Jan 1, 2024 for current subscriber auto-renewals. If cost is a barrier for you, please read the announcement. We want to help! ~Clay Smith

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In this retrospective cohort study of COVID-vaccinated patients aged 18-50 years old, there was a significant reduction in all cause hospital visits, hospitalization and death within 30 days among patients who received nirmatrelvir/ritonavir (NMV/r, aka Paxlovid) for symptomatic COVID-19 infection, particularly among those with cancer and/or cardiovascular disease, compared to propensity matched controls who did not receive NMV/r. 

Source
Oral Nirmatrelvir and Ritonavir for Coronavirus Disease 2019 in Vaccinated, Nonhospitalized Adults Aged 18-50 Years. Clin Infect Dis. 2023;77(9):1257-1264. doi:10.1093/cid/ciad400. 

Please read this announcement about upgrades to JournalFeed (CME, Amal Mattu, new website)! We also need to do a price increase due to rising costs. Price changes started Dec. 1, 2023 for new subscribers and on Jan 1, 2024 for current subscriber auto-renewals. If cost is a barrier for you, please read the announcement. We want to help! ~Clay Smith

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Emergency physicians often encounter patients requesting postexposure prophylaxis (PEP) for rabies in the ED, yet studies show a lack of awareness among physicians about rabies PEP protocols. Prompt and accurate decision-making in managing potential exposures based on exposure types, animal categories, and prior vaccination history are crucial in the decision to initiate PEP.

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While the majority of neck-related health care visits are self-limiting, in the correct context, a focused history and physical exam could unearth an undiagnosed cervical spinal cord compression potentially circumventing permanent disability.

Source
Clinical Examination of the Cervical Spine. N Engl J Med. 2023 Oct 26;389(17):e34. doi: 10.1056/NEJMvcm2204780.

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For the majority of out-of-hospital cardiac arrest (OHCA) patients undergoing standard (30:2 compressions:breaths) cardiopulmonary resuscitation (CPR) prior to definitive airway placement, bag-valve mask (BVM) ventilations did not achieve adequate lung volumes most of the time. Receiving adequate BVM ventilations >50% of the time was associated with significantly higher rates of return of spontaneous circulation (ROSC) and survival.

Source
Bag-Valve-Mask Ventilation and Survival from Out-of-Hospital Cardiac Arrest: A Multicenter Study. Circulation. 2023 Nov 12. doi: 10.1161/CIRCULATIONAHA.123.065561. Epub ahead of print.