January 2023 – JournalFeed

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An initial diagnostic workup that includes an E-FAST exam and targeted chest and pelvis x-rays allows clinicians an opportunity to assess and intervene appropriately on the majority of patients prior to WBCT in the setting of blunt trauma.

Source
Appropriateness of Initial Course of Action in the Management of Blunt Trauma Based on a Diagnostic Workup Including an Extended Ultrasonography Scan. JAMA Netw Open. 2022 Dec 1;5(12):e2245432. doi: 10.1001/jamanetworkopen.2022.45432.

Jan 30 2023January 30, 2023

Xylazine (aka Tranq) – What You Need to Know

Toxicology

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Xylazine is a non-opioid emerging drug of abuse that can cause significant respiratory and CNS depression in overdose as well as necrotic skin ulcerations. It does not respond to naloxone.

Source
Warning About Xylazine, a Veterinary Sedative Found in Illicit Drugs. JAMA. 2022 Dec 20;328(23):2296. doi: 10.1001/jama.2022.20045.

Jan 27 2023January 21, 2023

The Human Cost of 24/7/365

ED Operations, Wellness

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Emergency physicians (EPs) suffer from poor sleep quality and lower sleep quantity than recommended. EPs were also objectively more fatigued during late afternoon and evening shifts and spend almost a quarter of their shift in a fatigued state.

Source
Objective assessment of sleep and fatigue risk in emergency medicine physicians. Acad Emerg Med. 2022 Oct 14. doi: 10.1111/acem.14606. Epub ahead of print.

Jan 26 2023January 21, 2023

Exam Accuracy for Vertigo – HINTS for New SAEM Guidelines

ENT/Face, Neurology

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A general neurological exam has low sensitivity but high specificity for stroke in acute dizziness or vertigo. No modality is more sensitive than a HINTS exam by a trained provider.

Source
Diagnostic accuracy of the physical exam in emergency department patients with acute vertigo or dizziness: Systematic review and meta-analysis for GRACE-3. Acad Emerg Med. 2022 Dec 1. doi: 10.1111/acem.14630. Online ahead of print.

Jan 25 2023January 25, 2023

Ultrasound First for Appendicitis in Adults?

Surgery, Ultrasound

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When performed by an experienced EM physician or radiologist, a conclusive appendix ultrasound is both sensitive and specific when evaluating for acute appendicitis and can be used in place of CT.

Jan 24 2023January 21, 2023

Breaking NEWS – Best PE Scores | NEWS vs. PESI vs. sPESI

Venous Thromboembolism

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The National Early Warning Score (NEWS) was comparable to the validated Pulmonary Embolism Severity Index (PESI) and the simplified PESI (sPESI) in predicting 7-day ICU admission and 30-day mortality in patients with acute pulmonary embolism (PE).

Source
Use of the National Early Warning Score for predicting deterioration of patients with acute pulmonary embolism: a post-hoc analysis of the YEARS Study. Emerg Med J. 2022 Nov 7:emermed-2021-211506. doi: 10.1136/emermed-2021-211506. Epub ahead of print.

Jan 23 2023January 21, 2023

Lunacy? Does a Full Moon Mean More 911 Calls?

ED Operations, EMS

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A full moon has no association with EMS activation patterns in the United States.

Source
Full moons are not associated with increases in emergency medical services (EMS) activations (911 calls) in the United States. Am J Emerg Med. 2022 Nov;61:227-228. doi: 10.1016/j.ajem.2022.07.044. Epub 2022 Jul 20.

Jan 20 2023January 15, 2023

Don’t Miss Torsion – How to Get the Diagnosis

Ultrasound, Urology

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Diagnostic characteristics that help differentiate testicular torsion from other causes of acute scrotal pain include vomiting, age > 13, scrotal edema, and palpation of a hard testis. Use caution with normal ultrasound results in those with high pretest probability.

Source
Clinical risk factors for testicular torsion and a warning against falsely reassuring ultrasound scans: a 10-year single-centre experience. Emerg Med J. 2022 Dec 16;emermed-2021-211946. doi: 10.1136/emermed-2021-211946. Online ahead of print.

Jan 19 2023January 15, 2023

A Simple Way to Find More GI Bleeds on CT

GI, Imaging

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In patients with a gastrointestinal bleed (GIB), CT imaging was more often diagnostic when the specific indication (GIB) was listed within the requisition order and multiphase studies were ordered.

Source
Importance of communication of CT indication for imaging yield in patients with gastrointestinal bleed. Am J Emerg Med. 2022 Dec 5;64:101-105. doi: 10.1016/j.ajem.2022.12.003. Online ahead of print.

Jan 18 2023January 16, 2023

How to Read a CXR – A CXR Checklist

Education, Imaging

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Here is a consistent, systematic, and comprehensive approach to interpreting chest x-rays and a checklist to prevent common errors. We modified the checklist to make it easier to remember.