February 2023

Spoon Feed
The next couple of reviews will look at different authors making their case for why intravenous (IV) haloperidol (Haldol) should or should not be used in the emergency department setting.

Source
Haloperidol May Be Safely Administered Intravenously in the Emergency Department. Annals of Emergency Medicine. 2023;81:95-96. doi: 10.1016/j.annemergmed.2022.07.004

Spoon Feed
Patients with STEMI or STEMI equivalent who were treated within goal treatment times had significantly lower in-hospital mortality.

Source
Treatment time and In-Hospital Mortality Among Patients with ST-Segment Elevation Myocardial Infarction, 2018-2021. JAMA. 2022 Nov 22; 328(20): 2033-2040.

Spoon Feed
In patients presenting with angioedema, history of hypertension, shortness of breath, drooling, and anterior tongue or pharyngeal swelling were risk factors predicting eventual need for intubation.

Source
Clinical predictors of endotracheal intubation in patients presenting to the emergency department with angioedema. Am J Emerg Med. 2023 Jan;63:44-49. doi: 10.1016/j.ajem.2022.10.017. Epub 2022 Oct 19.

Spoon Feed
Zinc supplementation for patients with COVID-19 decreased 30-day ICU admission rate and led to shorter symptom duration. Subgroup analysis showed these effects were especially pronounced for elderly patients and those with comorbid conditions.

Source
Twice-Daily Oral Zinc in the Treatment of Patients With Coronavirus Disease 2019: A Randomized Double-Blind Controlled Trial. Clin Infect Dis. 2023;76(2):185-191. doi:10.1093/cid/ciac807

Spoon Feed
Molnupiravir does not decrease death or hospitalization in vaccinated patients with COVID-19 at high risk for progression to severe disease.

Spoon Feed
In this trial, investigators compared high-dose cephalexin (1000 mg QID) to standard dose (500 mg QID) for the treatment of non-purulent cellulitis. They found that high-dose cephalexin was associated with fewer instances of treatment failure but a higher proportion of adverse events.

Source
High-dose cephalexin for cellulitis: a pilot randomized controlled trial. CJEM. 2023 Jan;25(1):22-30. doi: 10.1007/s43678-022-00433-7. Epub 2023 Jan 2.

Spoon Feed
Current guidelines dictate that treatment of Group A Streptococcus pyogenes (GAS) necrotizing soft tissue infections (NSTI) and toxic shock syndrome (TSS) include clindamycin in conjunction to a beta lactam in order to inhibit exotoxin production; but might we consider co-treatment with linezolid instead?

Source
Should Linezolid Replace Clindamycin as the Adjunctive Antimicrobial of Choice in Group A Streptococcal Necrotizing Soft Tissue Infection and Toxic Shock Syndrome? A Focused Debate. Clin Infect Dis. 2023 Jan 13;76(2):346-350. doi: 10.1093/cid/ciac720.

Spoon Feed
Patients with alcohol-associated hepatitis have a high rate of complications and short-term mortality of 20-50%. Prompt recognition and treatment, including initiation of treatment for alcohol use disorder, is important to improve patient outcomes.

Source
Alcohol-Associated Hepatitis. NEJM. 2022 Dec 29; 387 (26): 2436-2448.

Spoon Feed
ED clinicians are often inaccurate in their estimations of patients’ blood alcohol content (BAC). Overestimation is common, especially in patients arriving by ambulance compared to walk-ins.

Source
Clinician assessment of blood alcohol levels among emergency department patients. Am J Emerg Med. 2023 Jan;63:110-112. doi: 10.1016/j.ajem.2022.10.045. Epub 2022 Oct 31.

Spoon Feed
The Western Trauma Association Algorithms Committee has released new evaluation and management guidelines and a step-by-step algorithm (see below) surrounding blunt thoracic aortic injury.