March 2023

Can We Observe Liver Lacs with Active Extravasation?

Imaging, Trauma

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Observation is highly effective in select hemodynamically stable patients with liver laceration and active extravasation and leads to few additional interventions in these patients, while angioembolization is associated with higher rates of drain placement for abscess or biloma and increased length of stay (LOS).

Source
An observation-first strategy for liver injuries with “blush” on computed tomography is safe and effective. J Trauma Acute Care Surg. 2023 Feb 1;94(2):281-287. doi: 10.1097/TA.0000000000003786. Epub 2022 Sep 23.

What Works (or Not) to Reduce Antibiotic Prescribing?

Infectious Disease, Pharmacy/Pharmacology

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Providing quarterly antibiotic prescription audits alongside peer benchmarking did not reduce antibiotic rates in a large cohort of primary care physicians in Switzerland.

Source
Effect of Antibiotic Prescription Audit and Feedback on Antibiotic Prescribing in Primary Care: A Randomized Clinical Trial. JAMA Intern Med. 2023 Feb 6. doi: 10.1001/jamainternmed.2022.6529. Online ahead of print.

Positive for Flu? No Antibiotics for You!

Infectious Disease, Pharmacy/Pharmacology

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Patients at two separate urgent care locations—one with rapid influenza diagnostic testing (RIDT) and one without—were compared on several parameters. Importantly, antibiotic prescribing was significantly lower, and antiviral prescribing was significantly higher in the group with RIDT testing.

Source
The Influence of Rapid Influenza Diagnostic Testing on Clinician Decision-making for Patients with Acute Respiratory Infection in Urgent Care. Clin Infect Dis. 2023 Feb 1;ciad038. doi: 10.1093/cid/ciad038. Online ahead of print.

APRV for ARDS – What’s the Evidence?

Critical Care

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Evidence does not yet support airway pressure release ventilation (APRV) as an alternative to conventional lung-protective ventilation in acute respiratory distress syndrome (ARDS). However, this approach is plausible and warrants continued investigation.

Source
Caution-Do Not Attempt This at Home. Airway Pressure Release Ventilation Should Not Routinely Be Used in Patients With or at Risk of Acute Respiratory Distress Syndrome Outside of a Clinical Trial. Crit Care Med. 2023 Jan 20. doi: 10.1097/CCM.0000000000005776. Epub ahead of print.

Should We Pause Compressions to Intubate During CPR?

Airway, Resuscitation

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Routinely pausing chest compressions during cardiac arrest to intubate in the emergency department is not necessary; this is especially true if you have video laryngoscopy and a bougie.

Source
First Attempt Success with Continued versus Paused Chest Compressions During Cardiac Arrest in the Emergency Department. Resuscitation. 2023 Feb 8;109726. doi: 10.1016/j.resuscitation.2023.109726. Online ahead of print.

Not Just for Kids – RSV vs Flu Impact on Adults

Infectious Disease, Pulmonary/Allergy

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Respiratory syncytial virus (RSV) is prevalent in hospitalized adults and is associated with higher odds of prolonged hospitalization and mechanical ventilation, particularly in patients with CHF and COPD.

Source
Prevalence and Clinical Outcomes of Respiratory Syncytial Virus versus Influenza in Adults Hospitalized with Acute Respiratory Illness from a Prospective Multicenter Study. Clin Infect Dis. 2023 Jan 24;ciad031. doi: 10.1093/cid/ciad031. Online ahead of print.

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