March 2023

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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.

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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.

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The authors describe a novel reduction method for posterior hip dislocations using a hydraulic lift to apply longitudinal traction on the upper leg.

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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.

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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.

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This multicenter randomized controlled trial (the INCEPTION trial), comparing ECPR vs conventional CPR for refractory cardiac arrest, showed no improvement in neurologically intact survival at 30 days.

Source
Early Extracorporeal CPR for Refractory Out-of-Hospital Cardiac Arrest. N Engl J Med. 2023 Jan 26;388(4):299-309. doi: 10.1056/NEJMoa2204511.

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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.

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Through the use of point-of-care ultrasound (POCUS) Emergency Medicine providers can optimize and tailor pre-intubation resuscitation in critically ill patients. See algorithm below.

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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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In this Cochrane review, hand-hygiene programs reduce the incidence of clinical acute respiratory illness (ARI), while masking probably does not provide additional benefit.

Source
Physical interventions to interrupt or reduce the spread of respiratory viruses. Cochrane Database Syst Rev. 2023 Jan 30;1(1):CD006207. doi: 10.1002/14651858.CD006207.pub6.