May 2023

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Pulling traction on a testicle with torsion is proposed by these authors to help relieve pressure, identify direction of torsion, and to make manual detorsion easier to perform. See figure below for technique.

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There was an increased number of patient deaths on ICU shifts with low nurse-to-nurse familiarity.

Source
Nurse-to-Nurse Familiarity and Mortality in the Critically Ill: A Multicenter Observational Study. Am J Respir Crit Care Med. 2023 Apr 15;207(8):1022-1029. doi: 10.1164/rccm.202204-0696OC.

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In a retrospective cohort of patients with acute pulmonary embolism (PE) and a low pulmonary embolism severity index (PESI) score, increased heart rate and bilateral PE were factors associated with physicians' decision for hospitalization.

Source
Bilateral Emboli and Highest Heart Rate Predict Hospitalization of Emergency Department Patients With Acute, Low-Risk Pulmonary Embolism [published online ahead of print, 2023 Apr 5]. Ann Emerg Med. 2023;S0196-0644(23)00123-3.

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This meta-analysis found Boss-Holzach-Matter/Davos and FARES had the most favorable value for success rates, while both FARES and modified external rotation were more favorable in reduction times. FARES also had the most favorable score for pain during reduction. 

Source
A Systematic Review With Pairwise and Network Meta-analysis of Closed Reduction Methods for Anterior Shoulder Dislocation. Annals of emergency medicine vol. 81,4 (2023): 453-465. doi:10.1016/j.annemergmed.2022.10.020 

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Using a 1-handed technique in infants <1yr and 2-handed technique in children >1yr resulted in deeper compressions, closer to AHA guideline recommendations, but compliance with rate and depth were mediocre regardless of technique.

Source
The effect of hand position on chest compression quality during CPR in young children: Findings from the Videography in Pediatric Resuscitation (VIPER) collaborative. Resuscitation. 2023 Apr;185:109741. doi: 10.1016/j.resuscitation.2023.109741. Epub 2023 Feb 16.

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Information gathered from post-mortem CT shows that fatal injury patterns in blunt trauma are similar for those who die prior to ED arrival vs. after arrival. The frequent identification of unevacuated pneumothorax and endotracheal tube misplacement suggests that mandatory surgical chest decompression and tube placement confirmation should always be performed on blunt trauma arrest patients.

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Among Medicaid-enrolled children, rates of outpatient follow-up after discharge from the ED for a mental health (MH) diagnosis are low, particularly for children who are Black, have fee-for-service (vs. capitated) coverage, and without previous outpatient mental health visits.

Source
Follow-up After Pediatric Mental Health Emergency Visits. Pediatrics. 2023 Mar 1;151(3):e2022057383. doi: 10.1542/peds.2022-057383.

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Tenecteplase was non-inferior to alteplase in patients with acute ischemic stroke who were eligible for intravenous thrombolytic therapy but ineligible or refused endovascular thrombectomy.

Source
Tenecteplase versus alteplase in acute ischaemic cerebrovascular events (TRACE-2): a phase 3, multicentre, open-label, randomised controlled, non-inferiority trial. Lancet. 2023 Feb 8;S0140-6736(22)02600-9. doi: 10.1016/S0140-6736(22)02600-9. Online ahead of print.

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The use of a subcutaneous insulin protocol for mild-to-moderate diabetic ketoacidosis (DKA) resulted in significant reductions in ED LOS.

Source
The SQuID Protocol (Subcutaneous Insulin in Diabetic Ketoacidosis): Impacts on ED Operational Metrics. Acad Emerg Med. 2023 Feb 12. doi: 10.1111/acem.14685. Online ahead of print.

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Patients who are discharged from the emergency department after presenting with abdominal pain and receiving opioids have 57% greater odds of return within 30 days. This population is also at higher risk for adverse effects from these medications.

Source
Return Rates for Opioid versus Nonopioid Management of Patients with Abdominal Pain in the Emergency Department. J Emerg Med. 2023 Apr;64(4):471-475. doi: 10.1016/j.jemermed.2023.01.008. Epub 2023 Mar 28.