June 2023

More Evidence that PERC Works!

Venous Thromboembolism

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Among patients in the RIETE database with confirmed pulmonary embolism (PE), there was a low failure rate when pulmonary embolism rule-out criteria (PERC) was applied in this retrospective cohort. PERC-negative patients who had PEs were less likely to have proximal PEs, and their rates of cardiopulmonary complications were lower when compared to PERC-positive patients.

Source
Safety of the pulmonary embolism rule-out criteria rule: Findings from the Registro Informatizado de la Enfermedad TromboEmbolica venosa (RIETE) registry. Acad Emerg Med. 2023 Apr 24. doi: 10.1111/acem.14744. Epub ahead of print.

What’s the Risk of VTE After Minor Surgery?

Venous Thromboembolism

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Some “minor” surgical procedures still carry an increased risk of venous thromboembolism postoperatively.  

Source
The risk of venous thromboembolism after minor surgical procedures: A population-based case-control study. J Thromb Haemost. 2023 Apr;21(4):975-982. doi: 10.1016/j.jtha.2022.11.035. Epub 2022 Dec 22.

Concussion – How Long Does It Really Take to Recover?

Neurology, Sports Medicine

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Post-concussion return to functional baseline occurs early for symptoms, balance, and mental status along with partial neurocognitive functioning. Visual-memory and reaction-time recovery, however, lag behind the other groups post-concussion.

Source
Time to Recovery as Measured on Clinical Assessments after Sport-Related Concussion. N Engl J Med. 2023 May 4;388(18):1717-1719. doi: 10.1056/NEJMc2301706.

Can ChatGPT Write for JournalFeed?

Education, Technology

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I think we need to have an open conversation about the power and usefulness of artificial intelligence, like Chat GPT.  It is not a fad, and this technology is only going to improve over time.  Thus, I want to be clear on the value we, as human authors, bring to you, the JournalFeed readers.

Guidelines for Reasonable and Appropriate Care in the Emergency Department 3 (GRACE-3) – Acute Dizziness and Vertigo in the Emergency Department 

ENT/Face, Neurology

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The GRACE-3 group (SAEM) provides us with a guideline based on their review we covered previously with the evidence for evaluating and managing adult patients presenting to emergency departments for acute dizziness. Emergency clinicians need additional training in physical exam techniques related to acute dizziness in order to perform them effectively, which should be a specialty-wide goal for the future. 

Source
Guidelines for reasonable and appropriate care in the emergency department 3 (GRACE-3): Acute dizziness and vertigo in the emergency department. Acad Emerg Med. 2023 May;30(5):442-486. doi: 10.1111/acem.14728.

Can Clinical or Lab Variables Predict Dehydration Severity in Children with DKA?

Endocrine, Pediatrics, Renal

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Most pediatric patients with diabetic ketoacidosis (DKA) have mild to moderate dehydration. Clinical and laboratory variables in isolation are not accurate predictors of rehydration needs.

Source
Clinical and Laboratory Predictors of Dehydration Severity in Children With Diabetic Ketoacidosis. Ann Emerg Med. 2023 Apr 4;S0196-0644(23)00002-1. doi: 10.1016/j.annemergmed.2023.01.001. Online ahead of print.

Should We Rx Inhaled Steroids for Asthma?

Pharmacy/Pharmacology, Pulmonary/Allergy

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In this study, only 6% of asthma patients discharged from the ED received a prescription for inhaled corticosteroids and only 14% had any outpatient follow-up within 30 days of their ED visit. Patients who were Hispanic, uninsured, and privately insured had the lowest odds of receiving an ICS prescription from the ED.

Source
Inhaled Corticosteroids Rarely Prescribed at Emergency Department Discharge Despite Low Rates of Follow-Up Care. J Emerg Med. 2023 May;64(5):555-563. doi: 10.1016/j.jemermed.2023.02.013. Epub 2023 Mar 21.

RECOVERY RCT – High or Low Dose Dexamethasone for COVID-19?

Infectious Disease, Pharmacy/Pharmacology

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In this large, randomized controlled trial, hypoxic patients requiring simple or no oxygen who received higher dose dexamethasone (20mg for 5 days, then 10mg for 5 days) had a higher mortality compared to patients who received usual care, most of whom were treated with 6mg per day of dexamethasone for 10 days.

Source
Higher dose corticosteroids in patients admitted to hospital with COVID-19 who are hypoxic but not requiring ventilatory support (RECOVERY): a randomised, controlled, open-label, platform trial. Lancet. 2023 May 6;401(10387):1499-1507. doi: 10.1016/S0140-6736(23)00510-X. Epub 2023 Apr 13.

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