September 2023

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Priapism is a semi-rare time sensitive emergent disease, and this article is a summary of guidelines for diagnosis and management.

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Diagnosis and Management of Priapism. JAMA vol. 330,6 (2023): 559-560. doi:10.1001/jama.2023.13377

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Neurosyphilis is on the rise – brush up on the facts now before you miss it.

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State-of-the-Art Review: Neurosyphilis. Clin Infect Dis. 2023 Aug 18;ciad437. doi: 10.1093/cid/ciad437. Online ahead of print.

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Syphilis is on the rise in certain subgroups. This article provides a well-organized infographic that can be used to summarize treatment and management of patients in all stages of infection.

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Children with persistent or worsening rhinosinusitis experienced a modest improvement in symptoms when given amoxicillin-clavulanate vs. placebo.

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Identifying Children Likely to Benefit From Antibiotics for Acute Sinusitis: A Randomized Clinical Trial. JAMA. 2023;330(4):349-358. doi:10.1001/jama.2023.10854

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An unprecedented 555 unfilled positions in the 2023 emergency medicine (EM) match were less likely a result of wavering interest in our specialty and more due to surging interest after the COVID pandemic (in 2021) and financial pressures within healthcare, resulting in a proliferation of training positions.

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The Emergency Medicine Match: Is the Sky Falling or Is This Just Growing Pains? Ann Emerg Med. 2023 Aug 4:S0196-0644(23)00576-0. doi: 10.1016/j.annemergmed.2023.07.004. Epub ahead of print.

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Blast injuries combine common polytrauma mechanisms - blunt, penetrating, burns - with the unique pathophysiology of blast wave injuries, and mass casualty scenarios. While rare, these patients are resource-intensive, prone to delayed yet rapid clinical deterioration, and carry high morbidity and mortality.

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High risk and low prevalence diseases: Blast injuries. Am J Emerg Med. 2023 Aug;70:46-56. doi: 10.1016/j.ajem.2023.05.003. Epub 2023 May 5.

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Treatment with direct oral anticoagulants (DOACs) in pediatric patients appears to reduce venous thromboembolism (VTE) recurrence compared to standard of care, with no difference in major bleeding or serious adverse events. Prophylaxis with DOACs was comparable to standard of care and was associated with a nonsignificant reduction in VTE.

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Efficacy and safety of direct oral anticoagulants in the pediatric population: a systematic review and a meta-analysis. J Thromb Haemost. 2023 Jul 20:S1538-7836(23)00573-1. doi: 10.1016/j.jtha.2023.07.011. Epub ahead of print.

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In non-ischemic right bundle branch block (RBBB) ECGs, we expect discordant ST depression and T wave inversions in leads V1-V3. ST segment elevation, or even an isoelectric ST segment, in these leads is abnormal and should make us concerned for ischemia. See below.

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In this video review, information contained in out-of-hospital cardiac arrest (OHCA) patient handoffs was highly variable, which is an area for quality improvement and standardization. Try this checklist!

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Emergency Medical Services handoff of patients in cardiac arrest in the Emergency Department: A retrospective video review study of duration and details of handoff. Resuscitation. 2023 Aug;189:109834. doi: 10.1016/j.resuscitation.2023.109834. Epub 2023 May 16.

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Need in medicine describes what is missing and the necessary corrective action (i.e. you need a transfusion), but this wording allows little latitude for discussion with patients and families. However, saying, "Can we talk about what this means and what to do next?" allows for dialogue without presuming the desired course of action.

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Reconsidering the Language of Serious Illness. JAMA. 2023 Aug 15;330(7):587-588. doi: 10.1001/jama.2023.11409.