October 2023

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After a non-diagnostic screening ultrasound for appendicitis, a rapid-MRI has high clinical accuracy in establishing the appropriate diagnosis (appendicitis or not) in a pediatric patient population.

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Properties of ultrasound-rapid MRI clinical diagnostic pathway in suspected pediatric appendicitis. Am J Emerg Med. 2023 Sep;71:217-224. doi: 10.1016/j.ajem.2023.06.026. Epub 2023 Jun 16.

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A multicenter, open RCT of adults with presumed uncomplicated appendicitis found no significant difference in perforation rates or complications with appendectomy before 8 or 24 hours.

Source
Role of preoperative in-hospital delay on appendiceal perforation while awaiting appendicectomy (PERFECT): a Nordic, pragmatic, open-label, multicentre, non-inferiority, randomized controlled trial.[published online ahead of print, 2023 Sep 14]. Lancet. 2023;S0140-6736(23)01311-9. doi:10.1016/S0140-6736(23)01311-9

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The STREAM-2 trial found half-dose tenecteplase was effective in treating STEMI patients ≥60, though with increased risk of intracranial hemorrhage.

Source
STREAM-2: Half-Dose Tenecteplase or Primary Percutaneous Coronary Intervention in Older Patients With ST-Segment-Elevation Myocardial Infarction: A Randomized, Open-Label Trial. Circulation. 2023 Aug 29;148(9):753-764. doi: 10.1161/CIRCULATIONAHA.123.064521. Epub 2023 Jul 13.

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A new cutoff of 10,000 colony-forming units per milliliter (CFU/mL) on urine culture to diagnose urinary tract infection (UTI) from catheterized specimens in infants and children <3 years improved sensitivity and specificity.

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Support for the Use of a New Cutoff to Define a Positive Urine Culture in Young Children. Pediatrics. 2023 Oct 1;152(4):e2023061931. doi: 10.1542/peds.2023-061931.

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Here are ten tips from the AHA for the next super-sick poisoned patient you encounter.

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Emergency department thoracotomy (EDT) is recommended in pulseless pediatric patients with signs of life* who have penetrating thoracic/abdominopelvic trauma; if pulseless with signs of life* and blunt trauma, a conditional recommendation is made.

Source
Emergency department thoracotomy in children: A Pediatric Trauma Society, Western Trauma Association, and Eastern Association for the Surgery of Trauma systematic review and practice management guideline. J Trauma Acute Care Surg. 2023 Sep 1;95(3):432-441. doi: 10.1097/TA.0000000000003879. Epub 2023 Mar 11.

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Emergency physician (EP) advancing age was associated with higher 7-day patient mortality. This is a call to keep current with literature, clinical skills, and best practices.

Source
Association Between Emergency Physician's Age and Mortality of Medicare Patients Aged 65 to 89 Years After Emergency Department Visit. Ann Emerg Med. 2023 Sep;82(3):301-312. doi: 10.1016/j.annemergmed.2023.02.010. Epub 2023 Mar 23.

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Don’t hang your hat on lactate clearance to assess therapeutic response to resuscitation in sepsis; there are too many confounders, and initial clearance does not necessarily project clinical course.

Source
Initial Lactate Clearance Is Confounded Highly by Comorbidities and Poorly Predicts Subsequent Lactate Trajectory. Chest. 2023 Sep;164(3):667-669. doi: 10.1016/j.chest.2023.04.023. Epub 2023 Apr 20.

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Personality disorders are common and complex emotional difficulties that are challenging to identify, categorize, and manage. Language surrounding these often-stigmatized diagnoses is changing, as are the recommendations on treatment of individuals with personality disorders.

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Positioning, preoxygenation, medication selection, and other questions surrounding emergent rapid sequence intubation (RSI) are addressed by an expert panel.