November 2023

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Risk stratification of patients with asymptomatic Brugada remains a clinical dilemma and makes expectant guidance difficult. This article has demonstrated the highest risk of arrythmia in those with spontaneous type-1 BrECG (Brugada ECG) as compared to those with drug-induced-only BrECG.

Source
Asymptomatic Patients With Brugada ECG Pattern: Long-Term Prognosis From a Large Prospective Study. Circulation. 2023 Nov 14;148(20):1543-1555. doi: 10.1161/CIRCULATIONAHA.123.064689. Epub 2023 Oct 13.

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The American Heart Association updated their neonatal resuscitation recommendations based on new evidence. The update focuses on umbilical cord management and best practices for administering positive pressure ventilation. Check-out these videos on neonatal resuscitation on Journal Feed!

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This RCT found no differences between high dose (16 mg) and low dose (4 mg) IV dexamethasone in patients who presented to EDs with migraine headaches. 

Source
Randomized Trial Comparing Low- vs High-Dose IV Dexamethasone for Patients With Moderate to Severe Migraine. Neurology vol. 101,14 (2023): e1448-e1454. doi:10.1212/WNL.0000000000207648

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Advanced statistics emulating clinical trial protocols from an ICU database did not identify consistent differences in 30-day mortality when ICU patients were intubated early (within 8 hours of admission) or late (after 48 hours).

Source
Emulating Target Trials Comparing Early and Delayed Intubation Strategies. Chest. 2023 Oct;164(4):885-891. doi: 10.1016/j.chest.2023.04.048. Epub 2023 May 5.

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In this multicenter, randomized controlled trial comparing suturing the fingernail back onto the nail bed versus simply covering the nail bed with a non-adherent dressing after repair of a nail bed injury, there was no statistically significant difference in infection rate or cosmetic outcome. 

Source
Effectiveness of nail bed repair in children with or without replacing the fingernail: NINJA multicentre randomized clinical trial. Br J Surg. 2023 Mar 30;110(4):432-438. doi: 10.1093/bjs/znad031.

Happy Thanksgiving!
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~The JournalFeed Team

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In a randomized control trial of discharged infants with bronchiolitis, enhanced home nasal suctioning with a mechanical device did not lead to reduced unscheduled health care revisits as compared to standard bulb suctioning.

Nasal Suctioning Therapy Among Infants With Bronchiolitis Discharged Home From the Emergency Department: A Randomized Clinical Trial. JAMA Netw Open. 2023;6(10):e2337810. Published 2023 Oct 2.

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Although infrequent, precipitous vaginal deliveries in the ED occur and are associated with higher rates of maternal and fetal complications. Here's how you can be prepared to manage these deliveries and common complications.

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This updated systematic review and meta-analysis showed no statistically significant difference in all-cause mortality or serious adverse events in sepsis patients given low vs higher fluid volumes.

Source
Lower vs Higher Fluid Volumes in Adult Patients With Sepsis: An Updated Systematic Review With Meta-Analysis and Trial Sequential Analysis. Chest. 2023 Oct;164(4):892-912. doi: 10.1016/j.chest.2023.04.036. Epub 2023 May 2.

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This cohort study of 1.8 million US healthcare workers (HCWs) found that registered nurses, health technicians, and health care support workers in the US were at increased risk of suicide relative to non-HCWs.

Source
Suicide Risks of Health Care Workers in the US. JAMA vol. 330,12 (2023): 1161-1166. doi:10.1001/jama.2023.15787

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In this large, multi-center retrospective study of academic pediatric emergency departments across the US and Canada, researchers found that children presenting with sickle cell disease vaso-occlusive events had nine times (900%) greater adjusted odds of discharge home if given intranasal fentanyl (INF).

Source
Intranasal fentanyl and discharge from the emergency department among children with sickle cell disease and vaso-occlusive pain: A multicenter pediatric emergency medicine perspective. Am J Hematol. 2023 Apr;98(4):620-627. doi: 10.1002/ajh.26837. Epub 2023 Feb 6.