December 2023
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Dec 15 2023
The Real Risks of Boarding in the Emergency Department
Please read this announcement about upgrades to JournalFeed (CME, Amal Mattu, new website)! We also need to do a price increase due to rising costs. Price changes started Dec. 1, 2023 for new subscribers and on Jan 1, 2024 for current subscriber auto-renewals. If cost is a barrier for you, please read the announcement. We want to help! ~Clay Smith
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In this large, multicenter prospective cohort study in France, researchers found that patients ≥75 years who were admitted overnight boarding in the ED had higher rates of in-hospital mortality, length of stay, and adverse events.Source
Overnight Stay in the Emergency Department and Mortality in Older Patients. JAMA Intern Med. 2023 Dec 1;183(12):1378-1385. doi: 10.1001/jamainternmed.2023.5961. -
Dec 14 2023
Phenobarbital vs Benzos for Alcohol Withdrawal – New Meta-analysis
Please read this announcement about upgrades to JournalFeed (CME, Amal Mattu, new website)! We also need to do a price increase due to rising costs. Price changes started Dec. 1, 2023 for new subscribers and on Jan 1, 2024 for current subscriber auto-renewals. If cost is a barrier for you, please read the announcement. We want to help! ~Clay Smith
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This systematic review and meta-analysis did not show significant improvement in measured patient outcomes for treatment of alcohol withdrawal syndrome with phenobarbital vs benzodiazepines.Source
Phenobarbital Treatment of Alcohol Withdrawal in the Emergency Department: A Systematic Review and Meta-analysis. Acad Emerg Med. 2023 Nov 3. doi: 10.1111/acem.14825. Online ahead of print. -
Dec 13 2023
Catatonia – What You Need to Know
Please read this announcement about upgrades to JournalFeed (CME, Amal Mattu, new website)! We also need to do a price increase due to rising costs. Price changes started Dec. 1, 2023 for new subscribers and on Jan 1, 2024 for current subscriber auto-renewals. If cost is a barrier for you, please read the announcement. We want to help! ~Clay Smith
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Catatonia is a psychiatric condition with variable and unpredictable clinical features. Let's dive into how to recognize, diagnose, and manage it in the ED. -
Dec 12 2023
Is 0/2 Hour hsTnT Rule Out Ready for Prime Time?
Please read this announcement about upgrades to JournalFeed (CME, Amal Mattu, new website)! We also need to do a price increase due to rising costs. Price changes started Dec. 1, 2023 for new subscribers and on Jan 1, 2024 for current subscriber auto-renewals. If cost is a barrier for you, please read the announcement. We want to help! ~Clay Smith
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This secondary analysis of the STOP CP cohort study found that in isolation, using a 0/2 hour hs-cTnT rule-out protocol did not achieve a NPV ≥ 99% for 30-day cardiac death or MI (CDMI). When combined with a low risk History, ECG, Age, and Risk factor (HEAR) score, it did - but at the cost of significantly decreased efficacy (ruling out only 30.7% of patients).Source
Performance of the 0/2-Hour hs-cTnT Accelerated Diagnostic Protocol in a Multisite United States Cohort. Acad Emerg Med. 2023 Nov 4. doi: 10.1111/acem.14827. Epub ahead of print. -
Dec 11 2023
More Boxcars? Transfusion Trigger for STEMI and NSTEMI
Please read this announcement about upgrades to JournalFeed (CME, Amal Mattu, new website)! We also need to do a price increase due to rising costs. Price changes started Dec. 1, 2023 for new subscribers and on Jan 1, 2024 for current subscriber auto-renewals. If cost is a barrier for you, please read the announcement. We want to help! ~Clay Smith
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Liberalizing the transfusion threshold to 10 g/dL (compared to 7-8 g/dL) for patients with myocardial infarction did not improve composite outcomes of myocardial infarction or death at 30 days.Source
Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia. N Engl J Med. 2023 Nov 11. doi: 10.1056/NEJMoa2307983. Epub ahead of print. -
Dec 08 2023
FLAME Massive PE Study – FlowTriever for Intravascular Thrombectomy
Please take a moment to read about some exciting upgrades (CME, Amal Mattu, new website!!) and pricing changes with JournalFeed. I don't want anyone to be caught off guard. I also don't want anyone to let cost be a barrier. So, please read it when you can. ~Clay Smith
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In this non-randomized prospective trial, patients with massive pulmonary embolism who were treated with the intravascular FlowTriever thrombectomy device had improved outcomes compared to those treated with other therapies.Source
Outcomes in High-Risk Pulmonary Embolism Patients Undergoing FlowTriever Mechanical Thrombectomy or Other Contemporary Therapies: Results From the FLAME Study. Circ Cardiovasc Interv. 2023;16(10):e013406. -
Dec 07 2023
Viruses LOWER Procalcitonin? Impact of Viral Infection on PCT in Febrile Infants
Please take a moment to read about some exciting upgrades (CME, Amal Mattu, new website!!) and pricing changes with JournalFeed. I don't want anyone to be caught off guard. I also don't want anyone to let cost be a barrier. So, please read it when you can. ~Clay Smith
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Procalcitonin (PCT) is suppressed in young febrile infants in the presence of confirmed viral infection (CVI), which lowers its sensitivity to detect bacterial infection (BI). Infants meeting the AAP cutoff of 0.5 ng/mL, even in the presence of CVI, should undergo full diagnostic workup for BI.Source
Effect of Viral Illness on Procalcitonin as a Predictor of Bacterial Infection in Febrile Infants. Hosp Pediatr. 2023 Nov 1;13(11):961-966. doi: 10.1542/hpeds.2022-007070. -
Dec 06 2023
Hemolytic Uremic Syndrome from Shiga-Toxin Producing E. coli
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This article provides a review of hemolytic-uremic syndrome (HUS) associated with Shiga toxin-producing Escherichia coli (STEC) infection. This condition, which disproportionately impacts children under five, is defined by thrombocytopenia, non-immune hemolytic anemia, and azotemia caused by thrombotic microangiopathy. -
Dec 05 2023
How to Manage Non-Convulsive Status Epilepticus
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This is a review of the diagnosis and management of non-convulsive status epilepticus (NCSE) in the emergency department. Nonspecific signs and symptoms at presentation make it challenging to identify, which can lead to under-diagnosis and delay in treatment.Source
Nonconvulsive Status Epilepticus: A Review for Emergency Clinicians. J Emerg Med. 2023 Oct;65(4):e259-e271. doi: 10.1016/j.jemermed.2023.05.012. Epub 2023 Jun 5. -
Dec 04 2023
Ketamine vs Etomidate RCT- Which Causes Higher SOFA Score?
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This single center RCT found no difference in maximum Sequential Organ Failure Assessment (SOFA) score between critically ill adult ED patients receiving ketamine vs etomidate for rapid sequence intubation (RSI).Source
The Effect of Ketamine Versus Etomidate for Rapid Sequence Intubation on Maximum Sequential Organ Failure Assessment Score: A Randomized Clinical Trial. The Journal of Emergency Medicine, Volume 65, Issue 5, 2023, Pages e371-e382, ISSN 0736-4679, https://doi.org/10.1016/j.jemermed.2023.06.009.