January 2024

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This article outlines the updated 2023 guidelines for diagnosis and management of atrial fibrillation. Continue reading for ways to incorporate them into your emergency medicine practice.

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This prospective multi-center stepped wedge trial found that routine molecular multiplex testing for all children who presented to pediatric EDs with acute gastroenteritis detected more clinically relevant pathogens (2.1% to 15%) and led to an adjusted 21% decrease in return visits.

Source
Clinical Impact of Multiplex Molecular Diagnostic Testing in Children With Acute Gastroenteritis Presenting to an Emergency Department: A Multicenter Prospective Study. Preprint. medRxiv. 2023;2023.07.27.23293208. Published 2023 Jul 31. doi:10.1101/2023.07.27.23293208

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In patients hospitalized with non-severe community-acquired pneumonia (CAP), beta-lactam (BL) only antibiotic regimens have been shown to have increased mortality as compared to other first-line regimens.

Source
Comparative Effectiveness of First-Line and Alternative Antibiotic Regimens in Hospitalized Patients With Nonsevere Community-Acquired Pneumonia: A Multicenter Retrospective Cohort Study. Chest. 2024 Jan;165(1):68-78. doi: 10.1016/j.chest.2023.08.008. Epub 2023 Aug 11.

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In patients with suspected acute poisoning who are comatose, a more restrictive intubation approach where intubation is withheld unless an accompanying emergent indication is present, may lead to fewer ICU admissions, decreased ICU length of stay, and decreased requirement for mechanical ventilation, with fewer adverse events.

Source
Effect of Noninvasive Airway Management of Comatose Patients With Acute Poisoning: A Randomized Clinical Trial. JAMA. 2023 Dec 19;330(23):2267-2274. doi: 10.1001/jama.2023.24391.

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Given a substantial increase in the number of children who have accidental ingestion of THC-based products, these authors advocate for consideration of early urine drug screen testing on children who present with altered mental status or neurological symptoms.

Source
Urine Toxicology Test for Children With Altered Mental Status. Pediatrics. 2023. Nov 1;152(5):e2022060861Doi: 10.1542/peds.

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Overall rates of intracranial hemorrhage (ICH) in patients >65 years of age with either definite or uncertain head trauma were found to be 11.4% and 1.7%, respectively, leading these authors to recommend head CT imaging on all geriatric patients presenting with possible head trauma.

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This meta-analysis found a reduction in all-cause mortality in patients hospitalized with severe CAP who received adjunctive corticosteroid therapy.

Source
Efficacy and Safety of Corticosteroid Therapy for Community-Acquired Pneumonia: A Meta-Analysis and Meta-Regression of Randomized, Controlled Trials. Clin Infect Dis. 2023 Dec 15;77(12):1704-1713. doi: 10.1093/cid/ciad496.

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Chair placement near the bedside is a simple intervention that increased the likelihood of physician sitting during patient encounters and yielded higher patient scores in satisfaction and communication.

Source
Effect of chair placement on physicians' behavior and patients' satisfaction: randomized deception trial. BMJ. 2023;383:e076309. Published 2023 Dec 15. doi:10.1136/bmj-2023-076309.

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Ever tried having your patient drink Coca-Cola to relieve an esophageal food bolus? This interesting and well-designed multicenter RCT suggests limited efficacy of this off-label approach. 

Source
Efficacy of cola ingestion for oesophageal food bolus impaction: open label, multicentre, randomised controlled trial. BMJ. 2023 Dec 11;383:e077294. doi: 10.1136/bmj-2023-077294.

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Use of a high-sensitivity troponin (hsTn) HEART pathway resulted in a small (but significant) increase in percentage of patients diagnosed with acute myocardial infarction (AMI) during index ED visit, and a small but significant decreased in diagnosis of AMI within 30 days after the visit when compared with conventional troponin assays (cTn). It also resulted in reduced hospital admission, stress testing, and coronary revascularization.

Source
Emergency Department Cardiac Risk Stratification With High-Sensitivity vs Conventional Troponin HEART Pathway. JAMA Netw Open. 2023 Dec 1;6(12):e2348351. doi: 10.1001/jamanetworkopen.2023.48351.