October 2024
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Oct 17 2024
Diagnostic Approach to Syphilis – Not So Painless After All
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There continues to be a lack of evidence to strongly recommend one treponemal assay over another in the diagnosis of syphilis, particularly given the varying accuracy of each test depending on the stage of the disease. For now, this review suggests the diagnostic algorithm recommended by the CDC (see below!) seems to be a reasonable approach, but more trials are needed to refine this.Source
Operating Characteristics of Diagnostic Tests for Syphilis. Acad Emerg Med. 2024 Sep 6; 00:1-3. doi: 10.1111/acem.15008. PMID: 39239836. -
Oct 16 2024
A New Rapid Way to Determine Viral vs Bacterial?
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This prospective study of a new proprietary rapid host-protein test, MeMed BV (MMBV), shows promising results for differentiating viral vs bacterial causes of fever. However, the gold standard for comparison was similar to current common practice, making it difficult to measure the added value of MMBV over usual care.Source
A rapid host-protein test for differentiating bacterial from viral infection: Apollo diagnostic accuracy study. J Am Coll Emerg Physicians Open. 2024 May 8;5(3):e13167. doi: 10.1002/emp2.13167. PMID: 38721037; PMCID: PMC11077430. -
Oct 15 2024
New Topical Antiseptic to Treat BV?
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Dequalinium chloride was noninferior to metronidazole for treatment of bacterial vaginosis (BV), with fewer side effects.Source
Efficacy of Dequalinium Chloride vs Metronidazole for the Treatment of Bacterial Vaginosis: A Randomized Clinical Trial. JAMA Netw Open. 2024 May 1;7(5):e248661. doi: 10.1001/jamanetworkopen.2024.8661. PMID: 38696172; PMCID: PMC11066704. -
Oct 14 2024
Does Defibrillator Pad Placement Matter for OHCA?
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Anterior-posterior (AP) - compared to standard anterolateral (AL) defibrillator pad placement - was associated with higher rates of ROSC among patients with out-of-hospital-cardiac-arrest (OHCA), but no difference in survival to discharge or functional survival at discharge was observed.Source
Initial Defibrillator Pad Position and Outcomes for Shockable Out-of-Hospital Cardiac Arrest. JAMA Netw Open. 2024 Sep 3;7(9):e2431673. doi: 10.1001/jamanetworkopen.2024.31673. PMID: 39250154; PMCID: PMC11385052. -
Oct 11 2024
LR or NS for Sickle Cell Pain Crisis?
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For sickle cell patients (particularly Hgb SS) with a vaso-occlusive episode (VOE), large volume resuscitation (>2L) with lactated ringers (LR) has been shown to have improved outcome measures compared to normal saline (NS).Source
Lactated Ringer vs Normal Saline Solution During Sickle Cell Vaso-Occlusive Episodes. JAMA Intern Med. 2024 Sep 9:e244428. doi: 10.1001/jamainternmed.2024.4428. Epub ahead of print. PMID: 39250114; PMCID: PMC11385329. -
Oct 10 2024
Can You Spot Cavernous Sinus Thrombosis?
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Cavernous sinus thrombosis (CST) is a rare but serious thrombophlebitic disease that can be easy to miss in the emergency department setting. This article provides an overview of CST as well as some pearls for clinching this diagnosis for emergency medicine physicians.Source
High risk and low prevalence diseases: Cavernous sinus thrombosis. Am J Emerg Med. 2024;83:47-53. doi:10.1016/j.ajem.2024.06.024.
PMID: 38959601. -
Oct 09 2024
The IV vs IO Debate in OHCA Continues…
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This retrospective observational analysis showed an association with more favorable neurologic outcomes, survival to hospital discharge, and ROSC upon ED arrival, in an IV-first approach compared to humeral IO in out-of-hospital cardiac arrests.Source
The association of intravenous vs. humeral-intraosseous vascular access with patient outcomes in adult out-of-hospital cardiac arrests. Resuscitation. 2024 Sep;202:110360. doi: 10.1016/j.resuscitation.2024.110360. Epub 2024 Aug 16. PMID: 39154890. -
Oct 08 2024
Still Seizing? New ACEP Policy on Second-Line Anticonvulsants
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ACEP released a clinical policy that addresses the choice of a second-line agent for adults with refractory seizures after adequate dosing of benzodiazepines.Source
Clinical Policy: Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Seizures: Approved by the ACEP Board of Directors, April 17, 2024. Ann Emerg Med. 2024 Jul;84(1):e1-e12. doi: 10.1016/j.annemergmed.2024.02.018. PMID: 38906639. -
Oct 07 2024
Is the HINTS Exam Accurate? A Systematic Review
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This systematic review snapshot found that when the HINTS exam is used by properly trained clinicians, it shows high sensitivity and moderate specificity to identify central causes of acute vestibular syndrome (AVS).Source
Are the HINTS and HINTS Plus Examinations Accurate for Identifying a Central Cause of Acute Vestibular Syndrome? Ann Emerg Med. 2024 Jul;84(1):60-62. doi: 10.1016/j.annemergmed.2024.01.027. Epub 2024 Feb 22. PMID: 38385911. -
Oct 04 2024
Imagining the Inevitable – Mental Drills for Emergency Skills
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Mental practice, a cognitive rehearsal technique from sports psychology, can enhance skill retention and competency in emergency medicine, particularly for high-acuity, low-frequency procedures.Source
Mental Practice: Applying Successful Strategies in Sports to the Practice of Emergency Medicine. Ann Emerg Med. 2024 Aug;84(2):159-166. doi: 10.1016/j.annemergmed.2023.12.011. Epub 2024 Jan 18. PMID: 38244027.