Written by Clay Smith
Spoon Feed
Here are the top ten most viewed JournalFeed articles from 2024. Enjoy!
Happy New Year!
- Phoenix Criteria – New Pediatric Sepsis Score
The Phoenix Sepsis Score, which is a novel clinical criterion for pediatric sepsis and septic shock developed using measures of organ dysfunction, outperforms existing IPSCC criteria for the diagnosis of pediatric sepsis and septic shock.
Development and Validation of the Phoenix Criteria for Pediatric Sepsis and Septic Shock. JAMA. 2024 Feb 27;331(8):675-686. doi: 10.1001/jama.2024.0196.
Comment: I haven’t actually used this in practice, but now that there is an MDCalc version, it seems more doable. - New 2023 AHA Atrial Fibrillation Guidelines
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.
2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2023 Nov 30. doi: 10.1161/CIR.0000000000001193. Online ahead of print.
Comment: I’m more hesitant to cardiovert without prior TEE after these guidelines but would consider if the CHA2DS2-VASc score 0-1 and symptom duration <12 hours. - How High Should We Set IPAP for Non-Invasive Ventilation in COPD?
This RCT found high-intensity non-invasive positive pressure ventilation (NPPV) in COPD patients with persistent hypercapnia decreased the need for endotracheal intubation according to prespecified criteria.
Effect of High-Intensity vs Low-Intensity Noninvasive Positive Pressure Ventilation on the Need for Endotracheal Intubation in Patients With an Acute Exacerbation of Chronic Obstructive Pulmonary Disease: The HAPPEN Randomized Clinical Trial. JAMA. 2024 Sep 16:e2415815. doi: 10.1001/jama.2024.15815. Epub ahead of print. PMID: 39283649; PMCID: PMC11406453.
Comment: I will feel free to increase IPAP to a goal tidal volume of 10-15 mL/kg predicted body weight, up to 20-30 cm H2O. - New IDSA Guideline on Intra-abdominal Infections and Imaging
The Infectious Diseases Society of America has published an update to clinical practice guidelines in the diagnosis of complicated intra-abdominal infections in various populations.
2024 Clinical Practice Guideline Update by the Infectious Diseases Society of America on Complicated Intra-abdominal Infections: Risk Assessment, Diagnostic Imaging, and Microbiological Evaluation in Adults, Children, and Pregnant People. Clin Infect Dis. 2024 Oct 4;79(Supplement_3):S81-S87. doi: 10.1093/cid/ciae346. PMID: 38965057
Comment: No need to be a one trick pony. There are other imaging modalities than CT for some intra-abdominal infections. - How to Treat Opioid Plus Xylazine Withdrawal
This descriptive study discussed a protocol to treat a fentanyl and xylazine subtype of opiate use withdrawal using one of four pathways. Use of the pathway resulted in lower against medical advice (AMA) dispositions and Clinical Opiate Withdrawal Scale (COWS) scores.
Tranq Dope: Characterization of an ED cohort treated with a novel opioid withdrawal protocol in the era of fentanyl/xylazine.Am J Emerg Med. 2024 Sep 4;85:130-139. doi: 10.1016/j.ajem.2024.08.036. Epub ahead of print. Erratum in: Am J Emerg Med. 2024 Oct 8:S0735-6757(24)00523-0. doi: 10.1016/j.ajem.2024.10.006. PMID: 39260041.
Comment: We may need to pile on the meds, such as olanzapine or guanfacine, even adding ketamine or droperidol (if normal QTc). - How to Manage Massive Hemoptysis
ED management of massive hemoptysis should focus on resuscitation (including airway management, reversal of coagulopathy), diagnostic imaging, and prompt consultation or referral for definitive management.
High risk and low incidence diseases: Massive hemoptysis. Am J Emerg Med. 2024 Sep 10;85:179-185. doi: 10.1016/j.ajem.2024.09.013. Epub ahead of print. PMID: 39278024.
Comment: Add TXA. Bleeding lung down. Mainstem good lung. Lead with large bore suction to intubate. CT contrast phase differs from CT for PE. - Large- or Small-Bore Chest Tubes for Hemothorax?
While there was concern for selection bias in a number of included studies, this systematic review and meta-analysis found that small–bore thoracostomy tubes may be appropriate to use in traumatic hemothorax.
Small versus large-bore thoracostomy for traumatic hemothorax: A systematic review and meta-analysis. J Trauma Acute Care Surg. 2024 Oct 1;97(4):631-638. doi: 10.1097/TA.0000000000004412. Epub 2024 Aug 30. PMID: 39213292.
Comment: This was a surprise. Really small, ≤14 Fr, chest tubes did as well as large, ≥20 Fr, in hemothorax. - ILCOR – 2023 Resuscitation Science Evidence Review
The International Liaison Committee on Resuscitation (ILCOR) released updates on a broad range of resuscitation practices. Check out this JournalFeed to stay up to date!
2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation. 2023 Nov 9. doi: 10.1161/CIR.0000000000001179. Online ahead of print.
Comment: Dual sequential defibrillation for refractory VF is good. Too much epinephrine may be bad; one very weak study suggests 3 mg max. - How to Treat Hypertensive Emergency
Hypertensive emergencies are associated with high morbidity and mortality and require specific strategies to diminish pressure-mediated organ injury, depending on the type of hypertensive presentation.
Evaluation and management of hypertensive emergency. BMJ. 2024 Jul 26;386:e077205. doi: 10.1136/bmj-2023-077205. PMID: 39059997.
Comment: Esmolol for dissection. NTG for pulmonary edema. Phentolamine for pheochromocytoma. Nicardipine for everything else. - GRACE-4 – New Guidelines for Alcohol Withdrawal, Alcohol Use Disorder, and Cannabis Hyperemesis
GRACE-4 is packed with practice-changing recommendations for patients with alcohol withdrawal syndrome (AWS), alcohol use disorder (AUD), and cannabinoid hyperemesis syndrome (CHS).
Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE-4): Alcohol use disorder and cannabinoid hyperemesis syndrome management in the emergency department. Acad Emerg Med. 2024 May;31(5):425-455. doi: 10.1111/acem.14911. PMID: 38747203.
Comment: Phenobarbital plus benzodiazepines is good. Naltrexone or acamprosate can help alcohol use disorder. Droperidol is good for cannabis hyperemesis.
How did this change my practice?
It didn’t seem fair to just make a list and not comment on how each article has impacted my practice this year, so I dropped some nuggets after each article. Happy New Year!
