Dealing With the ESBL Threat - Extended Spectrum β-lactamase Enterobacteriaceae

Dealing With the ESBL Threat - Extended Spectrum β-lactamase Enterobacteriaceae

Highly resistant, extended spectrum β-lactamase (ESBL) producing Enterobacteriaceae in the urine are becoming increasingly common in unexpected patients in the ED.

Predicting Severe Alcohol Withdrawal

Predicting Severe Alcohol Withdrawal

Individual risk factors associated with the development of severe alcohol withdrawal syndrome (SAWS) included a history of delirium tremens and baseline BP ≥ 140mmHg but no individual symptoms or signs associated with exclusion of SAWS. Composite measures fared better, such as the Prediction of Alcohol Withdrawal Severity Scale; a score ≥ 4 had a LR of 174 (95% CI 43-696).

Who's Giving Inappropriate Antibiotics - Urgent Care, Retail, Emergency, or Medical Office?

Who's Giving Inappropriate Antibiotics - Urgent Care, Retail, Emergency, or Medical Office?

Urgent care centers wrote the most inappropriate antibiotic prescriptions for viral respiratory illnesses.  They were followed by the ED, medical offices, and finally by retail health clinics.

Can We Use Beta-Blockers With COPD?

Can We Use Beta-Blockers With COPD?

Patients with cardiovascular disease and concomitant COPD can be safely treated with a combination long-acting beta-agonist and a long-acting muscarinic antagonist when on a baseline beta-blocker.

Predicting Outpatient Failure for Cellulitis

Predicting Outpatient Failure for Cellulitis

Tachypnea, chronic ulcers, prior MRSA colonization, and prior cellulitis in the past 12 months were all associated with an increased risk of oral antibiotic failure for treatment of non-purulent cellulitis.

Syncope/Pre-syncope and Outcome in PE Patients

Syncope/Pre-syncope and Outcome in PE Patients

Syncope or pre-syncope in patients with PE was associated with an increased risk for 30-day mortality (43% vs 6%) and was an independent predictor of 30-day mortality when accompanied by hemodynamic instability on admission.  Don't try to treat them as an outpatient.

ECG Predictors of Arrhythmia in Syncope

ECG Predictors of Arrhythmia in Syncope

In the evaluation of older patients with syncope, certain ECG abnormalities increase the risk of 30-day serious cardiac arrhythmias. These ECG abnormalities include non-sinus rhythm; multiple premature ventricular conductions; short PR interval; first degree atrioventricular block; complete left bundle branch block; and ST, T, and Q-wave abnormalities consistent with acute or chronic ischemia.

LR - When NOT to Use It

LR - When NOT to Use It

With all the talk of using balanced, lower chloride solutions for volume in the ED and ICU, we thought it might be a good idea to discuss the potential downsides of LR.

SMART Trial - Balanced Crystalloids vs NS in Critically Ill Adults

SMART Trial - Balanced Crystalloids vs NS in Critically Ill Adults

In patients admitted to the ICU, use of balanced fluids resulted in a lower rate of major acute kidney events (MAKE) at 30 days compared to normal saline (14.3% vs 15.4%). This is a NNT of 94 to avoid one MAKE.

SALT-ED Trial - Balanced Crystalloid vs NS

SALT-ED Trial - Balanced Crystalloid vs NS

In non-critically ill patients that received IV fluids in the ED, there was a lower incidence of major adverse kidney events in the balanced crystalloid group compared to saline (4.7% vs 5.6%) with a NNT of 111. There was no difference in terms of hospital-free days between the groups.

Fluoroquinolones - Risk of Aortic Aneurysm and Dissection

Fluoroquinolones - Risk of Aortic Aneurysm and Dissection

Fluoroquinolone use was associated with increased risk of developing newly diagnosed aortic aneurysm or dissection.

MRSA - I&D Only or Add Antibiotics?

MRSA - I&D Only or Add Antibiotics?

This meta-analysis of 4 RCTs found anti-MRSA antibiotics in addition to I&D led to a far better cure rate than I&D alone.

Should We Anticoagulate Subsegmental PE?

Should We Anticoagulate Subsegmental PE?

This systematic review suggested that we don't know if treating subsegmental PE harms or helps.  But this may inform decision making in patients in whom it would be very dangerous to anticoagulate.  It suggests a state of equipoise.

Metro Is So Retro - C. diff Guidelines

Metro Is So Retro - C. diff Guidelines

If you're still reaching for metronidazole in patients with suspected or confirmed C. difficile colitis, it's time to get up to speed with this summary.

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