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.

ICH in NOAC vs Warfarin and Mortality

ICH in NOAC vs Warfarin and Mortality

Among patients with ICH, those on non-vitamin K oral anticoagulants had a lower in-hospital risk of mortality compared to warfarin (26.5% vs 32.6%). Compared to warfarin, those on NOACs were more likely to be discharged home (+3.3%), be functionally independent (+2.5%), and have the ability to ambulate independently at discharge (+1.8%).

ACEi-ARBs and Hypotension After Induction

ACEi-ARBs and Hypotension After Induction

Hold ACE-inhibitors (ACEi) or angiotensin receptor blockers (ARBs) in patients you know will need surgery. These drugs are not associated with mortality but are associated with, at times, profound, sustained hypotension after induction.

Prevalence of PE in Syncope

Prevalence of PE in Syncope

This large, retrospective study found the prevalence of PE in hospitalized patients discharged with a diagnosis of syncope was 0.15% to 2.1%; 0.35% to 2.63% at 90-day follow up.  This was much lower than the PESIT trial, at 17.3%.

Reducing Elderly Transports to the ED for Falls

Reducing Elderly Transports to the ED for Falls

Paramedics responding to elderly patients who had fallen in an assisted living facility followed a protocol that included discussing the case with the patient's primary care physician (PCP).  This drastically reduced the number actually getting transported to the ED by 63% and was safe.

Should We Give Delayed Lytics for Stroke Over Age 80?

Should We Give Delayed Lytics for Stroke Over Age 80?

Elderly stroke patients over age 80 who received tPA >3 - 4.5 hours from time of onset were more likely to have symptomatic intracranial hemorrhage (SICH), 10% vs 8% in the <3-hour group, but overall mortality and percentage with good neurological outcome was the same in the delayed group as patients who received it in under 3 hours.

Member Login
Welcome, (First Name)!

Forgot? Show
Log In
Enter Member Area
My Profile Sign up to get full access. Log Out