Inhaled Tranexamic Acid for Hemoptysis?

Inhaled Tranexamic Acid for Hemoptysis?

For patients with hemoptysis, inhaled tranexamic acid was associated with significantly reduced expectorated blood volume, hospital length of stay, need for invasive interventions, and hemoptysis recurrence rate at one year.

Does This Patient Have Pertussis? Bedside Clues to Diagnosis

Does This Patient Have Pertussis? Bedside Clues to Diagnosis

Adults with cough <3weeks or 3-8 weeks with post-tussive vomiting or whooping should be treated for pertussis; those with fever or without paroxysmal cough should be considered to have an alternate diagnosis. Children with <4 weeks of cough and post-tussive vomiting may have pertussis, but it was much less clear than in adults.

Does Negative CTPA Rule Out High Pretest Probability PE?

Does Negative CTPA Rule Out High Pretest Probability PE?

For patients with high pretest probability for pulmonary embolism, a negative CT pulmonary angiography alone does not appear to adequately rule out venous thromboembolism.

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.

IOTA - Oxygen, Less Is More

IOTA - Oxygen, Less Is More

For adults with varied acute illnesses, use of supplemental oxygen in patients with room air SpO2 of 94% or greater was associated with increased short and longterm mortality.

New PE Guidelines From ACEP

New PE Guidelines From ACEP

ACEP has taken a stand on some of the most contemporary issues within the diagnosis and management of venous thromboembolic disease in the emergency department.

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%.

Hold the Z-Pak for Pediatric Pneumonia

Hold the Z-Pak for Pediatric Pneumonia

Young children with community acquired pneumonia seemed to do fine with a beta-lactam antibiotic only and didn't appear to benefit from adding a macrolide.

Do Pediatric CAP Patients Need a Blood Culture?

Do Pediatric CAP Patients Need a Blood Culture?

In children without other comorbidities, with moderate to severe community acquired pneumonia requiring hospitalization, the yield of blood culture was very low.  Most isolated organisms were Streptococcus pneumoniae, 82% of which were penicillin sensitive.

Pediatric Pneumonia Exam Unreliable - CARPE DIEM Study

Pediatric Pneumonia Exam Unreliable - CARPE DIEM Study

Substantial agreement on clinical exam findings in children with suspicion of pneumonia was only present for wheezing and retractions.  All other clinical exam findings had poor to moderate agreement between clinician examiners.

Does This Child Have Pneumonia?

Does This Child Have Pneumonia?

No clinical criteria were powerful diagnostic discriminators of the presence or absence of pneumonia in children, though some were fair.  When in doubt, a CXR is probably warranted, with the exceptions of obvious bronchiolitis or asthma.  Low SpO2 (</= 95 to 96%) or increased work of breathing were the best predictors of radiographic pneumonia in children; auscultatory findings and tachypnea were poor.  You don't need a CXR if no cough, no fever, no tachypnea, and normal SpO2.

How to Diagnose Pertussis at the Bedside

How to Diagnose Pertussis at the Bedside

I couldn't state it better than the author's conclusion: "In adult patients, the presence of whooping or posttussive vomiting should rule in a possible diagnosis of pertussis, whereas the lack of a paroxysmal cough or the presence of fever should rule it out. In children, posttussive vomiting is much less helpful as a clinical diagnostic test."

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