LRINEC Score, Physical Exam, or Imaging for Necrotizing Infection?

LRINEC Score, Physical Exam, or Imaging for Necrotizing Infection?

In this systematic review and meta-analysis, no single aspect of the physical examination, imaging, or LRINEC score had high enough sensitivity to exclude necrotizing soft tissue infections. Contrast CT performed the best, but it was only 94.3% sensitive at best. If you have a high clinical suspicion, early surgical consultation is necessary for definitive diagnosis and management.

Where Will You Cut the Neck? POCUS Makes Perfect

Where Will You Cut the Neck? POCUS Makes Perfect

Practicing to find the midpoint of the cricothyroid membrane with ultrasound is a much better way to learn than by using only external landmarks and no ultrasound.

PAMPer - Prehospital Plasma for Hemorrhagic Shock Saves Lives

PAMPer - Prehospital Plasma for Hemorrhagic Shock Saves Lives

Prehospital administration of 2 units of thawed plasma in adult trauma patients at risk for hemorrhagic shock reduced mortality compared to standard care, NNT = 10.

No Antibiotics for Diverticulitis...and other stuff the residents taught me this week

No Antibiotics for Diverticulitis...and other stuff the residents taught me this week

After almost twenty years as a doctor, constantly reading, it never ceases to amaze me how much I still don't know.  One of the highlights of my job is working with great residents who also teach me.  This week was no exception.  Here are two things I learned from our residents this week.

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.

Fix Leaks | Then Fill Bucket - Hypotensive Resuscitation

Fix Leaks | Then Fill Bucket - Hypotensive Resuscitation

Allowing penetrating or blunt trauma patients to remain temporarily hypotensive in the field vs giving volume resuscitation prior to definitive surgical repair improves mortality and seems to decrease blood loss and need for transfusion of blood products.

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.

Post-op Rx for Opiates and Subsequent Abuse

Post-op Rx for Opiates and Subsequent Abuse

Total duration of opioid use was the strongest predictor of misuse. Each refill and additional week of opioid use increased the hazard of misuse by 44% and 19.9% respectively. Shorter prescriptions (<2 weeks) of high vs low dosage prescriptions had a lower hazard.

Opioid Use Among Pediatric Patients After Surgery

Opioid Use Among Pediatric Patients After Surgery

In opioid naïve patients 13-21 years of age, persistent opioid use was found in 4.8% of the post-surgical group vs 0.1% of those in the non-surgical group. Procedures associated with the highest risk of persistent opioid use were cholecystectomy and colectomy. Independent risk factors included older age, female sex, diagnoses of substance use disorder and chronic pain.

Testicular Torsion Salvage at 24 Hours?

Testicular Torsion Salvage at 24 Hours?

Consider testicular torsion a surgical emergency even if it is past the usual 6-8 hour mark, which is traditionally taught as the outer limit of testicular viability.  This study found that the testicle could still be salvaged over half the time from 13-24 hours from onset.

How Aortic Dissection Presents

How Aortic Dissection Presents

Sudden-onset, severe ("worst-ever"), sharp chest pain was the hallmark type A and B aortic dissection.  Ripping or tearing pain was present in only half of patients.  Classic features of aortic regurgitation murmur and pulse deficit were frequently lacking.

She's My Surgeon - Female vs. Male Surgical Outcomes

She's My Surgeon - Female vs. Male Surgical Outcomes

Female surgeons had small but significantly improved 30-day mortality and other surgical outcomes over male surgeons, all other factors being equal.

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