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The only strong recommendation for corticosteroid use was in patients needing to be hospitalized with severe community acquired pneumonia. The panel recommended against high-dose/short duration corticosteroids in patients with septic shock.

Source
2024 Focused Update: Guidelines on Use of Corticosteroids in Sepsis, Acute Respiratory Distress Syndrome, and Community-Acquired Pneumonia. Crit Care Med. 2024 May 1;52(5):e219-e233. doi: 10.1097/CCM.0000000000006172. Epub 2024 Jan 19. PMID: 38240492

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In a controlled hypoxemia study, pulse oximetry was falsely elevated in subjects with darker skin pigmentation and low perfusion.

Source
Low Perfusion and Missed Diagnosis of Hypoxemia by Pulse Oximetry in Darkly Pigmented Skin: A Prospective Study. Anesth Analg. 2024 Mar 1;138(3):552-561. doi: 10.1213/ANE.0000000000006755. Epub 2023 Dec 18. PMID: 38109495.

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In patients hospitalized with non-severe community-acquired pneumonia (CAP), beta-lactam (BL) only antibiotic regimens have been shown to have increased mortality as compared to other first-line regimens.

Source
Comparative Effectiveness of First-Line and Alternative Antibiotic Regimens in Hospitalized Patients With Nonsevere Community-Acquired Pneumonia: A Multicenter Retrospective Cohort Study. Chest. 2024 Jan;165(1):68-78. doi: 10.1016/j.chest.2023.08.008. Epub 2023 Aug 11.

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This meta-analysis found a reduction in all-cause mortality in patients hospitalized with severe CAP who received adjunctive corticosteroid therapy.

Source
Efficacy and Safety of Corticosteroid Therapy for Community-Acquired Pneumonia: A Meta-Analysis and Meta-Regression of Randomized, Controlled Trials. Clin Infect Dis. 2023 Dec 15;77(12):1704-1713. doi: 10.1093/cid/ciad496.

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While removing low risk amoxicillin allergies in the pediatric ED setting by direct oral challenge (DOC) may be effective, numerous factors play a role in reliable implementation.

Source
Multisite Oral Amoxicillin Challenges During Pediatric Emergency Department Visits. JAMA Pediatr. 2023 Oct 2:e233659. doi: 10.1001/jamapediatrics.2023.3659. Online ahead of print.

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Anaphylaxis secondary to alpha-gal syndrome is increasing in frequency, particularly in the Southeast United States. It is important for Emergency Physicians to be aware of the rising incidence so as to include it on their differential.

Source
Alpha-Gal Syndrome: A Novel and Increasingly Common Cause of Anaphylaxis. Ann Emerg Med. 2023 Oct 11:S0196-0644(23)01187-3. doi: 10.1016/j.annemergmed.2023.08.491. Epub ahead of print.

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Asthma is a common disease in childhood and results in many hospital admissions. This study was aimed at evaluating whether admission (specifically to the PICU) could be avoided by early magnesium sulfate administration for severe asthma exacerbation.

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Starting with the PEN-FAST Decision Tool, direct oral challenges to low-risk individuals with reported penicillin allergies is safe, effective, and can remove a majority of mislabeled instances.

Source
Efficacy of a Clinical Decision Rule to Enable Direct Oral Challenge in Patients With Low-Risk Penicillin Allergy: The PALACE Randomized Clinical Trial. JAMA Intern Med. Published online July 17, 2023. doi:10.1001/jamainternmed.2023.2986

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PEN-FAST is a clinical decision-making tool that effectively identifies patients with self-reported penicillin allergy who are at negligible risk of hypersensitivity reaction after exposure to these antibiotics.

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The LUS-ARDS score can make a diagnosis of acute respiratory distress syndrome (ARDS) easier, particularly in patients who can’t have CT scan. The LUS-ARDS score performs similarly to the standard of care (Berlin criteria plus CXR evaluation) in diagnosis of ARDS in ventilated patients.