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In patients with ACS and concern for STEMI/NSTEMI requiring urgent intervention, randomization to the contrast volume reduction (CVR) group reduced the rate of acute kidney injury (AKI) and sustained kidney damage.

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Kidney Injury After Minimal Radiographic Contrast Administration in Patients With Acute Coronary Syndromes. J Am Coll Cardiol. 2024;83(11):1059-1069. doi:10.1016/j.jacc.2024.01.016

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Yesterday, we covered an article demonstrating the superior diagnostic accuracy of the new Duke-International Society for Cardiovascular Infectious Diseases Diagnostic (Duke-ISCVID) criteria. Today, we cover what the new criteria actually are.

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The 2023 Duke-International Society for Cardiovascular Infectious Diseases Criteria for Infective Endocarditis: Updating the Modified Duke Criteria. Clin Infect Dis. 2023 Aug 22;77(4):518-526. doi: 10.1093/cid/ciad271. Erratum in: Clin Infect Dis. 2023 Oct 13;77(8):1222.

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The use of radiopaque markers (ROM) in penetrating trauma is based on expert opinion and historical clinical practice; however, there is no high-quality evidence to support their routine use in clinical practice.

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The use of radiopaque markers is medical dogma. Acad Emerg Med. 2024 Feb;31(2):193-194. doi: 10.1111/acem.14858. Epub 2024 Feb 6.

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This summary of clinical guideline updates for the diagnosis and management of aortic diseases includes recommendation changes surrounding the importance of multidisciplinary care teams and referral to centers with higher case volumes when feasible for potentially better outcomes, transthoracic echocardiogram (TTE) at time of transthoracic aortic aneurysm (TAA), and updated aneurysm size recommendations for repair, to name a few. Keep reading for more details!

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Diagnosis and Management of Aortic Diseases. JAMA. 2023 Dec 21;331(4):352-353. doi: 10.1001/jama.2023.23668.

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In this large multicenter observational cohort study, 0.3% of patients presenting with potential acute aortic syndrome (AAS) symptoms ended up having AAS. Clinician gestalt outperformed the available clinical decision rules (CDRs).

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Diagnosis of Acute Aortic Syndrome in the Emergency Department (DAShED) study: an observational cohort study of people attending the emergency department with symptoms consistent with acute aortic syndrome. Emerg Med J. 2024;41(3):136-144. Published 2024 Feb 20. 

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This study demonstrated that patients 65 years and older with blunt head trauma are at high risk of significant traumatic brain injuries and poor outcomes even with low-risk mechanisms of injury such as ground level falls and no other high-risk criteria besides advanced age. These findings suggest routine head CT imaging may be helpful for elderly patients with head trauma as clinical assessment may not identify patients with significant pathology.

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Blunt Head Injury in the Elderly: Analysis of the NEXUS II Injury Cohort. Ann Emerg Med. 2024 Feb 9:S0196-0644(24)00003-9. doi: 10.1016/j.annemergmed.2024.01.003. Online ahead of print.

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In this retrospective trial of pediatric patients with suspected intussusception, abdominal radiographs occasionally identify alternate clinical diagnoses.       

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Yield of abdominal radiographs in children with suspected intussusception; rate of pneumoperitoneum and other abdominal pathology. Am J Emerg Med. Published online December 22, 2023. 

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While this humorous BMJ article has some excellent tongue-in-cheek acronyms, it also demonstrates some real dangers of bringing ferromagnetic objects into the MRI environment. Don't miss the online video of these objects hurtling toward the magnet! See below.

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Overall rates of intracranial hemorrhage (ICH) in patients >65 years of age with either definite or uncertain head trauma were found to be 11.4% and 1.7%, respectively, leading these authors to recommend head CT imaging on all geriatric patients presenting with possible head trauma.

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After a non-diagnostic screening ultrasound for appendicitis, a rapid-MRI has high clinical accuracy in establishing the appropriate diagnosis (appendicitis or not) in a pediatric patient population.

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Properties of ultrasound-rapid MRI clinical diagnostic pathway in suspected pediatric appendicitis. Am J Emerg Med. 2023 Sep;71:217-224. doi: 10.1016/j.ajem.2023.06.026. Epub 2023 Jun 16.