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Opioid pain medications offer no benefit compared to placebo for patients with acute back or neck pain.
Source
Opioid analgesia for acute low back pain and neck pain (the OPAL trial): a randomised placebo-controlled trial. Lancet. 2023 Jun 27:S0140-6736(23)00404-X. doi: 10.1016/S0140-6736(23)00404-X. Epub ahead of print.
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In a meta-analysis of 1,685 patients with suspected scaphoid fracture after negative plain radiographs, no clinical feature adequately rules out occult fracture. Â Â
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This meta-analysis found Boss-Holzach-Matter/Davos and FARES had the most favorable value for success rates, while both FARES and modified external rotation were more favorable in reduction times. FARES also had the most favorable score for pain during reduction.Â
Source
A Systematic Review With Pairwise and Network Meta-analysis of Closed Reduction Methods for Anterior Shoulder Dislocation. Annals of emergency medicine vol. 81,4 (2023): 453-465. doi:10.1016/j.annemergmed.2022.10.020Â
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Bacteremia is common in pediatric patients who present to the ED with fever and acute lower extremity pain. Obtain a blood cultures in these patients, as it is likely to assist in diagnosis or change management, particularly if they also have a higher fever, focal bony tenderness, or an elevated CRP.Â
Source
Bacteremia in Children With Fever and Acute Lower Extremity Pain. Pediatrics. 2023 Apr 4;e2022059504. doi: 10.1542/peds.2022-059504. Online ahead of print.
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The authors describe a novel reduction method for posterior hip dislocations using a hydraulic lift to apply longitudinal traction on the upper leg.
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Intra-articular lidocaine (IAL) is a safe alternative for the reduction of anterior shoulder dislocations and may have similar efficacy to intravenous (IV) sedation, with fewer adverse events and shorter ED length of stay.
Source
Intra-articular lidocaine versus intravenous sedation for closed reduction of acute anterior shoulder dislocation in the emergency department: a systematic review and meta-analysis. CJEM. 2022 Dec;24(8):809-819. doi: 10.1007/s43678-022-00368-z. Epub 2022 Oct 1.
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Otic quinolones (OQ) were associated with an increased risk of Achilles tendon rupture and all-type tendon rupture, but this was rare. Even with this risk, sometimes an OQ is still the right choice.
Source
Quinolone Ear Drops and Achilles Tendon Rupture. Clin Infect Dis. 2022 Sep 6;ciac709. doi: 10.1093/cid/ciac709. Online ahead of print.
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Empiric antibiotic therapy – without aspiration – is a reasonable approach for the management of suspected prepatellar septic bursitis in non-toxic patients with close outpatient follow up.
Source
Efficacy of empiric antibiotic therapy without aspiration for septic prepatellar bursitis in emergency department patients. Acad Emerg Med. 2022 Aug;29(8):1027-1032. doi: 10.1111/acem.14499. Epub 2022 Apr 25.
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Synovial fluid and peripheral blood neutrophil-to-lymphocyte ratios are promising novel diagnostic and prognostic biomarkers for septic arthritis.
Source
Synovial Fluid and Serum Neutrophil-to-Lymphocyte Ratio: Novel Biomarkers for the Diagnosis and Prognosis of Native Septic Arthritis in Adults. J Bone Joint Surg Am. 2022 Jun 20. doi: 10.2106/JBJS.21.01279. Online ahead of print.
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This article covers important pearls in the management of posterior hip dislocations along with 6 techniques all EM providers should know. Watch this hilarious YouTube video with all these techniques in under 2 minutes!
Source
Managing Posterior Hip Dislocations. Ann Emerg Med. 2022 Jun;79(6):554-559. doi: 10.1016/j.annemergmed.2022.01.027. Epub 2022 Mar 9.
