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ACEP released a clinical policy that addresses the choice of a second-line agent for adults with refractory seizures after adequate dosing of benzodiazepines.

Source
Clinical Policy: Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Seizures: Approved by the ACEP Board of Directors, April 17, 2024. Ann Emerg Med. 2024 Jul;84(1):e1-e12. doi: 10.1016/j.annemergmed.2024.02.018. PMID: 38906639.

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In adult patients with sepsis, empiric use of vancomycin and piperacillin/tazobactam compared to vancomycin and cefepime, when anti-anaerobic coverage was not clinically indicated, was associated with a 5% increase in mortality.

Source
Mortality of Patients With Sepsis Administered Piperacillin-Tazobactam vs Cefepime. JAMA Intern Med. 2024 Jul 1;184(7):769-777. doi: 10.1001/jamainternmed.2024.0581. PMID: 38739397.

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In this phase 2b randomized clinical trial of scheduled intravenous acetaminophen for critically ill sepsis patients, authors confirmed the safety of this strategy, but found no improvement in days alive and free of organ support.

Source
Acetaminophen for Prevention and Treatment of Organ Dysfunction in Critically Ill Patients With Sepsis: The ASTER Randomized Clinical Trial. JAMA. 2024;332(5):390-400. PMID: 38762798.

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This retrospective study suggests that full dose antibiotic challenges for patients with listed beta-lactam antibiotic allergies can be safely accomplished in the ED.

Source
Full-dose challenge of moderate, severe, and unknown beta-lactam allergies in the emergency department. Acad Emerg Med. 2024 Aug;31(8):777-781. doi: 10.1111/acem.14893. Epub 2024 Mar 21. PMID: 38511401.

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Patients on GLP-1 agonists might be at risk of delayed gastric emptying, which has significant implications for procedural sedation and endotracheal intubation.

Source
Use of Glucagon-Like Peptide-1-Agonists and Increased Risk of Procedural Sedation and Endotracheal Intubation in the Emergency Department. Ann Emerg Med. 2024 Aug;84(2):226-227. DOI: 10.1016/j.annemergmed.2024.03.007. PMID: 39032988.

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In non-traumatic out of hospital cardiac arrest (OHCA), administration of an initial dose of IM epinephrine by EMS prior to an established IV or IO was associated with improved survival outcomes. 

Source
Early intramuscular adrenaline administration is associated with improved survival from out-of-hospital cardiac arrest. Resuscitation. 2024 Aug;201:110266. doi: 10.1016/j.resuscitation.2024.110266. Epub 2024 Jun 9. PMID: 38857847.

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A single center retrospective treatment of 144 patients who tested positive for C. trachomatis found that 18% (n=26) of patients did not pick up their prescription for doxycycline. Those who did not obtain their doxycycline prescription were 3 times more likely to return to the ED within 28 days for the same chief complaint.

Source
Doxycycline adherence for the management of Chlamydia trachomatis infections. Am J Emerg Med. 2024;81:136-139. doi:10.1016/j.ajem.2024.05.003. PMID: 38728936.

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This was a large RCT of critically ill adults with suspected infection who were randomized to receive either continuous infusions or intermittent dosages of intravenous antibiotics. 90-day mortality between groups was not statistically significant, while clinical cure rate was higher in the continuous infusion group.

Source
Continuous vs Intermittent β-Lactam Antibiotic Infusions in Critically Ill Patients With Sepsis: The BLING III Randomized Clinical Trial. JAMA. Published online June 12, 2024.

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In patients with large vessel occlusions(LVO) presenting 4.5-24 hours after onset, without access to endovascular thrombectomy (ET), tenecteplase(TNK) administration bested standard medical treatment(SMT) in 90-day disability-free recovery.

Source
Tenecteplase for Ischemic Stroke at 4.5 to 24 Hours without Thrombectomy. N Engl J Med. 2024 Jun 14. doi: 10.1056/NEJMoa2402980. Epub ahead of print. PMID: 38884324.

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For acute ischemic stroke patients with recent DOAC ingestion who (1) had their DOAC level measured, (2) had DOAC reversal with idarucizumab, or (3) inadvertently received thrombolytics with DOAC subsequently discovered, there was not evidence of increased significant intracranial hemorrhage associated with off-label thrombolytic therapy.

Source
Intravenous Thrombolysis in Patients With Ischemic Stroke and Recent Ingestion of Direct Oral Anticoagulants. JAMA Neurol. 2023 Mar 1;80(3):233-243. doi: 10.1001/jamaneurol.2022.4782. Erratum in: JAMA Neurol. 2023 Apr 1;80(4):422. doi: 10.1001/jamaneurol.2022.5395. PMID: 36807495; PMCID: PMC9857462.