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This systematic review was conducted to answer the clinical question: Is there a superior parenteral medication or combination of medications for acute management of adult out-of-hospital or emergency department patients with severe agitation? These recommendations do not apply to pediatric, elderly (>65 years), pregnant, or out-of-hospital patients.  For these groups, additional studies are needed given unique risk profiles.

Source
Clinical Policy: Critical Issues in the Evaluation and Management of Adult Out-of-Hospital or Emergency Department Patients Presenting With Severe Agitation: Approved by the ACEP Board of Directors, October 6, 2023. Ann Emerg Med. 2024 Jan;83(1):e1-e30. doi: 10.1016/j.annemergmed.2023.09.010. PMID: 38105109.

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Clinicians have an important role in advising families on the appropriate evidence-based treatments for upper respiratory tract infections (URTIs) in children.

Source
Treatments for cough and common cold in children. BMJ. 2024 Jan 25;384:e075306. doi: 10.1136/bmj-2023-075306.

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Using online telemedicine platforms, the authors found that it was appallingly easy to rapidly obtain inappropriate antibiotic prescriptions for symptoms of viral URIs by paying a nominal fee. This highlights the need for increased education and regulations around inappropriate prescribing of antibiotics to safeguard the public and uphold good medical practices.

Source
Antibiotics on Demand: Advances in Asynchronous Telemedicine Call for Increased Antibiotic Surveillance. Clin Infect Dis. 2024 Feb 17;78(2):308-311. doi: 10.1093/cid/ciad472.

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This Bayesian network meta-analysis of RCTs indirectly compares hydrocortisone + fludrocortisone to hydrocortisone alone or placebo in septic shock and finds superiority with the combination regimen.

Source
Effectiveness of Fludrocortisone Plus Hydrocortisone Versus Hydrocortisone Alone in Septic Shock: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Am J Respir Crit Care Med. Published online January 25, 2024. doi:10.1164/rccm.202310-1785OC

Dr. Amal Mattu and friends have a new video course you don't want to miss. Take a look!

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A Bayesian meta-analysis found an 83.2% probability that ketamine lowers mortality compared to etomidate in critically ill patients undergoing intubation.

Source
Ketamine versus etomidate as an induction agent for tracheal intubation in critically ill adults: a Bayesian meta-analysis. Crit Care. 2024 Feb 17.

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The ACEP consensus seems to indicate that it may be safe for patients with a simple corneal abrasion to go home with 24 hour usage of topical anesthetics for pain relief, but the ophthalmologists are not on board.

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A meta-analysis of 15 randomized trials found that ketamine had a quicker analgesic effect than morphine, but morphine exhibited sustained reduction in pain at 120 minutes.

Source
Low-dose ketamine versus morphine in the treatment of acute pain in the emergency department: A meta-analysis of 15 randomized controlled trials. Am J Emerg Med. 2024;76:140-149. doi:10.1016/j.ajem.2023.11.056

Exciting news! JournalFeed and Dr. Amal Mattu's Top Picks Video Series is set to GO LIVE this week! It's free for Gold Spoon members or you can just get the video series. Watch this trailer and get excited!

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In this retrospective cohort study, there was no increased risk of intracranial hemorrhage, major bleeding, or in-hospital mortality in patients taking non-vitamin K antagonist oral anticoagulants compared to those not taking anticoagulants, but read the fine print.

Exciting news! JournalFeed and Dr. Amal Mattu's Top Picks Video Series is set to GO LIVE this week! It's free for Gold Spoon members or you can just get the video series. Watch this trailer and get excited!

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This systematic review and meta-analysis concluded, with moderate certainty evidence, that oseltamivir has little to no effect on hospitalization but does increase nausea and vomiting. 

Source
Evaluation of Oseltamivir Used to Prevent Hospitalization in Outpatients With Influenza. JAMA Intern Med. 2024 Jan 1;184(1):18-27. doi: 10.1001/jamainternmed.2023.0699. Erratum in: JAMA Intern Med. 2023 Nov 20;: PMID: 37306992; PMCID: PMC10262060.

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Patients with TBI who were intubated in the prehospital setting had no difference in 30-day mortality when comparing induction with ketamine versus etomidate.

Source
Etomidate versus Ketamine as prehospital induction agent in patients with suspected severe traumatic brain injury. Anesthesiology. 2024. Jan 8. Doi: 10.1097/ALN.0000000000004894. Online ahead of print.