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In contrast to yesterday's paper, this retrospective study of more than 8,000 out-of-hospital cardiac arrest (OHCA) patients detected higher rates of ROSC and survival discharge among patients who received naloxone.

Source
Naloxone and Patient Outcomes in Out-of-Hospital Cardiac Arrests in California. JAMA Netw Open. 2024 Aug 1;7(8):e2429154. doi: 10.1001/jamanetworkopen.2024.29154. PMID: 39163042; PMCID: PMC11337064.

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This analysis of more than 700 out-of-hospital cardiac arrest (OHCA) patients in an area with a high prevalence of opioid overdose did not find an association between naloxone administration and improved patient outcomes.

Source
Outcomes of Out-of-Hospital Cardiac Arrest Patients Who Received Naloxone in an Emergency Medical Services System With a High Prevalence Of Opioid Overdose. J Emerg Med. 2024 Sep;67(3):e249-e258. doi: 10.1016/j.jemermed.2024.03.038. Epub 2024 Apr 9. PMID: 39034160.

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Hypertensive emergencies are associated with high morbidity and mortality and require careful and specific strategies to diminish pressure-mediated organ injury depending on the presentation. 

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This was a multi-hospital retrospective study of patients who presented to the emergency department with severe hypertension without end organ damage. The authors found that the 1 year rate of major adverse cardiovascular events (MACE) was 15.5%.

Source
Emergency Department Blood Pressure Treatment and Outcomes in Adults Presenting with Severe Hypertension. West J Emerg Med. 2024;25(5):680-689.

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This article emphasizes the difference between hypertensive emergency and asymptomatic elevated blood pressure (BP); while hypertensive emergency requires prompt treatment to lower BP, treatment of asymptomatic elevated BP in acute care settings may be harmful. 

Source
The Management of Elevated Blood Pressure in the Acute Care Setting: A Scientific Statement From the American Heart Association. Hypertension. 2024 Aug;81(8):e94-e106. doi: 10.1161/HYP.0000000000000238. Epub 2024 May 28. PMID: 38804130.

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This large study in Canada of patients aged 66+ found that all commonly prescribed oral antibiotics were associated with an increased risk of serious cutaneous drug reactions (cADRs) relative to macrolides; however, few of these reactions led to hospitalization and an even smaller amount were true cutaneous emergencies (SJS/TEN).

Source
Oral Antibiotics and Risk of Serious Cutaneous Adverse Drug Reactions. JAMA. 2024 Sep 3;332(9):730-737. doi: 10.1001/jama.2024.11437. PMID: 39115856; PMCID: PMC11310841.

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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.