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Treponema pallidum, the bacteria that cause syphilis, has nearly universal (99.2%) resistance to azithromycin. Use penicillin in these patients.

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Near-Universal Resistance to Macrolides of Treponema pallidum in North America. N Engl J Med. 2024 Jun 13;390(22):2127-2128. doi: 10.1056/NEJMc2314441. PMID: 38865666

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Unfortunately, topical diclofenac did not demonstrate substantial pain control and provided no added benefit, even when co-administered with oral ibuprofen for specific patients with acute low back pain.

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Topical Diclofenac Versus Oral Ibuprofen Versus Diclofenac + Ibuprofen for Emergency Department Patients With Acute Low Back Pain: A Randomized Study. Ann Emerg Med. 2024 Jun;83(6):542-551. doi: 10.1016/j.annemergmed.2024.01.037. Epub 2024 Mar 2. PMID: 38441515

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An international, multi-center RCT found that administering pantoprazole to intubated ICU patients lowered the rate of upper GI bleeding compared to placebo.

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Stress Ulcer Prophylaxis during Invasive Mechanical Ventilation. N Engl J Med. Published online June 14, 2024. doi:10.1056/NEJMoa2404245

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GRACE-4 is packed with practice-changing recommendations for patients with alcohol withdrawal syndrome (AWS), alcohol use disorder (AUD), and cannabinoid hyperemesis syndrome (CHS).

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Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE-4): Alcohol use disorder and cannabinoid hyperemesis syndrome management in the emergency department. Acad Emerg Med. 2024 May;31(5):425-455. doi: 10.1111/acem.14911. PMID: 38747203.

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This was an analysis of the 2016-2019 National Hospital Ambulatory Medical Care Survey (NHAMCS) of patients presenting to the ED with asymptomatic hypertension. ED physicians infrequently diagnosed hypertension in this cohort and rarely initiated outpatient antihypertensive prescriptions.

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Missed Opportunities to Diagnose and Treat Asymptomatic Hypertension in Emergency Departments in the United States, 2016-2019. The Journal of emergency medicine vol. 66,5 (2024): e562-e570.

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The only strong recommendation for corticosteroid use was in patients needing to be hospitalized with severe community acquired pneumonia. The panel recommended against high-dose/short duration corticosteroids in patients with septic shock.

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2024 Focused Update: Guidelines on Use of Corticosteroids in Sepsis, Acute Respiratory Distress Syndrome, and Community-Acquired Pneumonia. Crit Care Med. 2024 May 1;52(5):e219-e233. doi: 10.1097/CCM.0000000000006172. Epub 2024 Jan 19. PMID: 38240492

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Ketamine has been shown to be efficacious in managing acute pain conditions in the emergency department (ED), and this study showed equal efficacy between nebulized and intravenous administration of sub-dissociative ketamine (IV-SDK).

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Comparison of Nebulized Ketamine to Intravenous Subdissociative Dose Ketamine for Treating Acute Painful Conditions in the Emergency Department: A Prospective, Randomized, Double-Blind, Double-Dummy Controlled Trial. Ann Emerg Med. 2024 May 1:S0196-0644(24)00171-9. doi: 10.1016/j.annemergmed.2024.03.024. Epub ahead of print. PMID: 38703175.

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This bias-adjusted meta-analysis of randomized controlled trials (RCT) finds a one-month mortality benefit in trauma patients receiving tranexamic acid (TXA) during initial emergency management.

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Tranexamic Acid for Traumatic Injury in the Emergency Setting: A Systematic Review and Bias-Adjusted Meta-Analysis of Randomized Controlled Trials. Ann Emerg Med. 2024 May;83(5):435-445. doi: 10.1016/j.annemergmed.2023.10.004. Epub 2023 Nov 22. PMID: 37999653.

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Time to alleviation of signs and symptoms of Covid-19 did not differ significantly between patients receiving treatment with nirmaltrevir-ritonavir and those receiving placebo.

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Nirmatrelvir for Vaccinated or Unvaccinated Adult Outpatients with Covid-19. N Engl J Med. 2024 Apr 4;390(13):1186-1195. doi: 10.1056/NEJMoa2309003. PMID: 38598573.

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A retrospective study of 60 patients who received a fixed-dose ketamine of 250 mg by EMS observed that 6 were intubated in the ED. There was no association between weight-based dose of ketamine and risk for intubation.

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Fixed dose ketamine for prehospital management of hyperactive delirium with severe agitation. Am J Emerg Med. Published online April 9, 2024. doi:10.1016/j.ajem.2024.04.011