Adding Fludrocortisone to Hydrocortisone Reduces Mortality in Septic Shock
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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
Ketamine for the Win? Induction Agents Compared
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.
New ACEP Guideline – Topical Anesthetics for Corneal Abrasion
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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.
Ketamine vs Morphine for Acute Pain
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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
NOAC + Stroke – Thrombolytic or Not?
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.
Oseltamivir Won’t Keep You Out of the Hospital
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.
Ketamine vs Etomidate in TBI – Prehospital Version
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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.
New 2023 AHA Atrial Fibrillation Guidelines
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This article outlines the updated 2023 guidelines for diagnosis and management of atrial fibrillation. Continue reading for ways to incorporate them into your emergency medicine practice.
CAP Coverage – Beta Lactam Only?
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In patients hospitalized with non-severe community-acquired pneumonia (CAP), beta-lactam (BL) only antibiotic regimens have been shown to have increased mortality as compared to other first-line regimens.
Source
Comparative Effectiveness of First-Line and Alternative Antibiotic Regimens in Hospitalized Patients With Nonsevere Community-Acquired Pneumonia: A Multicenter Retrospective Cohort Study. Chest. 2024 Jan;165(1):68-78. doi: 10.1016/j.chest.2023.08.008. Epub 2023 Aug 11.
New Meta-Analysis – Steroids Lower CAP Mortality
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This meta-analysis found a reduction in all-cause mortality in patients hospitalized with severe CAP who received adjunctive corticosteroid therapy.
Source
Efficacy and Safety of Corticosteroid Therapy for Community-Acquired Pneumonia: A Meta-Analysis and Meta-Regression of Randomized, Controlled Trials. Clin Infect Dis. 2023 Dec 15;77(12):1704-1713. doi: 10.1093/cid/ciad496.