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This is a review of the diagnosis and management of non-convulsive status epilepticus (NCSE) in the emergency department. Nonspecific signs and symptoms at presentation make it challenging to identify, which can lead to under-diagnosis and delay in treatment.

Source
Nonconvulsive Status Epilepticus: A Review for Emergency Clinicians. J Emerg Med. 2023 Oct;65(4):e259-e271. doi: 10.1016/j.jemermed.2023.05.012. Epub 2023 Jun 5.

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A randomized trial of patients in septic shock on norepinephrine found no benefit in those treated with an infusion of landiolol (β1-blocker). The trial was stopped early for concern of potential harm in the intervention group.

Source
Landiolol and Organ Failure in Patients With Septic Shock: The STRESS-L Randomized Clinical Trial. JAMA. 2023 Nov 7;330(17):1641-1652. doi: 10.1001/jama.2023.20134.

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This RCT found no differences between high dose (16 mg) and low dose (4 mg) IV dexamethasone in patients who presented to EDs with migraine headaches. 

Source
Randomized Trial Comparing Low- vs High-Dose IV Dexamethasone for Patients With Moderate to Severe Migraine. Neurology vol. 101,14 (2023): e1448-e1454. doi:10.1212/WNL.0000000000207648

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Anaphylaxis secondary to alpha-gal syndrome is increasing in frequency, particularly in the Southeast United States. It is important for Emergency Physicians to be aware of the rising incidence so as to include it on their differential.

Source
Alpha-Gal Syndrome: A Novel and Increasingly Common Cause of Anaphylaxis. Ann Emerg Med. 2023 Oct 11:S0196-0644(23)01187-3. doi: 10.1016/j.annemergmed.2023.08.491. Epub ahead of print.

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In this randomized control trial of patients receiving cefepime or piperacillin-tazobactam, there was no difference in risk of acute kidney injury between the two groups. However, those who received cefepime were more likely to have neurologic side effects.

Source
Cefepime vs Piperacillin-Tazobactam in Adults Hospitalized With Acute Infection: The ACORN Randomized Clinical Trial. JAMA. 2023 Oct 14:e2320583. doi: 10.1001/jama.2023.20583. Online ahead of print.

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The STREAM-2 trial found half-dose tenecteplase was effective in treating STEMI patients ≥60, though with increased risk of intracranial hemorrhage.

Source
STREAM-2: Half-Dose Tenecteplase or Primary Percutaneous Coronary Intervention in Older Patients With ST-Segment-Elevation Myocardial Infarction: A Randomized, Open-Label Trial. Circulation. 2023 Aug 29;148(9):753-764. doi: 10.1161/CIRCULATIONAHA.123.064521. Epub 2023 Jul 13.

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Here are ten tips from the AHA for the next super-sick poisoned patient you encounter.

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Positioning, preoxygenation, medication selection, and other questions surrounding emergent rapid sequence intubation (RSI) are addressed by an expert panel.

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Opioids, other than codeine, were found to be more effective when compared to non-opioids for treatment of acute musculoskeletal pain after ED discharge. However, they were also associated with a higher rate of adverse outcomes.

Source
Efficacy of prescribed opioids for acute pain after being discharged from the emergency department: A systematic review and meta-analysis. Acad Emerg Med. 2023 Aug 22. doi: 10.1111/acem.14790. Online ahead of print.

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This Danish nationwide cohort study found that in reproductive-age women, NSAID use alone increased the risk of venous thromboembolism (VTE). The magnitude of risk was compounded by concomitant use of hormonal contraception.

Source
Venous thromboembolism with use of hormonal contraception and non-steroidal anti-inflammatory drugs: nationwide cohort study. BMJ 2023; 382 :e074450 doi:10.1136/bmj-2022-074450.