Avoid the ‘Roids – Steroids for Lower Respiratory Infection
Oral steroids were of no benefit for non-asthmatic patients with bronchitis.
CroFab for Copperheads RCT
Crotalidae polyvalent immune antivenom (CroFab) improved limb disability in patients bitten by copperhead snakes.
Infusion vs IV Push Ketamine for Pain
A slow infusion of ketamine for pain control was as effective as IV push, with less sedation and far fewer patients having a feeling of unreality.
Reported PCN Allergy Doesn’t Mean Real PCN Allergy
All children in the PED who were low risk for penicillin allergy on this questionnaire were confirmed to have no true penicillin allergy with skin testing.
Idarucizumab Works – At Least in the Lab
Idarucizumab reverses anticoagulation 100% due to dabigatran in the test tube. It seemed to stop active bleeding in patients in about 2.5 hours, and reported operative hemostasis was good. But since this was an open label trial with no control group, we don't know how the outcomes would have compared with patients who were treated with other procoagulants or who were not treated.
Small Abscesses Do Better With Antibiotics
Even small abscesses, <5cm, benefitted from antibiotics. This is contrary to some prior studies' findings that I&D alone was adequate for small abscesses.
Alteplase for Submassive PE
This early study of thrombolytics plus heparin for submassive PE showed no mortality benefit but did show a decrease in need for escalation of care compared with heparin alone. Subsequent studies call lytics for submassive PE into question, so take the current evidence into account.
No Mag for You, Baby
Don't use IV magnesium for bronchiolitis. It doesn't work, and it may cause harm.
ED Oversedation May Cause ICU Harm
Excessive sedation of intubated adult patients in the ED was associated with increased in-hospital mortality. Aim for a RASS > -3.
Wait-and-See Antibiotics for Otitis Media
Allowing parents the option to wait and see if their child did not improve or worsened in 48 hours after the diagnosis of acute otitis media in the ED vs. filling the prescription right away resulted in a dramatic reduction in antibiotic use with little downside in this RCT.