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.
Direct Oral Challenge – Bye-Bye Penicillin Allergy!
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While removing low risk amoxicillin allergies in the pediatric ED setting by direct oral challenge (DOC) may be effective, numerous factors play a role in reliable implementation.
Source
Multisite Oral Amoxicillin Challenges During Pediatric Emergency Department Visits. JAMA Pediatr. 2023 Oct 2:e233659. doi: 10.1001/jamapediatrics.2023.3659. Online ahead of print.
Alpha-gal and Anaphylaxis – What You Need to Know
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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.
Does Early Magnesium in Pediatric Asthma Reduce PICU Admission?
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Asthma is a common disease in childhood and results in many hospital admissions. This study was aimed at evaluating whether admission (specifically to the PICU) could be avoided by early magnesium sulfate administration for severe asthma exacerbation.
PEN-FAST 2.0 – Directly Testing for PCN Allergy – The PALACE RCT
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Starting with the PEN-FAST Decision Tool, direct oral challenges to low-risk individuals with reported penicillin allergies is safe, effective, and can remove a majority of mislabeled instances.
Source
Efficacy of a Clinical Decision Rule to Enable Direct Oral Challenge in Patients With Low-Risk Penicillin Allergy: The PALACE Randomized Clinical Trial. JAMA Intern Med. Published online July 17, 2023. doi:10.1001/jamainternmed.2023.2986
Is This Patient REALLY Penicillin-Allergic? Try the PEN-FAST Decision Tool
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PEN-FAST is a clinical decision-making tool that effectively identifies patients with self-reported penicillin allergy who are at negligible risk of hypersensitivity reaction after exposure to these antibiotics.
LUS (Let’s Use Sonography) to Diagnose ARDS!
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The LUS-ARDS score can make a diagnosis of acute respiratory distress syndrome (ARDS) easier, particularly in patients who can’t have CT scan. The LUS-ARDS score performs similarly to the standard of care (Berlin criteria plus CXR evaluation) in diagnosis of ARDS in ventilated patients.
Should We Rx Inhaled Steroids for Asthma?
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In this study, only 6% of asthma patients discharged from the ED received a prescription for inhaled corticosteroids and only 14% had any outpatient follow-up within 30 days of their ED visit. Patients who were Hispanic, uninsured, and privately insured had the lowest odds of receiving an ICS prescription from the ED.
Source
Inhaled Corticosteroids Rarely Prescribed at Emergency Department Discharge Despite Low Rates of Follow-Up Care. J Emerg Med. 2023 May;64(5):555-563. doi: 10.1016/j.jemermed.2023.02.013. Epub 2023 Mar 21.
Primary Spontaneous Pneumothorax – Needle or Not?
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Primary spontaneous pneumothorax (PSP) may be most cost-effectively managed by observation alone in the appropriate patient population.