Surgery

ACEP Clinical Policy – Appendicitis

Imaging, Surgery

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This ACEP clinical policy covers issues in the evaluating and managing ED patients with suspected appendicitis including clinical prediction rules, comparative imaging modalities, and need for IV contrast in CT imaging.

Source
Clinical Policy: Critical Issues in the Evaluation and Management of Emergency Department Patients With Suspected Appendicitis: Approved by ACEP Board of Directors February 1, 2023. Ann Emerg Med. 2023 Jun;81(6):e115-e152. doi: 10.1016/j.annemergmed.2023.01.015.

AHA Statement – Surgical Embolectomy and ECMO for High-Risk PE

Critical Care, Surgery, Venous Thromboembolism

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This is a scientific statement from the American Heart Association emphasizing the need for more research on surgical embolectomy and mechanical circulatory support in the treatment of high-risk pulmonary embolism.

Source
Surgical Management and Mechanical Circulatory Support in High-Risk Pulmonary Embolisms: Historical Context, Current Status, and Future Directions: A Scientific Statement From the American Heart Association. Circulation. 2023;10.1161/CIR.0000000000001117. doi:10.1161/CIR.0000000000001117

Pediatric Appendicitis – Is Non-Op Management Safe?

Pediatrics, Surgery

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Nonoperative management (NOM) for uncomplicated appendicitis has become more common over the past 10 years in the pediatric population. Although many children do well, those who have recurrences have higher rates of surgical complications and hospitalizations.

Source
Nonoperative Management of Uncomplicated Appendicitis. Pediatrics. 2022 Apr 18;e2021054693. doi: 10.1542/peds.2021-054693. Online ahead of print.

Clear as Mud – Is Your Management of Diverticulitis Evidence-Based?

GI, Imaging, Surgery

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There are few studies that address the overall diagnosis and management of acute left sided colonic diverticulitis; many, over the past 3 decades, have poor strength of evidence or are largely inconclusive.

Source
Diagnostic Imaging and Medical Management of Acute Left-Sided Colonic Diverticulitis : A Systematic Review. Ann Intern Med. 2022 Mar;175(3):379-387. doi: 10.7326/M21-1645. Epub 2022 Jan 18.

Can You Spot a Ruptured AAA? Accuracy of Symptoms, Signs, CTA, and POCUS

Imaging, Surgery

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Symptoms and signs of ruptured abdominal aortic aneurysm (rAAA) are frustratingly insensitive. CTA is essential and is accurate. POCUS can accurately tell you a AAA is present but is not meant to diagnose rupture.

Source
Accuracy of Presenting Symptoms, Physical Examination, and Imaging for Diagnosis of Ruptured Abdominal Aortic Aneurysm -Systematic Review and Meta-Analysis. Acad Emerg Med. 2022 Feb 27. doi: 10.1111/acem.14475. Online ahead of print.

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