How do We Avoid the Aortic Landmines?
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In this large multicenter observational cohort study, 0.3% of patients presenting with potential acute aortic syndrome (AAS) symptoms ended up having AAS. Clinician gestalt outperformed the available clinical decision rules (CDRs).
Source
Diagnosis of Acute Aortic Syndrome in the Emergency Department (DAShED) study: an observational cohort study of people attending the emergency department with symptoms consistent with acute aortic syndrome. Emerg Med J. 2024;41(3):136-144. Published 2024 Feb 20.
What is the Yield of Abdominal X-ray in Suspected Intussusception?
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In this retrospective trial of pediatric patients with suspected intussusception, abdominal radiographs occasionally identify alternate clinical diagnoses.
Source
Yield of abdominal radiographs in children with suspected intussusception; rate of pneumoperitoneum and other abdominal pathology. Am J Emerg Med. Published online December 22, 2023.
Can We Seriously Consider Non-op Management of Appendicitis?
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This expert opinion piece recommends consideration of nonoperative antibiotic treatment for select cases of uncomplicated acute appendicitis.
Source
Treatment of Acute Uncomplicated Appendicitis. Treatment of Acute Uncomplicated Appendicitis. N Engl J Med. 2021 Sep 16;385(12):1116-1123. doi: 10.1056/NEJMcp2107675.
How Accurate Is an US + Fast MRI Pediatric Appendicitis Protocol?
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After a non-diagnostic screening ultrasound for appendicitis, a rapid-MRI has high clinical accuracy in establishing the appropriate diagnosis (appendicitis or not) in a pediatric patient population.
Source
Properties of ultrasound-rapid MRI clinical diagnostic pathway in suspected pediatric appendicitis. Am J Emerg Med. 2023 Sep;71:217-224. doi: 10.1016/j.ajem.2023.06.026. Epub 2023 Jun 16.
The PERFECT RCT – How Urgent Should Appendectomy Be?
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A multicenter, open RCT of adults with presumed uncomplicated appendicitis found no significant difference in perforation rates or complications with appendectomy before 8 or 24 hours.
Source
Role of preoperative in-hospital delay on appendiceal perforation while awaiting appendicectomy (PERFECT): a Nordic, pragmatic, open-label, multicentre, non-inferiority, randomized controlled trial.[published online ahead of print, 2023 Sep 14]. Lancet. 2023;S0140-6736(23)01311-9. doi:10.1016/S0140-6736(23)01311-9
When to Crack the Pediatric Chest – New Guidelines
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Emergency department thoracotomy (EDT) is recommended in pulseless pediatric patients with signs of life* who have penetrating thoracic/abdominopelvic trauma; if pulseless with signs of life* and blunt trauma, a conditional recommendation is made.
Source
Emergency department thoracotomy in children: A Pediatric Trauma Society, Western Trauma Association, and Eastern Association for the Surgery of Trauma systematic review and practice management guideline. J Trauma Acute Care Surg. 2023 Sep 1;95(3):432-441. doi: 10.1097/TA.0000000000003879. Epub 2023 Mar 11.
ACEP Clinical Policy – Appendicitis
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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.
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.
Should Trauma Patients Be Intubated in the Emergency Department or the OR?
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Patients who required hemorrhage control surgery after major trauma and were intubated in the ED had higher rates of adverse outcomes than those intubated in the OR. Importantly, patients with “clinical indications for intubation” were excluded from analysis.
How to Treat Thoracic Aortic Dissection
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Early identification and treatment of thoracic aortic dissection is paramount to patient survival and good clinical outcomes. Here's what you need to know.