tPA 4.5 to 9h or Wake-Up Stroke - New Meta-analysis

tPA 4.5 to 9h or Wake-Up Stroke - New Meta-analysis

Compared to the placebo group, patients who presented with ischemic stroke (4.5-9h from onset or wake-up stroke) with salvageable brain tissue identified on perfusion imaging and received tPA, had a slight improvement in functional outcome (mRS of 0-1) at 3 months (36% vs 29%) with higher rates of symptomatic intracerebral hemorrhage (5% vs <1%).

New Opiate Prescriptions and Downstream Risk of Misuse

New Opiate Prescriptions and Downstream Risk of Misuse

In patients given a new opiate prescription in the ED, 13.7% had persistent or high risk use over the next year. Higher doses led to greater risk, but even appropriate lower doses were associated with up to a 10% risk.

Sodium Polystyrene for Hyperkalemia and Serious GI Events

Sodium Polystyrene for Hyperkalemia and Serious GI Events

In this large population-based study, sodium polystyrene sulfonate use in elderly outpatients was associated with an almost 2-fold higher risk of serious adverse GI events within 30 days of initial prescription. The absolute risk increase was small, however.

Fluoroquinolones and Sudden Death

Fluoroquinolones and Sudden Death

Fluoroquinolone (FQ) antibiotics were associated with an increased odds of serious arrhythmic event (SAE) from 7 up to 90 days after taking them.

EcLiPSE - Should Levetiracetam Replace Phenytoin for Pediatric Status Epilepticus?

EcLiPSE - Should Levetiracetam Replace Phenytoin for Pediatric Status Epilepticus?

There was no difference in levetiracetam vs phenytoin as second-line agents after benzodiazepines for pediatric status epilepticus in median time to seizure cessation. Levetiracetam may have other advantages, as it is able to be given over 5 minutes (vs 20 minutes for phenytoin) and causes fewer adverse effects.

Door-to-Antibiotic And Mortality in Sepsis

Door-to-Antibiotic And Mortality in Sepsis

Mortality was higher when door-to-antibiotic time was > 3 h. However, there was no difference when comparing mortality in those given antibiotics within the first hour to those after the first hour.

Tramadol Isn't Addictive, Right?

Tramadol Isn't Addictive, Right?

Use of tramadol post-op was associated with an increased risk of prolonged use compared with other short acting opiates.

Lemierre's Syndrome - Sore Throat Gone Wrong

Lemierre's Syndrome - Sore Throat Gone Wrong

Sometimes sore throat isn’t just sore throat - it could be a life threatening complication. Learn about Lemierre’s syndrome with this quick-hitter teaching case from NEJM.

Off-Label Gabapentin and Pregabalin - Sketchy Evidence

Off-Label Gabapentin and Pregabalin - Sketchy Evidence

Gabapentinoids play a limited role for specific types of neuropathic pain, and pain reduction is modest at best. Side effects of dizziness, somnolence, and gait problems occur frequently.

New IDSA Guideline on Asymptomatic Bacteriuria

New IDSA Guideline on Asymptomatic Bacteriuria

The IDSA now only recommends screening for and treating asymptomatic bacteriuria (ASB) in pregnant women and those undergoing an invasive urologic procedure.

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