Blog
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Aug 10 2017
Ap-Ox Works – New Meta-analyses
Blasting nasal cannula oxygen (apneic oxygenation) during endotracheal intubation of ED patients led to higher O2 saturation, decreased episodes of desaturation, and improved first-pass success.
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Aug 09 2017
Sentinel Bleeds Are Bad Right?
Prior studies have shown that sentinel bleeds lead to worse outcomes if missed and subsequent aneurysmal subarachnoid hemorrhage (SAH) occurs, but this Kaiser Permanente case-control study suggests this may be a myth.
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Aug 08 2017
Haloperidol Works for Gastroparesis Symptoms
Haloperidol markedly reduced pain and nausea in ED patients with gastroparesis compared to usual care. But be careful. Haloperidol is not without side effects.
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Aug 07 2017
Don’t Rely on CT to Rule Out Open Globe
CT was specific for open globe but not sensitive. The best CT predictors of open globe were change in globe contour and vitreous hemorrhage. Open globe is a clinical or surgical diagnosis. CT alone can't rule it out.
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Aug 05 2017
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.
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Aug 04 2017
Don’t Count on the LRINEC Score for Necrotizing Fasciitis
Don't rely on the LRINEC score to distinguish which patients do or do not have necrotizing fasciitis (NF). It fails as a reliable diagnostic screening test. NF remains a clinical diagnosis.
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Aug 03 2017
5 Scary ECG Patterns Not to Miss from Mattu and Brady
Learn the ECG patterns for posterior MI, left main disease, the ominous isolated T-wave inversion in aVL, large upright T-wave in V1, and Wellen's warning. This full text article is mandatory reading.
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Aug 02 2017
Mostly Dead Is Slightly Alive – H&P in Chest Pain
History and exam features are not useless in the evaluation of patients with chest pain, but they must be used as part of a risk stratification strategy that includes ECG and troponin.
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Aug 01 2017
What Lurks in Infant CSF These Days?
E. coli and GBS were the most common pathogens causing meningitis in infants under 90 days in this cohort. Add ampicillin for the first month to cover Listeria. If gram-negative meningitis is present, consider changing to a carbapenem (like meropenem).
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Jul 31 2017
MRI Misses Stroke
False negative DWI MRI imaging happened in about 7% of cases. If you strongly suspect ischemic stroke clinically, especially posterior stroke, press to admit for further workup.