August 2016 EM Articles

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Prevalence and Diagnostic Performance of Isolated and Combined NEXUS Chest CT Decision Criteria.
Acad Emerg Med. 2016 Aug;23(8):863-9. doi: 10.1111/acem.13010. Epub 2016 Aug 1.
Spoon Feed: Selective chest CT in trauma is safe if you take a cautious approach and use the NEXUS CT Chest Rule.

 

Extravasation Risk Using Ultrasound-guided Peripheral Intravenous Catheters for Computed Tomography Contrast Administration.
Acad Emerg Med. 2016 Aug;23(8):918-21. doi: 10.1111/acem.13000. Epub 2016 Aug 1.
Spoon Feed: Do you have the anecdotal sense that ultrasound guided IVs blow more often with IV contrast in CT?  Your hunch is now proven with this study.  Unadjusted RR for contrast extravasation compared with standard IV was 14.

 

Double-blind Randomized Controlled Trial of Intranasal Dexmedetomidine Versus Intranasal Midazolam as Anxiolysis Prior to Pediatric Laceration Repair in the Emergency Department.
Acad Emerg Med. 2016 Aug;23(8):910-7. doi: 10.1111/acem.12998.
Spoon Feed: Intranasal dexmedetomidine was more effective at relieving procedural anxiety than intranasal midazolam in pediatric patients.

 

Potentially Avoidable Pediatric Interfacility Transfer Is a Costly Burden for Rural Families: A Cohort Study.
Acad Emerg Med. 2016 Aug;23(8):885-94. doi: 10.1111/acem.12972.
Spoon Feed: Up to 40% of pediatric ED transfers were potentially avoidable and cost families an extra $900.

 

Optimal dosing of intravenous ketamine for procedural sedation in children in the ED-a randomized controlled trial.
Am J Emerg Med. 2016 Aug;34(8):1347-53. doi:10.1016/j.ajem.2016.03.064. Epub 2016 Apr 2.
Spoon Feed: Ketamine at doses of 1mg/kg, 1.5 mg/kg, and 2 mg/kg were all effective and safe in children 3-18 years.  Lower doses required more frequent redosing.

 

A clinical score to obviate the need for cardiac stress testing in patients with acute chest pain and negative troponins.
Am J Emerg Med. 2016 Aug;34(8):1421-6. doi: 10.1016/j.ajem.2016.04.016. Epub 2016 Apr 13.
Spoon Feed: This novel scoring system to risk stratify patients with low risk chest pain was derived and then performed well in the validation set, with a NPV of 98.8%.  The score has to be a net zero.  It has now been internally validated. Look for external validation before putting this into practice.

 

Evidence of Respiratory Syncytial Virus Spread by Aerosol. Time to Revisit Infection Control Strategies?
Am J Respir Crit Care Med. 2016 Aug 1;194(3):308-16. doi: 10.1164/rccm.201509-1833OC.
Spoon Feed: RSV infection control calls for droplet precaution, but this article found particles small enough to be transmitted via aerosol, which would require an N-95 mask.

 

Influence of the Heel-to-Toe Drop of Standard Cushioned Running Shoes on Injury Risk in Leisure-Time Runners: A Randomized Controlled Trial With 6-Month Follow-up.
Am J Sports Med. 2016 Aug 8. pii: 0363546516654690. [Epub ahead of print]
Spoon Feed: This is FYI.  Many of you are runners and may find this interesting.

 

Can You Multitask? Evidence and Limitations of Task Switching and Multitasking in Emergency Medicine.
Ann Emerg Med. 2016 Aug;68(2):189-95. doi: 10.1016/j.annemergmed.2015.10.003. Epub 2015 Nov 14.
Spoon Feed: We can only multitask fully automatic behaviors.  Everything else is task-switching, which may lead to errors.

 

The Association Between Insurance and Transfer of Noninjured Children From Emergency Departments.
Ann Emerg Med. 2016 Aug 20. pii: S0196-0644(16)30262-1. doi: 10.1016/j.annemergmed.2016.06.007. [Epub ahead of print]
Spoon Feed: Kids with no insurance had almost 4 times the odds of being transferred, instead of admitted at the initial facility.  I smell a rat.

 

Characteristics of and Predictors for Apnea and Clinical Interventions During Procedural Sedation.
Ann Emerg Med. 2016 Aug 21. pii: S0196-0644(16)30379-1. doi: 10.1016/j.annemergmed.2016.07.010. [Epub ahead of print]
Spoon Feed: Apnea during sedation was predicted by abnormal EtCO2, propofol use, and older age.

 

Wells Rule and d-Dimer Testing to Rule Out Pulmonary Embolism: A Systematic Review and Individual-Patient Data Meta-analysis.
Ann Intern Med. 2016 Aug 16;165(4):253-61. doi: 10.7326/M16-0031. Epub 2016 May 17.
Spoon Feed: Age adjusted D-dimer is safe and decreases the number of people needing further PE workup.

 

Prevalence and Localization of Pulmonary Embolism in Unexplained Acute Exacerbations of COPD: A systematic review and meta-analysis.
Chest. 2016 Aug 11. pii: S0012-3692(16)53752-0. doi: 10.1016/j.chest.2016.07.034. [Epub ahead of print]
Spoon Feed: PE prevalence was high in patients with acute exacerbation of COPD, 16.1%.

 

Lactated Ringer Is Associated With Reduced Mortality and Less Acute Kidney Injury in Critically Ill Patients: A Retrospective Cohort Analysis.
Crit Care Med. 2016 Aug 5. [Epub ahead of print]
Spoon Feed: FYI

 

Role of physician perception of patient smile on pretest probability assessment for acute pulmonary embolism.
Emerg Med J. 2016 Aug 2. pii: emermed-2016-205874. doi: 10.1136/emermed-2016-205874. [Epub ahead of print]
Spoon Feed: A smiling face affected physician estimate of the Wells score, making it less reliable, but it didn't affect physician gestalt for PE.  A patient can smile while having a PE.

 

Does emergency physician empathy reduce thoughts of litigation? A randomised trial.
Emerg Med J. 2016 Aug;33(8):548-52. doi: 10.1136/emermed-2015-205312. Epub 2016 Mar 21.
Spoon Feed: Empathetic doctors may get sued less often.

 

Quick-Wee: a novel non-invasive urine collection method.
Emerg Med J. 2016 Aug 26. pii: emermed-2016-206000. doi: 10.1136/emermed-2016-206000. [Epub ahead of print]
Spoon Feed: How do you make an infant urinate on demand?  Try the Quick-Wee method.

 

Emergency Medicine Management of Sickle Cell Disease Complications: An Evidence-Based Update.
J Emerg Med. 2016 Aug 20. pii: S0736-4679(16)30172-X. doi: 10.1016/j.jemermed.2016.05.042. [Epub ahead of print]
Spoon Feed: FYI

 

Clinical Presentation of Pediatric Patients at Risk for Sudden Cardiac Arrest.
J Pediatr. 2016 Aug 5. pii: S0022-3476(16)30518-2. doi: 10.1016/j.jpeds.2016.06.088. [Epub ahead of print]
Spoon Feed: High-risk family history, exercise chest pain, exercise syncope, or unexplained syncope in a child warrants pediatric cardiology evaluation with no exertion until cleared by them.

 

Detection of Pulmonary Embolism in High-Risk Children.
J Pediatr. 2016 Aug 24. pii: S0022-3476(16)30648-5. doi: 10.1016/j.jpeds.2016.07.046. [Epub ahead of print]
Spoon Feed: The PERC rule performed well in this small retrospective study of pediatric patients.

 

Nonsteroidal Anti-Inflammatory Drug without Antibiotics for Acute Viral Infection Increases the Empyema Risk in Children: A Matched Case-Control Study.
J Pediatr. 2016 Aug;175:47-53.e3. doi: 10.1016/j.jpeds.2016.05.025. Epub 2016 Jun 20.
Spoon Feed: FYI

 

Evaluation and Management of Febrile Children: A Review.
JAMA Pediatr. 2016 Aug 1;170(8):794-800. doi: 10.1001/jamapediatrics.2016.0596.
Spoon Feed: This is a helpful review article on the workup and management of febrile kids.  Infants <90 days are still a challenge, but vaccinated kids >90 days have UTI as the main serious bacterial infection.

 

Association of Acetaminophen Use During Pregnancy With Behavioral Problems in Childhood: Evidence Against Confounding.
JAMA Pediatr. 2016 Aug 15. doi: 10.1001/jamapediatrics.2016.1775. [Epub ahead of print]
Spoon Feed: FYI

 

Association Between Trauma Center Type and Mortality Among Injured Adolescent Patients.
JAMA Pediatr. 2016 Aug 1;170(8):780-6. doi:10.1001/jamapediatrics.2016.0805.
Spoon Feed: FYI

 

Effect of time to operation on mortality for hypotensive patients with gunshot wounds to the torso: The golden 10 minutes.
J Trauma Acute Care Surg. 2016 Aug 3. [Epub ahead of print]
Spoon Feed: Hypotensive patients with gunshot wounds are almost half as likely to die if in the OR in under 10 minutes.

 

Prehospital traumatic cardiac arrest: Management and outcomes from the resuscitation outcomes consortium epistry-trauma and PROPHET registries.
J Trauma Acute Care Surg. 2016 Aug;81(2):285-93. doi: 10.1097/TA.0000000000001070.
Spoon Feed: FYI

 

Risk of intracerebral haemorrhage with alteplase after acute ischaemic stroke: a secondary analysis of an individual patient data meta-analysis.
Lancet Neurol. 2016 Aug;15(9):925-33. doi: 10.1016/S1474-4422(16)30076-X. Epub 2016 Jun 8.
Spoon Feed: FYI

 

Acetaminophen versus Ibuprofen in Young Children with Mild Persistent Asthma.
N Engl J Med. 2016 Aug 18;375(7):619-30. doi: 10.1056/NEJMoa1515990.
Spoon Feed: Acetaminophen did not make asthma worse.

 

The effect of anesthetic management during intra-arterial therapy for acute stroke in MR CLEAN.
Neurology. 2016 Aug 16;87(7):656-64. doi: 10.1212/WNL.0000000000002976. Epub 2016 Jul 15.
Spoon Feed: Patients needing a general anesthetic did not benefit from stent retriever treatment.

 

Procedural Sedation Outside of the Operating Room Using Ketamine in 22,645 Children: A Report From the Pediatric Sedation Research Consortium.
Pediatr Crit Care Med. 2016 Aug 8. [Epub ahead of print]
Spoon Feed: Ketamine use outside the OR was safe in kids, with adverse events about 7%, serious events <2%.

 

Targeted Temperature Management After Pediatric Cardiac Arrest Due To Drowning: Outcomes and Complications.
Pediatr Crit Care Med. 2016 Aug;17(8):712-20. doi: 10.1097/PCC.0000000000000763.
Spoon Feed: Therapeutic hypothermia did not benefit pediatric drowning victims over normothermia.

 

A Randomized Controlled Trial of Positioning for Lumbar Puncture in Young Infants.
Pediatr Emerg Care. 2016 Aug;32(8):504-7. doi: 10.1097/PEC.0000000000000469.
Spoon Feed: This RCT showed infant LP success was the same whether supine or sitting up.

 

Removal From Play After Concussion and Recovery Time.
Pediatrics. 2016 Aug 29. pii: e20160910. [Epub ahead of print]
Spoon Feed: Recovery time was double and symptoms worse when kids were not removed from play after concussion.

 

Gait Disturbance as the Presenting Symptom in Young Children With Anti-NMDA Receptor Encephalitis.
Pediatrics. 2016 Aug 16. pii: e20160901. [Epub ahead of print]
Spoon Feed: FYI

 

Amiodarone or lidocaine for cardiac arrest: A systematic review and meta-analysis.
Resuscitation. 2016 Aug 3;107:31-37. doi: 10.1016/j.resuscitation.2016.07.235. [Epub ahead of print]
Spoon Feed: Similar to the recent NEJM study, neither amiodarone nor lidocaine improved survival to hospital discharge in out of hospital cardiac arrest with shockable rhythm in this systematic review.

 

Use of double sequential external defibrillation for refractory ventricular fibrillation during out-of-hospital cardiac arrest.
Resuscitation. 2016 Aug 10. pii: S0300-9572(16)30398-7. doi: 10.1016/j.resuscitation.2016.08.002. [Epub ahead of print]
Spoon Feed: FYI