October 2016 EM Articles

NNR* This Month = 109

You'd have to read 2617 articles to find these 24 hotties.

*NNR = Number Needed to Read

 

Point-of-Care Ultrasound for Diagnosis of Abscess in Skin and Soft Tissue Infections.
Acad Emerg Med. 2016 Oct 21. doi: 10.1111/acem.13049. [Epub ahead of print]
Spoon Feed: POCUS is accurate in helping decide which skin infections need incision and drainage vs treatment for cellulitis only.

 

Comparison of Four Views to Single-view Ultrasound Protocols to Identify Clinically Significant Pneumothorax.
Acad Emerg Med. 2016 Oct;23(10):1170-1175. doi: 10.1111/acem.13054. Epub 2016 Sep 27.
Spoon Feed: Single view POCUS was just as good as 4-view in detecting clinically significant PTX.

 

The High Risk of Contrast-induced Nephropathy in Patients with Suspected Pulmonary Embolism Despite Three Different Prophylaxis: A Randomized Controlled Trial.
Acad Emerg Med. 2016 Oct;23(10):1136-1145. doi: 10.1111/acem.13051. Epub 2016 Sep 27.
Spoon Feed: None of the IV fluid regimens used for prophylaxis of CIN after CTPA made an impact on the development of CIN, which was around 25% regardless of which fluid was given.
 

Analyses of demographical and injury characteristics of adult and pediatric patients injured in Syrian civil war.
Am J Emerg Med. 2016 Oct 6. pii: S0735-6757(16)30703-3. doi: 10.1016/j.ajem.2016.10.008. [Epub ahead of print]
Spoon Feed: The civil war in Syria has had a terrible impact on its people.  Adults were injured more often than kids (18% peds); blunt trauma was most common; head injury was the most commonly injured area of the body, disproportionately so in children.

 

Effect of scribes on patient throughput, revenue, and patient and provider satisfaction: a systematic review and meta-analysis.
Am J Emerg Med. 2016 Oct;34(10):2018-2028. doi: 10.1016/j.ajem.2016.07.056. Epub 2016 Jul 28.
Spoon Feed: Scribes may help increase the number of patients seen per hour and also may increase revenue.  They also seemed to make providers and patients more satisfied.

 

Midazolam-Droperidol, Droperidol, or Olanzapine for Acute Agitation: A Randomized Clinical Trial.
Ann Emerg Med. 2016 Oct 10. pii: S0196-0644(16)30456-5. doi: 10.1016/j.annemergmed.2016.07.033. [Epub ahead of print]
Spoon Feed: For agitation, the combination of midazolam 5 mg/droperidol 5 mg IV was better and faster onset than droperidol 10 mg IV and olanzapine 10 mg IV.

 

Factors Associated With Participation in an Emergency Department-Based Take-Home Naloxone Program for At-Risk Opioid Users.
Ann Emerg Med. 2016 Oct 10. pii: S0196-0644(16)30407-3. doi: 10.1016/j.annemergmed.2016.07.027. [Epub ahead of print]
Spoon Feed: Two-thirds of opiate abusing patients were willing to accept take-home naloxone.  This could save lives.

 

Clinical Presentations and Outcomes of Children With Basilar Skull Fractures After Blunt Head Trauma.
Ann Emerg Med. 2016 Oct;68(4):431-440.e1. doi: 10.1016/j.annemergmed.2016.04.058. Epub 2016 Jul 25.
Spoon Feed: If a child has exam findings concerning for BSF, do a head CT.  If they have isolated BSF and a completely normal neurological exam after a period of ED observation, they have a low risk of adverse outcome and could be considered for discharge.  Personally, I lean toward admission if a BSF is present.

 

Human Trafficking: A Guide to Identification and Approach for the Emergency Physician.
Ann Emerg Med. 2016 Oct;68(4):501-508.e1. doi: 10.1016/j.annemergmed.2016.03.049. Epub 2016 Apr 26.
Spoon Feed: This is an important article on spotting victims of human trafficking.

 

Antibiotics Versus Surgical Therapy for Uncomplicated Appendicitis: Systematic Review and Meta-analysis of Controlled Trials (PROSPERO 2015: CRD42015016882).
Ann Surg. 2016 Oct 17. [Epub ahead of print]
Spoon Feed: Surgery is the definitive treatment for appendicitis, with a low complication and failure rate.  Medical therapy is an option, although 1/4 of patients will eventually need surgery.

 

80% of China's clinical trial data are fraudulent, investigation finds.
BMJ. 2016 Oct 5;355:i5396. doi: 10.1136/bmj.i5396.
Spoon Feed: If you have full text access to BMJ, this is worth a read.  The title says it all: 80% of clinical trial data were fraudulent.  It was well documented.  This has implications regarding the validity of recent trials out of China and regarding international research collaboration with China.

 

Procalcitonin as an Early Marker of the Need for Invasive Respiratory or Vasopressor Support in Adults With Community-Acquired Pneumonia.
Chest. 2016 Oct;150(4):819-828. doi: 10.1016/j.chest.2016.04.010. Epub 2016 Apr 21.
Spoon Feed: When deciding whether a patient with community-acquired pneumonia needs ICU admission, PCT can help predict the risk for subsequent intubation or pressors.

 

Experts Consensus Recommendations for the Management of Calcium Channel Blocker Poisoning in Adults.
Crit Care Med. 2016 Oct 3. [Epub ahead of print]
Spoon Feed: Look over this stepwise approach to beta-blocker overdose.  Make sure you know all the treatment options.

 

Association Among ICU Congestion, ICU Admission Decision, and Patient Outcomes.
Crit Care Med. 2016 Oct;44(10):1814-21. doi: 10.1097/CCM.0000000000001850.
Spoon Feed: Graciously stand your ground when a patient needs ICU level care and don't get talked into admitting to the floor when your training tells you otherwise. That is acting in the patient's best interest.  If we can free up room in the ED for all-comers, the ICU can too.

 

Review article: Why is there still a debate regarding the safety and efficacy of intravenous thrombolysis in the management of presumed acute ischaemic stroke? A systematic review and meta-analysis.
Emerg Med Australas. 2016 Oct;28(5):496-510. doi: 10.1111/1742-6723.12653. Epub 2016 Aug 25.
Spoon Feed: I agree with the authors' conclusion.  "The available data are unlikely to resolve the controversy..."  I am not opposed to tPA for stroke, but I think the patient deserves true informed consent.

 

Apnoeic oxygenation via high-flow nasal cannula oxygen combined with non-invasive ventilation preoxygenation for intubation in hypoxaemic patients in the intensive care unit: the single-centre, blinded, randomised controlled OPTINIV trial.
Intensive Care Med. 2016 Oct 11. [Epub ahead of print]
Spoon Feed: Blow as much oxygen into every hole in a patients face as you can when preoxygenating sick, hypoxic patients.  The combination of HFNC + NIV worked very well in this study.

 

Does the Use of Ibuprofen in Children with Extremity Fractures Increase their Risk for Bone Healing Complications?
J Emerg Med. 2016 Oct 14. pii: S0736-4679(16)30802-2. doi: 10.1016/j.jemermed.2016.09.027. [Epub ahead of print]
Spoon Feed: The dogma is - no NSAIDs for fractures - because it increases the risk of bone healing complications, but this study challenges that.

 

New Electrocardiographic Changes in Patients Diagnosed with Pulmonary Embolism.
J Emerg Med. 2016 Oct 11. pii: S0736-4679(16)30720-X. doi: 10.1016/j.jemermed.2016.09.009. [Epub ahead of print]
Spoon Feed: ECG changes are common in PE, most often new inferior T-wave inversions or flattening or new sinus tachycardia.  But 1/4 had no change.

 

Pyuria and Urine Cultures in Patients with Acute Renal Colic.
J Emerg Med. 2016 Oct;51(4):358-364. doi: 10.1016/j.jemermed.2015.10.043. Epub 2016 Jul 29.
Spoon Feed: Not all patients with a few WBCs on UA/micro have infection.  But the more WBCs, the greater the risk.  Also large LE on UA means greater risk.  Be sure to get a urine culture on these patients.

 

Treatments for Hyperemesis Gravidarum and Nausea and Vomiting in Pregnancy: A Systematic Review.
JAMA. 2016 Oct 4;316(13):1392-1401. doi: 10.1001/jama.2016.14337.
Spoon Feed: All of the agents discussed worked.  Ondansetron worked better than others as severity increased.  Corticosteroids are an option for severe cases. Here is an audio summary of ondansetron safety in pregnancy on UC:RAP, in case you missed it.

 

Effect of Conservative vs Conventional Oxygen Therapy on Mortality Among Patients in an Intensive Care Unit: The Oxygen-ICU Randomized Clinical Trial.
JAMA. 2016 Oct 18;316(15):1583-1589. doi: 10.1001/jama.2016.11993.
Spoon Feed: Target SpO2 94-97% in critically ill patients.  This study adds more evidence that hyperoxia is bad for patients.

 

Trial of Amitriptyline, Topiramate, and Placebo for Pediatric Migraine.
N Engl J Med. 2016 Oct 27. [Epub ahead of print]
Spoon Feed: These two drugs do not seem to help prevent migraine headache in kids and may cause harm.

 

Effect of Short-Term vs. Long-Term Blood Storage on Mortality after Transfusion.
N Engl J Med. 2016 Oct 24. [Epub ahead of print]
Spoon Feed: Transfusion of older PRBCs does not appear to cause harm.

 

Prevalence of Pulmonary Embolism among Patients Hospitalized for Syncope.
N Engl J Med. 2016 Oct 20;375(16):1524-1531.
Spoon Feed: You will hear about this study and may be asked to consider PE workup more often in syncope patients you admit.  I think the best way to think about this is to work up patients for PE who have symptoms that concern you that they may have a PE and not to feel obligated to perform universal PE screening on all patients admitted for syncope.

The FOAM world has blown up about this article.  Here are some good reads: