September 2016 EM Articles

NNR* THIS MONTH = 122

You'd have to read 3163 article to find these 26!

*NNR = number needed to read

ED Management of Patients with Febrile Neutropenia: Guideline Concordant or Overly Aggressive?

Acad Emerg Med. 2016 Sep 9. doi: 10.1111/acem.13079. [Epub ahead of print]
Spoon Feed: Using validated risk scores, like MASCC, some patients with fever and neutropenia can be safely treated at home on oral antibiotics.

Assessment of Right Ventricular Strain by Computed Tomography versus Echocardiography in Acute Pulmonary Embolism.
Acad Emerg Med. 2016 Sep 24. doi: 10.1111/acem.13108. [Epub ahead of print]
Spoon Feed: CTPA has good sensitivity for detecting RV strain but is not specific and is a poor sole predictor of bad outcome if TTE does not confirm RV strain.

The American Board of Emergency Medicine ConCert Examination: Emergency Physicians' Perceptions of Learning and Career Benefits.
Acad Emerg Med. 2016 Sep;23(9):1082-5. doi: 10.1111/acem.12971. Epub 2016 Sep 6.
Spoon Feed: This ABEM study found that we reinforce old concepts and learn some new information by taking the ConCert exam, but a more important question is if this expensive process improves patient outcomes.

Apneic Oxygenation During Prolonged Laryngoscopy in Obese Patients: A Randomized, Controlled Trial of Buccal RAE Tube Oxygen Administration.
Anesth Analg. 2016 Sep 20. [Epub ahead of print]
Spoon Feed: Buccal O2 allowed 12.5 minutes of apnea without hypoxia in obese patients.

Effect of Tamsulosin on Stone Passage for Ureteral Stones: A Systematic Review and Meta-analysis.
Ann Emerg Med. 2016 Sep 7. pii: S0196-0644(16)30364-X. doi: 10.1016/j.annemergmed.2016.06.044. [Epub ahead of print]
Spoon Feed: Tamsulosin helps larger stones pass but is of no benefit for smaller (<5 mm) stones, according this this meta-analysis of 8 RCTs.

Treatment With Prothrombin Complex Concentrate to Enable Emergency Lumbar Puncture in Patients Receiving Vitamin K Antagonists.
Ann Emerg Med. 2016 Sep;68(3):340-4. doi: 10.1016/j.annemergmed.2016.03.003. Epub 2016 Apr 14.
Spoon Feed: PCC is an effective way to reverse warfarin for emergent LP.

Early Identification of Patients With Out-of-Hospital Cardiac Arrest With No Chance of Survival and Consideration for Organ Donation.
Ann Intern Med. 2016 Sep 13:1-9. doi: 10.7326/M16-0402. [Epub ahead of print]
Spoon Feed: FYI.  Seems a bit morbid to make an organ donation prediction rule.  Congrats, your loved one will die but they have great donor potential!

Non-steroidal anti-inflammatory drugs and risk of heart failure in four European countries: nested case-control study.
BMJ. 2016 Sep 28;354:i4857. doi: 10.1136/bmj.i4857.
Spoon Feed: NSAIDs increase the risk of hospitalization for heart failure and should be avoided in at-risk patients.

Induction of Therapeutic Hypothermia During Out-of-Hospital Cardiac Arrest Using a Rapid Infusion of Cold Saline: The RINSE Trial (Rapid Infusion of Cold Normal Saline).
Circulation. 2016 Sep 13;134(11):797-805. doi: 10.1161/CIRCULATIONAHA.116.021989. Epub 2016 Aug 25.
Spoon Feed: Prehospital cold saline during CPR did not improve outcome and may have caused harm.

Chloride Content of Fluids Used for Large-Volume Resuscitation Is Associated With Reduced Survival.
Crit Care Med. 2016 Sep 15. [Epub ahead of print]
Spoon Feed: For every 100 meq of increased chloride load in patients needing large amounts of isotonic fluid, hazard for death increased 5.5% even after controlling for potential confounders.

Cardiac Arrests Associated With Tracheal Intubations in PICUs: A Multicenter Cohort Study.
Crit Care Med. 2016 Sep;44(9):1675-82. doi: 10.1097/CCM.0000000000001741.
Spoon Feed: Pediatric patients who are unstable, hypoxic, have known difficult airway, or have cardiac disease are at greater risk for arrest during or post-intubation.

Diagnostic accuracy of the APPY1 Test in patients aged 2-20 years with suspected acute appendicitis presenting to emergency departments.
Emerg Med J. 2016 Sep 9. pii: emermed-2015-205259. doi: 10.1136/emermed-2015-205259. [Epub ahead of print]
Spoon Feed: FYI.  This blood test, a composite of inflammatory markers, performed pretty well.

Association Between MRI Exposure During Pregnancy and Fetal and Childhood Outcomes.
JAMA. 2016 Sep 6;316(9):952-61. doi: 10.1001/jama.2016.12126.
Spoon Feed: MRI in the first trimester appears safe for the fetus, although exposure to gadolinium contrast should be avoided.

Will This Hemodynamically Unstable Patient Respond to a Bolus of Intravenous Fluids?
JAMA. 2016 Sep 27;316(12):1298-309. doi: 10.1001/jama.2016.12310.
Spoon Feed: Increased cardiac output with passive leg raise is the best marker of fluid responsiveness.

Time to Treatment With Endovascular Thrombectomy and Outcomes From Ischemic Stroke: A Meta-analysis.
JAMA. 2016 Sep 27;316(12):1279-88. doi: 10.1001/jama.2016.13647.
Spoon Feed: The faster a patient can have cerebrovascular thrombectomy, the better the odds of disability-free outcome.

Stroke.
Lancet. 2016 Sep 13. pii: S0140-6736(16)30962-X. doi: 10.1016/S0140-6736(16)30962-X. [Epub ahead of print]
Spoon Feed: Every once in a while, we want to include particularly good review articles, and this is one of them.  Read this with alacrity!

Andexanet Alfa for Acute Major Bleeding Associated with Factor Xa Inhibitors.
N Engl J Med. 2016 Sep 22;375(12):1131-41. doi: 10.1056/NEJMoa1607887. Epub 2016 Aug 30.
Spoon Feed: FYI. A new reversal agent for factor Xa inhibitors is being tested.

Double-Blind Randomized Clinical Trial Comparing Dopamine and Epinephrine in Pediatric Fluid-Refractory Hypotensive Septic Shock.
Pediatr Crit Care Med. 2016 Sep 23. [Epub ahead of print]
Spoon Feed: Epinephrine resolved early fluid-nonresponsive shock faster than dopamine.

Codeine: Time To Say "No".
Pediatrics. 2016 Sep 19. pii: e20151648. [Epub ahead of print]
Spoon Feed: Stop using codeine in kids.  It's a terrible choice.

Liquid Medication Errors and Dosing Tools: A Randomized Controlled Experiment.
Pediatrics. 2016 Sep 12. pii: e20160357. [Epub ahead of print]
Spoon Feed: Give parents dosing syringes vs. cups; use mL-only markings (not teaspoons) to reduce pediatric dosing errors.

Evaluation of a New Strategy for Clean-Catch Urine in Infants.
Pediatrics. 2016 Sep;138(3). pii: e20160573. doi: 10.1542/peds.2016-0573. Epub 2016 Aug 19.
Spoon Feed: This is another way to obtain a clean catch UA in infants in 45 seconds.

Discontinuation and Nonpublication of Randomized Clinical Trials Conducted in Children.
Pediatrics. 2016 Sep;138(3). pii: e20160223. doi: 10.1542/peds.2016-0223. Epub 2016 Aug 4.
Spoon Feed: FYI. Many family allow their children to face some risk and be enrolled in trials  which are never completed or never published.

Double Sequential External Defibrillation and Survival from Out-of-Hospital Cardiac Arrest: A Case Report.
Prehosp Emerg Care. 2016 Sep-Oct;20(5):662-6. doi: 10.3109/10903127.2016.1168891. Epub 2016 Apr 14.
Spoon Feed: For shock-refractory v-fib, double sequential defibrillation is an option.

Assessing the Risk of Prehospital Administration of Naloxone with Subsequent Refusal of Care.
Prehosp Emerg Care. 2016 Sep-Oct;20(5):566-9. doi: 10.3109/10903127.2016.1142626. Epub 2016 Mar 28.
Spoon Feed: Transport is recommended after rescue with naloxone, but refusal of EMS transport carries a low risk for the patient.

Patients without ST elevation after return of spontaneous circulation may benefit from emergent percutaneous intervention: A systematic review and meta-analysis.
Resuscitation. 2016 Sep 15;108:54-60. doi: 10.1016/j.resuscitation.2016.09.004. [Epub ahead of print]
Spoon Feed: A large percentage of patients would benefit from post-arrest cath even if they lack STEMI criteria on ECG.

Validation of a Functional Pyelocalyceal Renal Model for the Evaluation of Renal Calculi Passage While Riding a Roller Coaster.
J Am Osteopath Assoc. 2016 Oct 1;116(10):647-52. doi: 10.7556/jaoa.2016.128.
Spoon Feed: Kidney stones passed better after roller coaster riding using this silicon model, though the roller-coaster-as-therapy option may be a lot to ask of a person with a kidney stone.