Academic Emergency Medicine

None

American Journal of Emergency Medicine

Modified PRIEST score for identification of very low-risk COVID patients

Annals of Emergency Medicine

Risk of Traumatic Brain Injuries in Infants Younger than 3 Months With Minor Blunt Head Trauma

• Of the 514/1081 (47.5%) infants who met the PECARN low-risk criteria, 1/514 (0.2%, 95% confidence interval [CI] 0.005% to 1.1%), had clinically important traumatic brain injuries1/514 (0.2%, 95% confidence interval [CI] 0.005% to 1.1%)

Managing Diabetic Ketoacidosis in Children

Caring for Transgender Patients: Complications of Gender-Affirming Genital Surgeries

Consensus Recommendations on the Treatment of Opioid Use Disorder in the Emergency Department

Preventing Post-Lumbar Puncture Headache

• Use pencil tip (Sprotte or Whittacre) rather cutting tip (Quincke) needles to reduce risk of post LP headache, does not affect success of LP.

BMJ

Circulation

Early Rhythm Control Therapy in Patients With Atrial Fibrillation and Heart Failure

EMCRIT

Emergency Medicine Journal

Multicentre external validation of the Canadian Syncope Risk Score to predict adverse events and comparison with clinical judgement

EMRAP

Heat Stroke

• Use a body bag (the same ones used to transport patients to the morgue) to cool patient rapidly in 20-30 minutes. Put patient in the bag and fill with ice and water.

Critical Care Mailbag: Perfusion Index

• Pulse ox waveform depends on perfusion index (ratio of pulsatile blood over non-pulsatile blood), <0.5 has a poor waveform.
• Low cardiac output (cardiogenic shock) or vasoconstriction (hemorrhagic shock) cause lower perfusion index and poor waveform, while septic shock tends to be warm and hypotensive due to poor vasoconstriction.

Myasthenia Gravis

• Have patient count to 40, if they can’t get past 15, patient at risk for respiratory failure.
• Avoid Succinylcholine, unpredictable response

Tachycardia in Pregnancy

• Diltiazem, Adenosine, Procainamide good
• Amiodarone bad
• Cardiovert if necessary, avoid abdomen

JAMA

None available free. Basics trial showed no difference between NS and balanced crystalloid but not available for free.

Journal of Emergency Medicine

Journal of Clinical Virology

Comparing the diagnostic accuracy of rapid antigen detection tests to real time polymerase chain reaction in the diagnosis of SARS-CoV-2 infection: A systematic review and meta-analysis

• Sensitivity of RADTs is 68%, 99% specific.  Sensitivity 87% in patients with </=5 days of symptoms.

Lancet

Awake prone positioning for COVID-19 acute hypoxaemic respiratory failure- a randomised, controlled, multinational, open-label meta-trial

• See review of article in REBELEM below.

NEJM

Medicare for More — Why We Still Need a Public Option and How to Get There

Treatment of Acute Uncomplicated Appendicitis

PEDIATRICS

None

REBELEM

The PRIEST Score: Predicting Adverse Outcomes in COVID-19

Rebellion21: 5 Things Your Intensivist Wishes You did in the ED for Critically Ill Patients via Sara Gray, MD

1. Optimize Resuscitation
   1. POCUS to assess fluid resuscitation
   2. Adequate IV access
   3. Foley
   4. NG tube
   5. HOB elevation
   6. Early antibiotics in appropriate cases
2. Optimize Ventilator Parameters
   1. Wean FiO2 as tolerated (Avoid hyperoxia)
   2. TV 4 – 8cc/kg ideal body weight
   3. Continuous EtCO2 tracing
3. Sedation Strategy
   1. Optimize pain control – Analgesia 1^st strategy
   2. Add sedation 2^nd
4. Peripheral Pressors Safely
   1. Big (≥18g) IV in a proximal site to prevent extravasation
   2. Check site q1hr for color, temperature, and perfusion (Compare to contralateral side)
5. Communication
   1. What is patients code status? Who did you confirm code status with?
   2. Easy or difficult airway? Has ramifications for how quickly/safely extubation can occur

RECOVERY RS: CPAP vs HFNO vs Conventional Oxygen Therapy in COVID-19

• For patients with COVID-19 pneumonia and acute hypoxemic respiratory failure, CPAP reduced the need for intubation compared to conventional oxygen therapy. However, HFNO did not reduce the need for intubation compared to conventional oxygen therapy. Neither intervention showed a statistically significant mortality benefit compared to conventional oxygen therapy, however, the study was not powered for this outcome.  Although the conclusion of the trial is CPAP > HFNO > COT, there may be some scenarios where HFNO > CPAP to reduce adverse events (i.e awake prone positioning, patient nutrition, etc).  
• IBCC/Farkas agrees.

Awake Proning for COVID-19 Acute Hypoxemic Respiratory Failure

• This is the highest-level evidence we have to date on awake prone positioning. In this trial of patients with hypoxemic respiratory failure due to COVID-19, awake prone positioning reduced the incidence of treatment failure (intubation and death), which was primarily driven by decreased intubation compared to standard care.  Not only was there no signal of harm from awake prone positioning, but even longer durations of awake prone positioning (>8hrs/day) were associated with a lower risk of treatment failure.