Academic Emergency Medicine

Patient values and preferences in pulmonary embolism testing in the emergency department

• Insight into patients’ expectations
  • Patients expect 100% certainty from their physician
  • Trust CT and multiple tests over physician judgement

• These beliefs require additional physician time to educate

American Journal of Emergency Medicine

None

Annals of Emergency Medicine

Naloxone and Buprenorphine Prescribing Following US Emergency Department Visits for Suspected Opioid Overdose: August 2019 to April 2021

• Naloxone and Bupe only prescribed after 1 in 13 and 1 in 12 opiate overdoses respectively.

BMJ

None

Circulation

American Heart Association’s Life’s Simple 7: Lifestyle Recommendations, Polygenic Risk, and Lifetime Risk of Coronary Heart Disease

• Don’t smoke, Stay lean, Low Cholesterol, Eat well, Exercise, Manage BP, Manage Sugar

CJEM

Wide-complex tachycardias in the ED: how do we make good care even better?

• Differentiate primary WCT (AF, Aflutter, Sinus Tach, VT) from secondary WCT (see list below of most common).
• Treat appropriately
• Slow rate<100
• Anticoagulate AF, Aflutter

Diagnosis and management of wide complex tachycardia in the emergency department

Wide Complex Tachycardia Differentiation: A Reappraisal of the State‐of‐the‐Art

A blueprint for building an emergency department quality improvement and patient safety committee

EMCRIT

EMCrit 319 – Safe and Smart Reversal of Anticoagulation / Anti-platelet Agents in 2022

Emergency Medicine Journal

None

EMRAP

Tracheostomy Emergency

• Try to pass suction catheter.
• If can’t pass, then deflate cuff and bag through mouth
• If Trach is more than 7 days old then can attempt to replace
• If no Trach then place a 6.0 ETT
• Pass Trach over a bougie

Crashing Aortic Stenosis

• Best way to improve hypotension is with vasopressors
  • Phenylephrine useful because no increase in HR, careful if patient already has bradycardia.
  • Vasopressin also good, similar hemodynamic effects to phenylephrine, start at .04 units/minute
  • Goal is to get MAP to 65 to improve coronary perfusion which will improve contractility.
• Weingart starts with vasopressin and then adds phenylephrine or norepinephrine.
• Patients usually too unstable for major surgery
• Valvuloplasty with interventional cardiology can be very useful.

Pharmacology Corner: Potassium Binders

• No high quality studies showing efficacy of kayexelate
• Serious adverse effects: colonic necrosis
• Veltasa reduces potassium 0.6 meq at 2 hours and no difference at 6 hours.

Intranasal Ketamine and “Ketadex”

JAMA

None

Journal of Emergency Medicine

None

Lancet

Resuscitation with blood products in patients with trauma-related haemorrhagic shock receiving prehospital care (RePHILL): a multicentre, open-label, randomised, controlled, phase 3 trial

• No benefit to prehospital transfusion

Duration of effectiveness of vaccines against SARS-CoV-2 infection and COVID-19 disease: results of a systematic review and meta-regression

• Vaccine efficacy dropped by 10% from 1 month to 6 months against severe disease but dropped by 25% against symptomatic disease.

Paul Farmer- Obituary

“He put the poor, the marginal, the disabled…he put them first”

NEJM

Decompression Sickness and Arterial Gas Embolism

The Patient Resident

Extracorporeal Kidney-Replacement Therapy for Acute Kidney Injury

Chronic Pancreatitis

CT or Invasive Coronary Angiography in Stable Chest Pain

• Among patients referred for ICA because of stable chest pain and intermediate pretest probability of CAD, the risk of major adverse cardiovascular events was similar in the CT group and the ICA group. The frequency of major procedure- related complications was lower with an initial CT strategy.

PEDIATRICS

None

REBELEM

REBEL Core Cast 77.0 – Pyogenic Flexor Tenosynovitis

• Think about flexor tenosynovitis in a patient with atraumatic finger pain.  They may have any combination of these signs:
  • Tenderness along the course of the flexor tendon
  • Symmetrical swelling of the finger – often called the sausage digit
  • Pain on passive extension of the finger and
  • Patient holds the finger in a flex position at rest for increased comfort

The SCOUT–CAP Trial: 5d Abx vs. 10d Abx in Pediatric CAP

• 5d course as good as 10d
  • UPTODATE supports this conclusion and cites this study

REBEL Cast Ep108: The PLUS Trial – Balanced vs Unbalanced Fluids in the Critically Ill

• Finfer, S et al. Balanced Multielectrolyte Solution Versus Saline in Critically Ill Adults. NEJM 2022
• In critically ill adults in the ICU requiring intravenous fluids, it appears the type of fluid does not make a difference on the outcomes of mortality or AKI.

Resuscitation