Academic Emergency Medicine

Accuracy of the European Society of Cardiology 0/1- , 0/2- , and
0/3- hour algorithms for diagnosing acute myocardial infarction

• 0/1h algorithm had excellent specificity (94%) and sensitivity (99%, CI 98.5-99.5%)

American Journal of Emergency Medicine

Bioterrorism: An analysis of biological agents used in terrorist events.

2020 webPOISONCONTROL data summary

• webPoisoncontrol is an alternative resource to calling poison control, quick and easy to use, will recommend call to poison control for more complex cases.

Clinical update on COVID-19 for the emergency clinician: Presentation
and evaluation

Annals of Emergency Medicine

Are Emergency Departments Responding to the Aging Demography?

• Discusses NEWS which is a triage screening tool to identify folks who have higher risk for death or ICU care.
• Adding age to NEWS improves the accuracy.
• Also encourages the use of the FRAILTY scale which identifies elderly who may need institutional care.

Thinking Beyond the Emergency Department: Addressing Homelessness in Residency Education

• Great summary of homelessness beneficial to EM physicians far beyond residency.
• Practical steps:
  1. Screen everyone for homelessness
  2. Hand out insurance application (quadruples chance of obtaining insurance).
  3. Provide location of closest social services office to apply for transitional and permanent housing.
  4. Provide location of closest low cost/free ambulatory care services/dental care.
  5. Provide location of closest detox/substance abuse facilities.

What Is The Diagnostic Accuracy of Rapid Nucleic Acid Tests for Group A Streptococcal Pharyngitis?

• Rapid Nucleic Acid Tests more sensitive (97% vs 82%) and equally specific to the traditional Rapid Antigen Detection Test (RADT).
• Most hospitals currently use RADT.
• Currently negative RADT requires a follow-up culture in high risk groups per the Uptodate algorithm but rapid nuclear acid test may negate that requirement.

BMJ

Risks of deep vein thrombosis, pulmonary embolism, and bleeding after covid-19: nationwide self-controlled cases series and matched cohort study

• Covid-19 is an independent risk factor for deep vein thrombosis, pulmonary embolism, and bleeding, and that the risk of these outcomes is increased for three, six, and two months after covid-19, respectively

Circulation

None

CJEM

Computed tomography angiography for acute headache may be more painful than lumbar puncture

• While CTA is a good option for acute headache patients with delayed presentation (e.g. > 1 week after headache onset), when LP is contraindicated, not feasible or has indeterminate results, it should not routinely replace LP. CTA will work for 96.7% patients, but will identify incidental aneurysms in 3.3%, leading to difficult decisions for our neurosurgical colleagues, increased patient morbidity and mortality due to unnecessary aneurysm repairs or increased patient anxiety.

Just the facts: how to diagnose and manage patients with multiple myeloma in the emergency department?

• Multiple myeloma patients present commonly with one or more of the “CRAB” symptoms which reflect end organ damage: hyperCalcemia, Renal failure, Anemia, or lytic Bone lesions.

Just the facts: testing patients with suspected pulmonary embolism

Just the facts: drowning

EMCRIT

EMCrit Wee – Saving EM: Is Less More? with Atkinson and Innes

• EM is valuable but EDs need to do less, can’t be the catch-all for society’s problems.
• Fascinating conversation with two authors of recent CJEM editorial.
  • Authors push for public health solution that offloads noncritical EM to after hours primary care clinics, telemedicine, etc.
  • Weingart contends that the specialty is headed for a schism of two specialties: 1) after hours primary care who can also manage sick patients for the first 20 minutes; 2) resuscitationist who has the training and skill set to manage critically ill patients beyond the first 20 minutes.

EMCrit 321 – CV-EMCrit – Acute Valve Disasters – Critical Aortic & Mitral Regurgitation and Bonus: VSDs with Trina Augustin

EMCrit 320 – MotR – Tension & Relaxation | Flow & Burnout

• Amazing podcast on how to achieve flow and reduce burnout
• Great paradigm for balancing relaxation and positive tension

• Great book recommendations
  1. The Art of Learning- Josh Waitzkin
  2. Joy on Demand- Chade-Meng Ten
  3. Happiness- Daniel Haybron

Emergency Medicine Journal

None

EMRAP

Acute Angle Closure Glaucoma

• Initial treatment is 4 topical drops, given 1-2 minutes apart and repeated q5minutes for a total of 3 doses of each drop.
  1. Timolol (B-blocker- decrease aqueous humor production)
  2. Dorzolamide (carbonic anhydrase inhibitor- decrease aqueous humor production)
  3. Latanoprost (prostaglandin analogue- increase aqueous humor outflow)
  4. Brimonidine (alphagan) or apraclonidine (alpha agonist- decrease aqueous humor production and increase outflow)
  5. Uptodate also recommends 2% pilocarpine
• IV mannitol or diamox if pressure not improved when IOP rechecked at 30 minutes.

JAMA

Aspirin Use to Prevent Cardiovascular Disease US Preventive Services Task Force Recommendation Statement

• net benefit of low-dose aspirin use in adults aged 40 to 59 years who have a 10% or greater 10-year CVD risk is small; that persons not at increased risk for bleeding and willing to take low-dose aspirin daily are more likely to benefit (C recommendation); and recommends against initiating low-dose aspirin use for the primary prevention of CVD in adults 60 years or older (D recommendation).
• 10 year CVD risk calculator is available on MDCALC: ASCVD Risk Calculator.

Secondary Attack Rates for Omicron and Delta Variants of SARS-CoV-2 in Norwegian Households

• Secondary attack rate was 25.1% (95% CI, 24.4%-25.9%) when the variant of the index case was Omicron, 19.4%(95% CI, 19.0%-19.8%) when it was Delta, and 17.9% (95%CI, 17.5%-18.4%) when it was nonclassified.

Journal of Emergency Medicine

None

Lancet

None

NEJM

Cancer-Associated Hypercalcemia

PEDIATRICS

None

REBELEM

None

Resuscitation

Femoral artery Doppler ultrasound is more accurate than manual palpation for pulse detection in cardiac arrest