Fact of the Day - April 2016
Brought to you by the AAEM Resident & Student Association (AAEM/RSA)April 14, 2016
While the current recommendation for bronchiolitis is ultimately “do nothing”, we often try albuterol or racepi nebs; children with RSV may benefit more from albuterol and steroids according to new evidence of having asthma-like qualities.
Mansbach JM, Clark S, Teach SJ, et al. Children Hospitalized with Rhinovirus Bronchiolitis Have Asthma-Like Characteristics. J Pediatr. 2016; epub. PMID: 26875009
April 13, 2016
In 441 STEMI patients, supplemental oxygen use in patients without hypoxia appeared to be associated with larger infarct size.
Stub D, Smith K, Bernard S, et al. Air Versus Oxygen in ST-Segment Elevation Myocardial Infarction. Circulation. 2015;131(24):2143–2150. PMID 26740484
April 12, 2016
While IV acetaminophen may have been an attractive intervention for pain management, according to a systematic review there is limited evidence supporting it's use in an ED setting.
Sin B, Wai M, Tatunchak T, Motov SM. The use of intravenous acetaminophen for acute pain in the emergency department. Acad Emerg Med. 2016. PMID 26824905
April 11, 2016
First pass intubations have higher success when supplementing with apneic oxygenation; increases patient safety and decreases hypoxemia and need for multiple attempts.
Sakles JC, Mosier J, Patanwala AE, Arcaris B, Dicken J. First Pass Success without Hypoxemia is Increased with the Use of Apneic Oxygenation During RSI in the Emergency Department. Acad Emerg Med. 2016. PMID 26836712
April 10, 2016
In patients at high risk for Gonorrhea or Chlamydia, presumptive treatment with Rocephin 250mg IM and Azithromycin 1 gm each once, is appropriate.
Liang S, Reno H. Update on Emerging Infections: News from the Centers for Disease Control and Prevention. Ann Emerg Med. 2015:66(5):526-528
April 09, 2016
Approximately 20-30% of children who die from child abuse had been seen previously for abusive injuries.
Tiyyagura G, Gawel M, Koziel JR, Asnes A, Bechtel K. Barriers and Facilitators to Detecting Child Abuse and Neglect in General Emergency Departments. Ann Emerg Med. 2015;66(5):447-54.
April 08, 2016
The guideline threshold for intubating patients in myasthenic crises follows the 20/30/40 rule: <20 mL/kg vital capacity, <-30 cmH2O negative inspiratory force, <40 cm H2O peak expiratory cm H2O.
Chaudhuri A, Behan PO. Myasthenic crisis. QJM. 2009;102(2):97-107.
April 07, 2016
In patients with GI bleeds, most studies have shown no difference between bolus then continuous PPI infusion versus intermittent PPI administration (IV or PO) for the prevention of recurrent bleeds.
Sachar H, Vaidya K, Laine L. Intermittent vs continuous proton pump inhibitor therapy for high-risk bleeding ulcers: a systematic review and meta-analysis. JAMA Intern Med. 2014;174(11):1755-62. http://archinte.jamanetwork.com/article.aspx?articleid=1901116
April 06, 2016
Steroids can be indicated in refractory pericarditis though have also been shown to lead to greater risk of recurrence.
Soler-soler J, Sagristà-sauleda J, Permanyer-miralda G. Relapsing pericarditis. Heart. 2004;90(11):1364-8. http://heart.bmj.com/content/90/11/1364.long
April 05, 2016
Patients with a history of invasive thoracic procedures could have a pleuro-pleural communication and thus be at risk of developing bilateral pneumothoraces.
Grathwohl KW, Derdak S. Images in clinical medicine. Buffalo chest. N Engl J Med. 2003 Nov 6;349(19):1829. http://www.nejm.org/doi/full/10.1056/NEJMicm010281
April 04, 2016
CT assessed right sided ventricular dysfunction predicts mortality in hemodynamically stable PE
Wester JR, Friedman BW. Can CT-assessed right-sided ventricular dysfunctioin predict mortality in hemodynamically stable PE? 2015. 66 (5); 546-548. doi:10.1016/j.annemergmed.2015.04.023.
April 03, 2016
Varicose vein bleeding of the lower extremities is an unusual but pressing indication for treatment, and can be lethal. Control hemorrhage with elevation of the limb, direct pressure to the bleeding site, and possible figure 8 stitch. Refer to vascular once bleeding is controlled for possible sclerotherapy or vein ligation/excision
Alguire, P. Scovell,S. Overview and Management of Lower Extremity Chronic Venous Disease. Uptodate. Last updated: Mar 19, 2015.
April 02, 2016
Calcium is no longer recommended for treatment of black widow bites. First line therapy is benzodiazepines and opiates followed by antivenin for those not responding to initial therapy, or those who are high risk: age greater than 60 years, pediatric patients with grade 2-3 reaction, hypertension, or coronary artery disease. Tetanus prophylaxis should also be administered.
Clark R, Wethern-Kestner S, Vance M, Gerkin R. Clinical Presentation and Treatment of Black Widow Envenomation: A Review of 163 cases. Annals of Emergency Medicine, 1992: 21(7):782-787.
April 01, 2016
Children 1-6 years old who received J-Tip instead of vapocoolant spray had decreased venipuncture pain.
Lunoe MM, Drendel AL, Levas MN, et al. A randomized clinical trial of jet-injected lidocaine to reduce venipuncture pain for young children. 2015. 66 (5); 466-474. doi:10.1016/j.annemergmed.2015.04.003
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