Miller, JB. Cerebrovascular risks with rapid blood pressure lowering in the absence of hypertensive emergency. Am J Emerg Med. 2018 Aug 21. pii: S0735-6757(18)30690-9. doi: 10.1016/j.ajem.2018.08.052. There are not many studies of affects of blood pressure lowering on ED patients in the absence of end organ disease. This one is an interesting one and should …
Quick Hit Article
Quick Hit Article #9: Thiamine for severe sepsis? Yes, No and Maybe?
Today’s quick hit article is probably the first in a long list of articles to come looking at Thiamine, vitamin C, or steroids for septic shock. Woolum. Effect of Thiamine Administration on Lactate Clearance and Mortality in Patients With Septic Shock. Critical Care Medicine 2018. Bottom Line: When compared in a chart review, patients with …
Quick Hit Article #8: Say No To Flouro(Quinolone) in Pyelo
Quick Hit Article: Pyelonephritis treatment in the community emergency department: Cephalosporins vs. first-line agents. Vogler Am J Emerg Med. 2018 Aug 8. pii: S0735-6757(18)30652-1 The Bottom Line: In this retropsective chart review with moderate (not optimal) methods, patients placed on cephalosporins had significantly less treatment failure (0% vs 23%, p< 0.001) than when placed on either …
(Really) Quick Hit Article #7 – LR does not clinically increase serum lactate. If you believe in lactate…come along with me…
Source: J Emerg Med. 2018 Jul 20. pii: S0736-4679(18)30602-4 Today’s (really) quick hit is a neat little article trying to answer the question “Does Lactated Ringers increase your serum lactic acid. Given that sepsis seems to be the only diagnosis of anymore, can our friend lactic acid still help us if we are giving 30 ml/kg …
Quick Hit Article #6: How much insulin to give ESRD patients with Hyper K?
One of the most physiologically complicated yet overly simplified “set it and forget it” protocols in emergency medicine just might be the acute treatment of hyperkalemia. We all have the protocol in our head and can write it up in our sleep (hopefully) but how effective is it? How safe is it? How evidenced based …
Quick Hit Article #5: Epi in cardiac arrest – Saving the heart! Saving the brain?
The long awaited (you were all waiting for it right?) PARAMEDIC2 trial for epinephrine in “out of hospital cardiac arrest” (OHCA) is finally here from the UK. We all know and love epi. We give it every 2-5 minutes in codes but why are we doing it? How well does it help us in return …
Quick Hit Article #4: Aspirin NOT tPA for mild strokes – Big Pharma at it again…
Reference: Khatri P, Kleindorfer DO, Devlin T, et al. Effect of Alteplase vs Aspirin on Functional Outcome for Patients With Acute Ischemic Stroke and Minor Nondisabling Neurologic DeficitsThe PRISMS Randomized Clinical Trial. JAMA. 2018;320(2):156–166. doi:10.1001/jama.2018.8496 I love me some stroke! However, nothing gets me as riled up as much as a good ole tPA for stroke study …
QUICK HIT #3: THE ED TEMPERATURE VITAL SIGN – Its HOT! But How Hot????
Yes, summer in Arizona is hot but we aren’t talking weather – hot. We are talking fever – hot, as in, is our ED temperature measurements correct? The scientist part of me wants accuracy, the caring part of me wants not to put things in peoples bum! So, is there a happy medium when it …
QUICK HIT ARTICLE #2: Hi Flo!
The Article: Doshi. P. High-Velocity Nasal Insufflation in the Treatment of Respiratory Failure: A Randomized Clinical Trial. Ann Emerg Med. 2018;72:73-83. To be or not to be, chocolate or vanilla, Bipap or High Flow… That is the question. In respiratory failure which modality is best for the distressed patient to prevent intubation. I’ve always …
QUICK HIT ARTICLE #1 : Should you be “PRO” PROcalcitonin? PRObably not.
Source: Huang DT et al. Procalcitonin-Guided Use of Antibiotics for Lower Respiratory Tract Infection. N Engl J Med. 2018 May 20. Sepsis (well more correctly severe sepsis/shock) is as dangerous as fake news but so is ordering cr(a)p that wont help you in the management of your patients. The current darling of the useless …