Critical Care & Emergencies (all articles) | Links Medicus Content Curation & Alerts in Medicine

RCT supports the use of therapeutic heparin in moderately ill patients admitted to the hospital with Covid-19.

17 Oct, 2021 | 21:35h | UTC

Effectiveness of therapeutic heparin versus prophylactic heparin on death, mechanical ventilation, or intensive care unit admission in moderately ill patients with covid-19 admitted to hospital: RAPID randomised clinical trial – The BMJ

Commentary: High-dose of readily available blood thinner reduces risk of death for moderately ill COVID-19 patients – St. Michael’s Hospital

Related studies (some conflicting results)

RCT: Therapeutic-dose heparin superior to standard prophylactic or intermediate-dose heparins for thromboprophylaxis in high-risk hospitalized patients with COVID-19.

Another meta-analysis suggests standard-dose prophylactic anticoagulation is the best option for patients hospitalized with Covid-19.

M-A: Safety and efficacy of different prophylactic anticoagulation dosing regimens in critically and non-critically ill patients with COVID-19 – According to this analysis, standard-dose prophylactic anticoagulation should be the standard of care for hospitalized patients with COVID-19 who do not have an indication for therapeutic anticoagulation, irrespective of disease severity.

RCT: In noncritically ill patients hospitalized with Covid-19, therapeutic-dose anticoagulation with heparin increased the probability of survival to hospital discharge compared with usual-care thromboprophylaxis.

RCT: In critically ill patients with Covid-19, therapeutic anticoagulation with heparin did not result in improved outcomes compared to usual-care pharmacologic thromboprophylaxis.

RCT: In patients hospitalized with Covid-19 with elevated D-Dimer, a full-dose anticoagulation strategy based on rivaroxaban (full-dose heparins in unstable patients) + rivaroxaban to day 30 was not better than prophylactic anticoagulation and increased bleeding risk.

Commentary on Twitter

What are the effects of therapeutic heparin compared with prophylactic heparin among moderately ill patients with covid-19 admitted to hospital? #BMJResearch by @sholzberg and colleagues.

Includes a #VisualAbstract summarising the study #BMJInfographic https://t.co/82VisuBKSU pic.twitter.com/b06TdIJvLX

— The BMJ (@bmj_latest) October 15, 2021

Serious injury risk higher for horse riding than for football, motor racing, or skiing – “Chest most common site of injury, but head and neck injuries most lethal”.

17 Oct, 2021 | 21:08h | UTC

News release: Serious injury risk higher for horse riding than for football, motor racing, or skiing – BMJ

Original study: Hearing hoofbeats? Think head and neck trauma: a 10-year NTDB analysis of equestrian-related trauma in the USA – Trauma Surgery & Acute Care Open

Commentary: Horse Riding More Dangerous Than Skiis And Motorcycles, Injury Data Reveal – Science Alert

Review: Management of infectious emergencies for the inpatient dermatologist.

17 Oct, 2021 | 21:06h | UTC

Management of Infectious Emergencies for the Inpatient Dermatologist – Current Dermatology Reports (if this link is paywalled, try this one)

Review: Timing of antibiotic therapy in the ICU.

17 Oct, 2021 | 21:05h | UTC

Timing of antibiotic therapy in the ICU – Critical Care

Intracerebral hemorrhage: diagnosis, emergency management, and prognosis.

15 Oct, 2021 | 02:12h | UTC

Intracerebral Hemorrhage: Diagnosis, Emergency Management, and Prognosis – emDocs

Systematic Review: Ultrasound guidance for arterial (other than femoral) catheterization in adults may improve first attempt and overall success rates compared to palpation.

14 Oct, 2021 | 09:41h | UTC

Ultrasound guidance for arterial (other than femoral) catheterisation in adults – Cochrane Library

M-A: Frequency of Neurologic Manifestations in COVID-19 – up to one-third of patients (89% hospitalized) experienced at least one neurological manifestation.

13 Oct, 2021 | 01:40h | UTC

Frequency of Neurologic Manifestations in COVID-19: A Systematic Review and Meta-analysis – Neurology

Consensus Guidance: Hyperkalemia management in the emergency department.

13 Oct, 2021 | 01:34h | UTC

Hyperkalemia management in the emergency department: An expert panel consensus – Journal of the American College of Emergency Physicians Open

Podcast: Hyperkalemia, Diet, K+ Binders, Exercise

Hyperkalemia: Pathophysiology, Risk Factors and Consequence

Hyperkalemia: Pathophysiology, Risk Factors and Consequence (several articles)

RCT: No benefit from antithrombotic therapy (aspirin or apixaban) in outpatients with clinically stable symptomatic COVID-19.

12 Oct, 2021 | 00:28h | UTC

Effect of Antithrombotic Therapy on Clinical Outcomes in Outpatients With Clinically Stable Symptomatic COVID-19: The ACTIV-4B Randomized Clinical Trial – JAMA

Editorial: Antithrombotic Therapy for Outpatients With COVID-19: Implications for Clinical Practice and Future Research – JAMA

Commentary on Twitter

Data do not support the use of aspirin or apixaban in the outpatient setting to reduce the major adverse cardiovascular or pulmonary consequences associated with symptomatic but clinically stable #SARSCoV2 infection https://t.co/SH6OefXOCj #COVID19

— JAMA (@JAMA_current) October 11, 2021

D-Dimer testing for the exclusion of pulmonary embolism has limited clinical utility among hospitalized patients with COVID-19 – most patients with or without pulmonary embolism have increased levels.

12 Oct, 2021 | 00:26h | UTC

D-Dimer Testing for the Exclusion of Pulmonary Embolism Among Hospitalized Patients With COVID-19 – JAMA Network Open

Commentary: D-Dimer Level Not Useful for Ruling Out PE in COVID-19 Patients – HealthDay

How antiviral pill Molnupiravir shot ahead in the COVID drug hunt.

12 Oct, 2021 | 00:18h | UTC

How antiviral pill molnupiravir shot ahead in the COVID drug hunt – Nature

What we know — and don’t know — about Merck’s new Covid-19 pill.

[Press release – not published yet] Merck announces oral antiviral Molnupiravir reduced the risk of hospitalization or death by approximately 50 Percent compared to placebo for patients with mild or moderate COVID-19.

Merck’s Covid-19 pill is great news but may not be a game-changer.

Video | A Pill For COVID? A Doctor Explains Molnupiravir.

RCT: In patients with acute ischemic stroke and large vessel occlusion, thrombectomy with combined contact aspiration and stent retriever was not better than stent retriever alone.

12 Oct, 2021 | 00:04h | UTC

Effect of Thrombectomy With Combined Contact Aspiration and Stent Retriever vs Stent Retriever Alone on Revascularization in Patients With Acute Ischemic Stroke and Large Vessel Occlusion: The ASTER2 Randomized Clinical Trial – JAMA (link to abstract – $ for full-text)

Commentaries:

Little Benefit From Adding Aspiration to Thrombectomy for Stroke – Medscape (free registration required)

Combo Thrombectomy Approach No Better for Large Vessel Strokes – MedPage Today (free registration required)

Commentary on Twitter

Clinical trial found the rate of near-total or total reperfusion at the end of the endovascular procedure was not significantly different for patients receiving thrombectomy with contact aspiration and stent retriever combined vs stent retriever alone https://t.co/SQTEnysFBG

— JAMA (@JAMA_current) September 28, 2021

Cluster RCT: An antimicrobial stewardship intervention safely reduced the use of broad-spectrum antibiotics among patients hospitalized with moderately severe community-acquired pneumonia.

11 Oct, 2021 | 23:55h | UTC

Narrow-spectrum antibiotics for community-acquired pneumonia in Dutch adults (CAP-PACT): a cross-sectional, stepped-wedge, cluster-randomised, non-inferiority, antimicrobial stewardship intervention trial – The Lancet Infectious Diseases (link to abstract – $ for full-text)

RCT: Therapeutic-dose heparin superior to standard prophylactic or intermediate-dose heparins for thromboprophylaxis in high-risk hospitalized patients with COVID-19.

10 Oct, 2021 | 21:53h | UTC

Efficacy and Safety of Therapeutic-Dose Heparin vs Standard Prophylactic or Intermediate-Dose Heparins for Thromboprophylaxis in High-risk Hospitalized Patients With COVID-19: The HEP-COVID Randomized Clinical Trial – JAMA Internal Medicine

Invited commentary: Anticoagulant Therapy in Patients Hospitalized With COVID-19 – JAMA Internal Medicine

Related studies (some conflicting results)

Another meta-analysis suggests standard-dose prophylactic anticoagulation is the best option for patients hospitalized with Covid-19.

RCT: In critically ill patients with Covid-19, therapeutic anticoagulation with heparin did not result in improved outcomes compared to usual-care pharmacologic thromboprophylaxis.

Commentary on Twitter

Thromboprophylaxis w therapeutic-dose LMWH reduced major thromboembolism and death by 32% compared with institutional standard heparin without increased major bleeding among #COVID19 inpatients with elevated D-dimers. The effect wasn't seen in ICU patients https://t.co/Wrgj2Ho5lv

— JAMA Internal Medicine (@JAMAInternalMed) October 7, 2021

WHO Guidance: Antigen-detection in the diagnosis of SARS-CoV-2 infection.

8 Oct, 2021 | 10:47h | UTC

Antigen-detection in the diagnosis of SARS-CoV-2 infection – World Health Organization

Related infographics:

Use of antigen detection rapid diagnostic testing – World Health Organization

Diagnostic testing for SARS-CoV-2 infection – World Health Organization

Commentary on Twitter (thread – click for more)

Testing remains a critical component to the strategy to end the #COVID19 pandemic, and testing needs to be reliable, accessible, affordable, fast and linked to public health action.

So many around 🌍 have worked hard to increase testing capacities @WHO https://t.co/VDPdU0VK4g

— Maria Van Kerkhove (@mvankerkhove) October 7, 2021

Study shows an increased risk of Guillain-Barré Syndrome with the J&J vaccine; the estimated observed to expected rate ratio was 4.18 for the 42-day window.

8 Oct, 2021 | 10:40h | UTC

Association of Receipt of the Ad26.COV2.S COVID-19 Vaccine With Presumptive Guillain-Barré Syndrome, February-July 2021 – JAMA

Commentary on Twitter

Study suggests a potential small but statistically significant safety concern for #GuillainBarré syndrome following receipt of the @JanssenUS #COVID19 vaccine; findings considered preliminary pending analysis of medical records to establish a definitive Dx https://t.co/yZjJVkp6BA

— JAMA (@JAMA_current) October 7, 2021

RCT: Immediate drainage did not improve outcomes compared to postponed intervention in patients with infected necrotizing pancreatitis.

7 Oct, 2021 | 10:35h | UTC

Immediate versus Postponed Intervention for Infected Necrotizing Pancreatitis – New England Journal of Medicine

What we know — and don’t know — about Merck’s new Covid-19 pill.

6 Oct, 2021 | 10:07h | UTC

What we know — and don’t know — about Merck’s new Covid-19 pill – STAT

Merck’s Covid-19 pill is great news but may not be a game-changer.

Video | A Pill For COVID? A Doctor Explains Molnupiravir.

SILENCE Randomized Trial: In patients at the end of life, prophylactic subcutaneous scopolamine butylbromide reduces the occurrence of the death rattle (noisy breathing caused by mucus in the upper respiratory tract).

6 Oct, 2021 | 09:54h | UTC

Effect of Prophylactic Subcutaneous Scopolamine Butylbromide on Death Rattle in Patients at the End of LifeThe SILENCE Randomized Clinical Trial – JAMA (free for a limited period)

Editorial: Preventing Death Rattle With Prophylactic Subcutaneous Scopolamine Butylbromide – JAMA (free for a limited period)

Author interview: Scopolamine Butylbromide for Preventing End-of-Life Death Rattle – JAMA

Commentary on Twitter

In a randomized clinical trial among patients near the end of life, prophylactic subcutaneous scopolamine butylbromide significantly reduced the occurrence of death rattle https://t.co/e6BDI5yirY pic.twitter.com/hHfhC2iYHh

— JAMA (@JAMA_current) October 5, 2021

RCT: An active strategy for diagnosing pulmonary embolism did not improve outcomes in patients hospitalized for COPD exacerbation.

6 Oct, 2021 | 09:52h | UTC

Effect of a Pulmonary Embolism Diagnostic Strategy on Clinical Outcomes in Patients Hospitalized for COPD Exacerbation: A Randomized Clinical Trial – JAMA (free for a limited period)

Commentary on Twitter

Among patients hospitalized for an exacerbation of #COPD, addition of an active diagnostic strategy for pulmonary embolism to usual care compared with usual care alone did not improve a composite set of health outcomes https://t.co/7mOi5lOBD8

— JAMA (@JAMA_current) October 5, 2021