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Emergency Medicine

[Press release – not published yet] RCT: Pfizer’s novel Covid-19 oral antiviral treatment candidate reduced risk of hospitalization or death by 89% in interim analysis of phase 2/3 EPIC-HR study.

7 Nov, 2021 | 20:35h | UTC

Pfizer’s novel Covid-19 oral antiviral treatment candidate reduced risk of hospitalization or death by 89% in interim analysis of phase 2/3 EPIC-HR Study

Commentaries:

Expert reaction to press release from Pfizer giving interim analysis of their Phase 2/3 EPIC-HR study of PAXLOVID™ in non-hospitalized high-risk adults with COVID-19 – Science Media Centre

Pfizer’s Good News Is the World’s Good News – Science

Experimental Pfizer pill prevents Covid hospitalizations and deaths – STAT

Pfizer Says New Anti-Viral Drug Combination Cuts Risks Of Serious COVID-19 By 89% – Health Policy Watch

Pfizer reports good results against severe COVID-19 for its antiviral pill – CIDRAP

Covid: Pfizer says antiviral pill 89% effective in high-risk cases – BBC

Pfizer says COVID-19 pill cut hospital, death risk by 90% – Associated Press

Pfizer’s COVID-19 pill treatment reduces risk of being hospitalized or dying by 89%, company says – ABC News

 

Commentary on Twitter (thread – click for more)

 

New study challenges the idea that a coronary artery calcium score of 0 is enough for ruling out coronary stenosis in symptomatic patients, especially in young adults.

7 Nov, 2021 | 20:09h | UTC

Association of Age With the Diagnostic Value of Coronary Artery Calcium Score for Ruling Out Coronary Stenosis in Symptomatic Patients – JAMA Cardiology (link to abstract – $ for full-text)

Commentary: Zero CAC Questionable for Ruling Out Obstructive CAD in Young Adults – TCTMD

 

Commentary from the author on Twitter (thread – click for more)

 

Things We Do for No Reason: Prescribing Tramadol for Inpatients in Pain.

5 Nov, 2021 | 09:44h | UTC

Things We Do for No Reason: Prescribing Tramadol for Inpatients in Pain – Journal of Hospital Medicine

Related:

Large observational study suggests Tramadol is associated with increased risk of adverse outcomes compared to Codeine.

Tramadol: Where do we go from here? – “Tramadol’s unpredictability, unique potential harms, and lack of advantage over other opioids or NSAIDs are now well recognized”.

Cohort Study: Chronic Use of Tramadol After Acute Pain Episode

 

ASH Guideline issued a conditional recommendation against routine use of outpatient anticoagulant prophylaxis in patients with COVID-19 being discharged from the hospital.

4 Nov, 2021 | 10:03h | UTC

American Society of Hematology living guidelines on the use of anticoagulation for thromboprophylaxis in patients with COVID-19: July 2021 update on post-discharge thromboprophylaxis – Blood Advances

 

Short Review: Cardiac injury in Covid-19.

3 Nov, 2021 | 10:04h | UTC

Cardiac injury in COVID-19 – Intensive Care Medicine

 

Commentary on Twitter

 

Review: The role of chest imaging in the diagnosis, management, and monitoring of Covid-19.

3 Nov, 2021 | 10:05h | UTC

The role of chest imaging in the diagnosis, management, and monitoring of coronavirus disease 2019 (COVID-19) – Insights into Imaging

 

RCT: Among children with community-acquired pneumonia discharged within 48 hours from the ED or hospital, lower-dose outpatient oral amoxicillin was noninferior to a higher dose, and a 3-day duration course was noninferior to 7 days.

3 Nov, 2021 | 09:56h | UTC

Effect of Amoxicillin Dose and Treatment Duration on the Need for Antibiotic Re-treatment in Children With Community-Acquired Pneumonia: The CAP-IT Randomized Clinical Trial – JAMA (free for a limited period)

Related:

RCT: 5 days of high-dose amoxicillin therapy noninferior to 10 days for the treatment of pediatric community-acquired pneumonia

Randomized Trial: Amoxicillin for 3 Days Noninferior to Amoxicillin for 5 Days for Chest-Indrawing Pneumonia in Children

ACP Guidance: Appropriate Use of Short-Course Antibiotics in Common Infections

RCT: 7 days of antibiotic therapy as good as 14 days for afebrile men with urinary tract infection.

RCT: A Seven-days course of antibiotics for the treatment of bloodstream infections by Enterobacterales was noninferior to a 14-days course.

RCT: Among patients with prosthetic joint infection, antibiotic therapy for 6 weeks was NOT shown to be noninferior to antibiotic therapy for 12 weeks and resulted in a higher percentage of patients with unfavorable outcomes.

Randomized Trial: Seven vs. Fourteen Days of Antibiotic Therapy for Uncomplicated Gram-negative Bacteremia

 

Commentary on Twitter

 

A comprehensive review of vascular complications in COVID-19.

2 Nov, 2021 | 03:01h | UTC

A comprehensive review of vascular complications in COVID-19 – Journal of Thrombosis and Thrombolysis

 

Short Review: Ketamine for the treatment of acute pain.

2 Nov, 2021 | 02:43h | UTC

Ketamine for the treatment of acute pain – Canadian Medical Association Journal

 

Commentary on Twitter

 

Cohort Study: Among patients with ST-segment elevation myocardial infarction, a concomitant Covid-19 diagnosis is associated with increased in-hospital mortality.

31 Oct, 2021 | 20:10h | UTC

Association Between COVID-19 Diagnosis and In-Hospital Mortality in Patients Hospitalized With ST-Segment Elevation Myocardial Infarction – JAMA

Editorial: Myocardial Infarction During the COVID-19 Pandemic – JAMA

Commentary: STEMI and COVID-19 Often a Lethal Combo, Affirms Largest Study Yet – TCTMD

 

Commentary from the author on Twitter (thread – click for more)

 

Review: How I manage a patient with MRSA bacteremia.

31 Oct, 2021 | 19:54h | UTC

How I manage a patient with MRSA bacteraemia – Clinical Microbiology and Infection

 

2021 AHA/ACC Guideline for the Evaluation and Diagnosis of Chest Pain.

29 Oct, 2021 | 09:57h | UTC

2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines – Journal of the American College of Cardiology

Executive Summary: 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain – Journal of the American College of Cardiology

News Release: First-Ever Guideline Focused Solely on Chest Pain Evaluation, Diagnosis Released

Guideline Hub: Guideline for the Evaluation and Diagnosis of Chest Pain

Key Points: 2021 AHA/ACC Chest Pain Guideline – American College of Cardiology

Commentary: New Chest Pain Guidelines Out at Last: Most Tests Have a Role – TCTMD

 

Commentary on Twitter (thread – click for more)

 

Brain injury after cardiac arrest: pathophysiology, treatment, and prognosis.

29 Oct, 2021 | 09:49h | UTC

Brain injury after cardiac arrest: pathophysiology, treatment, and prognosis – Intensive Care Medicine

 

Commentary on Twitter

 

RCT: Early treatment of Covid-19 with SARS-CoV-2 neutralizing antibody Sotrovimab is associated with reduced risk of hospitalization.

28 Oct, 2021 | 10:20h | UTC

Early Treatment for Covid-19 with SARS-CoV-2 Neutralizing Antibody Sotrovimab – New England Journal of Medicine

 

Commentary on Twitter

 

RCT: Early treatment with fluvoxamine reduced the risk of emergency care and hospitalization among patients with COVID-19.

28 Oct, 2021 | 10:22h | UTC

Effect of early treatment with fluvoxamine on risk of emergency care and hospitalisation among patients with COVID-19: the TOGETHER randomised, platform clinical trial – The Lancet Global Health

Commentaries:

Expert reaction to study looking at fluvoxamine as a COVID-19 treatment in high-risk outpatients with early-diagnosed COVID-19 – Science Media Centre

The TOGETHER Trial: COVID-19 and Fluvoxamine Take Two – REBEL EM

The antidepressant fluvoxamine can keep COVID-19 patients out of the hospital – ScienceNews

Related:

[Preprint] RCT: Fluvoxamine reduced the risk for ER visits and hospitalization among patients with Covid-19.

Opinion | Could this be our first effective, inexpensive, widely available outpatient treatment for COVID-19? (It’s fluvoxamine).

Preliminary study shows fluvoxamine may reduce clinical deterioration in outpatients with symptomatic COVID-19

 

Commentary on Twitter

 

Anticoagulants and diabetes agents are among the most frequent causes of emergency department visits attributed to medication harms.

27 Oct, 2021 | 01:15h | UTC

US Emergency Department Visits Attributed to Medication Harms, 2017-2019 – JAMA (link to abstract – $ for full-text)

Commentaries:

Number of emergency room visits for medication harms increases with age – MedicalResearch.com

Blood thinners, diabetes meds among top causes of drug-related ER visits – UPI

 

Systematic Review: Antibiotics for the treatment of COVID‐19 – “We are certain that risk of death in hospitalized COVID‐19 patients is not reduced by treatment with azithromycin after 28 days”.

26 Oct, 2021 | 02:07h | UTC

Antibiotics for the treatment of COVID‐19 – Cochrane Library

 

Commentary on Twitter

 

Cohort Study: Bacterial Superinfection Pneumonia in Patients Mechanically Ventilated for COVID-19 Pneumonia – “Bacterial superinfection within 48 hours of intubation was detected in 21 percent of patients”.

26 Oct, 2021 | 01:59h | UTC

Bacterial Superinfection Pneumonia in Patients Mechanically Ventilated for COVID-19 Pneumonia – American Journal of Respiratory and Critical Care Medicine

Commentary: Potential Overuse of Antibiotics Found in Patients with Severe COVID-19 Pneumonia – American Thoracic Society

 

Commentary on Twitter

 

Opinion | COVID STEROID-2: Double the steroid, double the fun? – “Dexamethasone 6 mg/day alone is likely suboptimal for most patients with severe COVID pneumonia. Dexamethasone 12 mg/day may provide a reasonable intensity of immunomodulation”.

25 Oct, 2021 | 00:01h | UTC

COVID STEROID-2: Double the steroid, double the fun? – PulmCrit

Original study: RCT: In adults with Covid-19 and severe hypoxemia, 12 mg vs. 6 mg of Dexamethasone did not result in a statistically significant difference in the number of days alive without life support.

 

Commentary on Twitter

 

Review: Cardiac involvement in the long-term implications of COVID-19.

24 Oct, 2021 | 23:59h | UTC

Cardiac involvement in the long-term implications of COVID-19 – Nature Reviews Cardiology

 

2021 Interim Guidance to Health Care Providers for Basic and Advanced Cardiac Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19.

24 Oct, 2021 | 23:49h | UTC

2021 Interim Guidance to Health Care Providers for Basic and Advanced Cardiac Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19 – Circulation: Cardiovascular Quality and Outcomes

Commentary: CPR on a COVID Patient: Not a Moment to Waste Looking for PPE: Updated AHA guidance says resuscitation should not be delayed by mask availability – MedPage Today (free registration required)

 

Commentary on Twitter (thread – click for more)

 

RCT: In comatose survivors of out-of-hospital cardiac arrest, there was no difference in mortality and neurologic outcomes with mild (target temperature of 34 °C) vs. moderate therapeutic hypothermia (target temperature of 31 °C).

24 Oct, 2021 | 23:46h | UTC

Effect of Moderate vs Mild Therapeutic Hypothermia on Mortality and Neurologic Outcomes in Comatose Survivors of Out-of-Hospital Cardiac Arrest: The CAPITAL CHILL Randomized Clinical Trial – JAMA (free for a limited period)

Related:

Cooling After Cardiac Arrest – The Sclerosis of Therapeutic Fashion – “The story of how an ineffective therapy persisted for decades”

RCT: In patients with coma after out-of-hospital cardiac arrest, targeted hypothermia did not improve outcomes.

Study commentary: a history of hypothermia for cardiac arrest, 2002-2021 (RIP).

M-A: Targeted temperature management following out-of-hospital cardiac arrest – “Routine use of moderate or deep hypothermia in comatose survivors of OHCA may potentially be associated with more harm than benefit”.

 

Commentary on Twitter

 

Guideline: Transfusion strategies in bleeding critically ill adults.

24 Oct, 2021 | 23:47h | UTC

Transfusion strategies in bleeding critically ill adults: a clinical practice guideline from the European Society of Intensive Care Medicine – Intensive Care Medicine

 

Commentary on Twitter

 

The cost-effectiveness of cefazolin compared to anti-staphylococcal penicillins for the treatment of methicillin-sensitive Staphylococcus aureus bacteremia.

24 Oct, 2021 | 23:41h | UTC

The cost-effectiveness of cefazolin compared to anti-staphylococcal penicillins for the treatment of methicillin-sensitive Staphylococcus aureus bacteremia – Open Forum of Infectious Diseases

Related:

Meta-Analysis: Cefazolin vs. Anti-staphylococcal Penicillins for the Treatment of Staphylococcus aureus Bacteremia

Meta-Analysis: Cefazolin vs. Antistaphylococcal Penicillins for MSSA Bacteremia

 

Commentaries on Twitter

 

M-A: In patients with Staphylococcus aureus bacteremia, combination therapy does not reduce mortality and is associated with increased risks of adverse events.

24 Oct, 2021 | 23:42h | UTC

The Effect of Combination Therapy on Mortality and Adverse Events in Patients with Staphylococcus aureus Bacteraemia: A Systematic Review and Meta-analysis of Randomized Controlled Trials – Infectious Diseases and Therapy

 

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