Emergency Medicine
RCT | Videolaryngoscopy improves first-pass tracheal intubation success compared with direct laryngoscopy
21 Mar, 2023 | 13:21h | UTC
Review | Surviving sepsis campaign
20 Mar, 2023 | 13:17h | UTCSurviving Sepsis Campaign – Critical Care Medicine
Review | Neurogenic shock: definition, identification, and management in the ED
20 Mar, 2023 | 13:09h | UTCNeurogenic Shock: Definition, Identification, and Management in the ED – emDocs
Cohort Study | COVID-19 outpatients mostly at low risk for VTE, but age, being male, and obesity are risk factors
17 Mar, 2023 | 13:11h | UTCSummary: The article discusses a cohort study that aimed to assess the risk of venous thromboembolism (VTE) among outpatients with COVID-19 and identify independent predictors of VTE.
The study used data from two integrated healthcare delivery systems in California and included 398.530 nonhospitalized adults aged 18 years or older with COVID-19 diagnosed between January 1, 2020, and January 31, 2021, with follow-up through February 28, 2021.
The results showed that the overall risk of VTE among outpatients with COVID-19 is low, but higher in the first 30 days after diagnosis. Factors associated with a higher risk of VTE in COVID-19 outpatients included:
- Age 55 years or older.
- Being male.
- history of VTE or thrombophilia.
- Body mass index greater than or equal to 30.0.
The study’s results could inform future randomized trials to explore targeted VTE preventive strategies and more intensive short-term surveillance for patients with COVID-19 who are at a higher risk of developing VTE.
Commentary: Venous blood clots rare among COVID-19 outpatients, study finds – CIDRAP
Commentary on Twitter
The rate of VTE was low in outpatients with #COVID19 in the first 30 days, and even lower >30 days. Factors associated with a higher risk of VTE in included age ≥55, male, prior VTE/thrombophilia, and BMI ≥30. https://t.co/3hwfDW88k4
— JAMA Network Open (@JAMANetworkOpen) March 13, 2023
Guidelines for the management of patients with substance intoxication presenting to the ED
17 Mar, 2023 | 13:09h | UTC
RCT | Pre-hospital rule-out of NSTE-ACS by ambulance paramedics with point-of-care troponin is feasible and cost-saving
16 Mar, 2023 | 13:27h | UTCSummary: Using a point-of-care (POC) troponin measurement, this randomized trial in the Netherlands assessed the safety and healthcare costs of a pre-hospital rule-out strategy for patients with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS).
The study included only patients considered at low risk with a HEAR (History, ECG, Age, Risk factors) score ≤3. A total of 863 low-risk participants were randomized to direct transfer to the ED or a pre-hospital rule-out strategy with POC troponin measurement.
The trial found that pre-hospital rule-out of NSTE-ACS in low-risk patients using a single POC troponin measurement is feasible, significantly reduces healthcare costs, and is associated with a low incidence of major adverse cardiac events.
The HEAR score, combined with a POC troponin measurement by ambulance paramedics, accurately identifies low-risk patients for whom ED evaluation is unnecessary. Implementing this pre-hospital rule-out strategy in low-risk patients could significantly reduce healthcare costs through more efficient use of ambulance services and fewer ED visits. It is worth noting, however, that further studies in other localities are necessary before the widespread use of this strategy can be implemented.
Commentaries:
JC: Can we rule out ACS by a single prehospital troponin measurement? – St. Emyln’s
Rule-Out of NSTE-ACS by a Prehospital Troponin Measurement – American College of Cardiology
Review | Improving vasopressor use in cardiac arrest
16 Mar, 2023 | 13:08h | UTCImproving vasopressor use in cardiac arrest – Critical Care
Out-of-hospital cardiac arrest – review of recent practice-informing trials
15 Mar, 2023 | 15:09h | UTCOut-of-hospital cardiac arrest – Intensive Care Medicine (if the link is paywalled, try this one)
Commentary on Twitter
#OHCA? 6 trials with potential to influence guidelines/practice:
? COCA: Calcium for #OHCA
⚡️ DOSE VF: double sequential external defib
? INCEPTION: early #ECLS
? EXACT: ⬇️ O2
❄️ TTM2: targeted hypo vs normothermia
? BOX: BP & O2 targets post #resus
?️ https://t.co/xtGmuYtXKF pic.twitter.com/3BOlfl5hRd— Intensive Care Medicine (@yourICM) March 13, 2023
Review | Approach to the patient with adrenal hemorrhage
15 Mar, 2023 | 15:03h | UTCApproach to the Patient With Adrenal Hemorrhage – The Journal of Clinical Endocrinology & Metabolism
Review | Prehospital stroke management and mobile stroke units
15 Mar, 2023 | 14:54h | UTCPrehospital stroke management and mobile stroke units – Current Opinion in Neurology
M-A | Pretest probability assessment and D-Dimer are preferred for the initial evaluation of suspected PE in pregnant women
15 Mar, 2023 | 14:50h | UTC
AHA Scientific Statement | Atrial fibrillation occurring during acute hospitalization
14 Mar, 2023 | 14:04h | UTC
Mortality rates and clinical manifestations of severe hypothyroidism in the ICU: a French multicenter cohort study
14 Mar, 2023 | 13:44h | UTCSummary: This article presents the findings of a retrospective multicenter cohort study conducted over 18 years in 32 French ICUs to investigate severe hypothyroidism (SH) requiring ICU admission.
The study included 82 patients with SH, with thyroiditis and thyroidectomy being the primary causes, and levothyroxine discontinuation, sepsis, and amiodarone-related hypothyroidism being the most frequent triggers.
Patients with SH presented with various clinical symptoms, including hypothermia, hemodynamic failure, and coma, with in-ICU and 6-month mortality rates being 26% and 39%, respectively. The study also found that patients with hemodynamic and respiratory failure on admission to the ICU had a higher likelihood of mortality.
Levothyroxine replacement was provided to all patients, but the administration route and loading dose varied. The authors recommend early diagnosis, prompt levothyroxine administration, and close monitoring of cardiac and hemodynamic parameters for SH patients admitted to the ICU.
Ultrasound-guided nerve blocks | Suggested procedural guidelines for emergency physicians
14 Mar, 2023 | 13:41h | UTC
Podcast and Brief Review | TIA/Stroke pearls for the hospitalist
14 Mar, 2023 | 13:36h | UTC#385 TIA/Stroke for the Hospitalist featuring Dr. Karima Benameur – The Curbsiders
Review | Guideline-based management of acute respiratory failure and acute respiratory distress syndrome
14 Mar, 2023 | 13:17h | UTC
RCT | Immediate complete revascularization non-inferior to staged approach in ACS patients with multivessel disease
13 Mar, 2023 | 15:10h | UTCSummary: Patients with an acute coronary syndrome and multivessel disease not presenting with cardiogenic shock usually benefit from complete revascularization by percutaneous coronary intervention (PCI). Complete revascularization involves treating all significant blockages in the coronary arteries, including those not causing symptoms (non-culprit lesions).
The BIOVASC randomized non-inferiority trial investigated whether patients with acute coronary syndrome and multivessel coronary disease should undergo immediate complete revascularization during the index procedure or undergo a staged approach with PCI of the culprit lesion only during the index procedure followed by another procedure within 6 weeks of all non-culprit lesions deemed to be clinically significant. The exclusion criteria were:
- Previous coronary artery bypass surgery.
- Cardiogenic shock.
- Single-vessel coronary disease.
- The presence of a chronic coronary total occlusion.
A total of 1525 patients with acute coronary syndrome and multivessel coronary disease were randomly assigned to either an immediate complete revascularization group (764 patients) or a staged complete revascularization group (761 patients). The primary outcome was a composite of all-cause mortality, myocardial infarction, unplanned ischemia-driven revascularization, or cerebrovascular events at 1 year after the index procedure. The study found that immediate complete revascularization was non-inferior to staged complete revascularization for the primary outcome.
Article: Immediate versus staged complete revascularisation in patients presenting with acute coronary syndrome and multivessel coronary disease (BIOVASC): a prospective, open-label, non-inferiority, randomised trial – The Lancet (free registration required)
Commentaries:
Revascularisation in acute coronary syndromes: change in practice? – The Lancet (free registration required)
No Downside to Immediate Complete Revascularization in ACS: BIOVASC – TCTMD
Immediate Complete Revascularization Non-Inferior to Staged Procedure in BIOVASC Trial – HCP Live
Related:
One-Year Outcomes after PCI Strategies in Cardiogenic Shock – New England Journal of Medicine
Review | Commonly missed findings on chest radiographs: causes and consequences
13 Mar, 2023 | 15:07h | UTCCommonly Missed Findings on Chest Radiographs: Causes and Consequences – CHEST (free for a limited period)
See also: Reducing Errors Resulting From Commonly Missed Chest Radiography Findings – CHEST (free for a limited period)
Review | Reducing errors resulting from commonly missed chest radiography findings
13 Mar, 2023 | 15:06h | UTCReducing Errors Resulting From Commonly Missed Chest Radiography Findings – CHEST (free for a limited period)
See also: Commonly Missed Findings on Chest Radiographs: Causes and Consequences – CHEST (free for a limited period)
M-A | Routine anaerobic coverage for aspiration pneumonia: limited evidence of benefit
13 Mar, 2023 | 15:03h | UTCSummary: Treating aspiration pneumonia with antibiotics that cover anaerobic bacteria has become common practice in many services, but recent studies suggest that this may not necessarily improve prognosis.
Out of 2523 publications, this systematic review and meta-analysis only included one randomized control trial and two observational studies. The study found no clear benefit of anaerobic coverage and concluded that there is not enough data to evaluate the necessity of anaerobic coverage in the antibiotic treatment of aspiration pneumonia.
The authors suggest that covering anaerobic bacteria with antibiotics may not be needed as an initial treatment for aspiration pneumonia if there is no formation of abscess or empyema and the patient has good oral hygiene.
Related: BTS clinical statement on aspiration pneumonia – Thorax
Brief Review | How we escalate vasopressor and corticosteroid therapy in patients with septic shock
13 Mar, 2023 | 15:04h | UTCHow We Escalate Vasopressor and Corticosteroid Therapy in Patients With Septic Shock – CHEST (free for a limited period)
ISCCM Guidelines for the use of procalcitonin for rational use of antibiotics
13 Mar, 2023 | 14:57h | UTC
ESC 0/1-hour algorithm unable to safely exclude 30-day cardiac death or MI in patients with known coronary artery disease, study finds
8 Mar, 2023 | 14:12h | UTCSummary:
The study aimed to determine if the European Society of Cardiology (ESC) 0/1-hour algorithm using high-sensitivity cardiac troponin T (hs-cTnT) could achieve a negative predictive value of 99% or higher for 30-day cardiac death or myocardial infarction (MI) among emergency department patients with chest pain and known coronary artery disease (CAD).
The study included 1430 adults, and the algorithm had a negative predictive value of 96.6% for 30-day cardiac death or MI among patients with known CAD, suggesting that the algorithm may not be able to safely exclude 30-day cardiac death or MI in these patients.
These findings suggest that clinicians should be cautious when using the ESC 0/1-hour hs-cTnT algorithm in patients with known CAD.
Article: Performance of the European Society of Cardiology 0/1-Hour Algorithm With High-Sensitivity Cardiac Troponin T Among Patients With Known Coronary Artery Disease – JAMA Cardiology (link to abstract – $ for full-text)
Related:
Performance of the European Society of Cardiology 0/1-Hour, 0/2-Hour, and 0/3-Hour Algorithms for Rapid Triage of Acute Myocardial Infarction: An International Collaborative Meta-analysis – Annals of Internal Medicine (link to abstract – $ for full-text)
Commentary on Twitter
In this diagnostic study of 1430 adults, the high-sensitivity troponin T (hs-cTnT) ESC 0/1-hour algorithm had a negative predictive value of 96.6% for 30-day cardiac death or MI among patients with known coronary artery disease. https://t.co/FnILIazEnU
— JAMA Cardiology (@JAMACardio) March 1, 2023
M-A | Real-time ultrasound guidance as compared to landmark technique for subclavian central venous cannulation
8 Mar, 2023 | 14:04h | UTCReal-Time Ultrasound Guidance as Compared to Landmark Technique for Subclavian Central Venous Cannulation: A Systematic Review and Meta-Analysis With Trial Sequential Analysis – Critical Care Medicine (link to abstract – $ for full-text)
Review | Acquired disorders of hypomagnesemia
7 Mar, 2023 | 13:09h | UTCAcquired Disorders of Hypomagnesemia – Mayo Clinic Proceedings