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SOBRE EL AUTOR **

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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com

WORLD EMERGENCY MEDICINE SOCIETIES

Scott Weingart. EMCrit RACC Podcast 217 – The Ultimate “Ultimate” BVM. EMCrit Blog. Published on February 5, 2018. Available at [https://emcrit.org/racc/ultimate-bvm/ ]

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martes, 20 de febrero de 2018

C.difficile - New Guidelines

Emergency Medicine PharmD - February 19, 2018
By Mixon T - Peer reviewed by: Cocchio C & Dietrich S
"The Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) convened a group of experts to publish an update to their 2010 C.difficile infection (CDI) guidelines. Below is a summary of the new guidelines from the perspective of an emergency medicine (EM) pharmacist...
Take Home Points
  • IDSA/SHEA have released new CDI guidelines.
  • Emergency medicine pharmacists should play a huge role in antimicrobial stewardship, which is a key component in minimizing the occurrence of CDI.
  • Vancomycin PO or fidaxomicin are now the recommended first line agents for CDI, however, the high cost associated with these therapies may prohibit their use in some patients.
  • Metronidazole should only be considered when vancomycin PO or fidaxomicin are unavailable for adults. It is still a first line option for children.
  • Vancomycin PO therapy may be extended in patients with active CDI, or used prophylactically in patients with previous CDI episodes to prevent recurrent infection while on systemic antibiotics.
  • FIRVANQTM, a new oral liquid vancomycin formation, will soon be available, but cost information is currently unknown."

PROPER to PERC

R.E.B.E.L.EM - February 19, 2018
"Background: The diagnosis of PE is a tricky thing. We want to limit over-testing patients and therefore, over-diagnosis. On the other hand, we don’t want to limit testing so much that we miss the diagnosis where treatment would make a difference. The pulmonary embolism rule-out criteria (PERC) was created to reduce testing in patients who have a low probability of PE (i.e. prevalence of <1.8%) in which further testing would not be necessary. There have been many observational trials published on this score but until now there has not been a prospective randomized clinical trial (The PROPER Trial)...
Author Conclusion: “Among very low-risk patients with suspected PE, randomization to a PERC strategy vs conventional strategy did not result in an inferior rate of thromboembolic events over 3 months. These findings support the safety of PERC for very low-risk patients presenting to the emergency department.”
Clinical Take Home Point: In a “low risk” patient population, use of PERC over usual care, was non-inferior in both diagnosis and mortality associated with PE. An added benefit of using PERC over usual care in this study was a 10% decrease in imaging and 40min decrease in ED LOS."

Circulation first

World Journal of Emergency Surgery logo
Ferrada P et al.  World Journal of Emergency Surgery 2018; 13:8
..."Conclusion
The current study highlights that many trauma centers are already initiating circulation first prior to intubation when treating hypovolemic shock (CAB), even in patients with a low GCS. This practice was not associated with an increased mortality. Further prospective investigation is warranted."

domingo, 18 de febrero de 2018

Ketamine for Analgesia

Approved by the Emergency Nurses Association January 2018
Approved by the Society of Emergency Medicine Physician Assistants December 2017
Approved October 2017
As an adjunct to this policy, ACEP has prepared a Policy Resource Education Paper (PREP) titled, “Sub-dissociative Dose Ketamine for Analgesia.” 
A joint policy statement of the American College of Emergency Physicians, the Emergency Nurses Association, and the Society of Emergency Medicine Physician Assistants

Ruling Out PE

PulmCCM
PulmCCM -  Feb 16, 2018 - By Scott Aberegg
"This post is going to be an in-depth "journal club" style analysis of the PROPER trial.
In this week's JAMA, Freund et al report the results of the PROPER randomized controlled trial of the PERC (pulmonary embolism rule -out criteria) rule for safely excluding pulmonary embolism (PE) in the emergency department (ED) among patients with a "low clinical gestalt" of having PE. All things pulmonary and all things noninferiority being pet topics of mine, I had to delve deeper into this article because frankly the abstract confused me..."

Travel History

St. Emlyn´s - September 22, 2017 - By Janos Baombe
"Why is this important for the EP?
Global international travel has exponentially risen in the past decades and a large proportion of the destinations include tropical and subtropical countries.
The importance of taking a travel history to establish the possibility of an imported infection has been emphasised over half a century ago by Maegraith in his publication “Unde Venis?“1 (where are you coming from? – in Latin)
Most post-travel illnesses can be managed on an out-patient basis with appropriate follow-up. Some patients, especially those with systemic febrile illnesses, or those who are clinically unwell may however need hospital admission. Furthermore, potentially severe, transmissible infections require enhanced infection control measures and may require higher levels of care.
Emergency physicians (and other admitting clinicians!) are unfortunately often omitting to include a full travel history in their medical history taking for a variety of reasons (lack of knowledge, time pressures, volume of patients etc). The absence of a travel history in a patient with potential imported illness can affect not only clinical care but also have some severe public health implications..."

miércoles, 14 de febrero de 2018

Managing Chaos

AM Rounds
AM Round - By: Teresa Chan - February 13, 2018
...The skill of managing the multiplicity of patients in a single ED, however, was a bit of a mystery to me. To be honest, I still recall one day in my final year of residency training when I looked at the ED tracker board and was struck by the realization that I knew all the details and plans for all 16 patients listed..."

Outpatient PE

Emergency Physicians Monthly
Emergency Physicians Monthly - By Long B and Koyfman A - January 22, 2018
"Treatment options, management approach, and bleeding risks for the outpatient handling of pulmonary embolism"

martes, 13 de febrero de 2018

Deep Vein Thrombosis

An online community of practice for Canadian EM physicians
CanadiEM - By Kerstin de Wit - February 13, 2018
"Main Messages
  1. Physicians cannot correctly diagnose or exclude DVT without having measured pretest probability of DVT.
  2. Pretest probability of DVT is accurately and reliably measured using the Wells score for DVT.
  3. D-dimer and ultrasound results should always be reviewed in the context of the patient’s Wells score.
  4. Always record the Wells score and D-dimer in the patient chart for better between-physician communication and for medicolegal reasons.
  5. Know which type of ultrasound is performed by your lab (proximal or complete), and know how to interpret the results."

BiPAP & HFNC

PulmCrit (EMCrit)
PulmCrit - February 12, 2018 - By Josh Farkas 
"Skillful use of BiPAP and high-flow nasal cannula (HFNC) can avoid intubation and improve outcomes. However, there isn't comprehensive evidence about the nitty-gritty details of these techniques. In this post I will use my opinions to fill some gaps in the evidence (1). Noninvasive respiratory support remains more of an art than a science, perhaps a dark art at that...

  • The role of noninvasive respiratory support is generally to reduce the patient's work of breathing, thereby avoiding diaphragmatic exhaustion.
  • The goal of noninvasive respiratory support isn't to immediately normalize the ABG.
  • Serial evaluation by experienced practitioners is generally far more useful than monitoring ABG values.
  • The choice of BiPAP vs. HFNC may be made on the basis of the patient's diagnosis (e.g. pneumonia vs. heart failure), not the ABG values.
  • BiPAP should never be used to “blow off” CO2 in a patient with hypoventilation due to drug intoxication."

Peripheral Vasopressors

R.E.B.E.L.EM - February 12, 2018
"Background: We have discussed the safety of peripheral vasopressors on REBEL EM before. In that review by Loubani et al was a systematic review of 85 articles and 270 patients. 95% of the extravasation events occurred in PIVs with infusions running greater than 4 hours and 85% of extravasation events occurred in PIVs distal to the antecubital fossa. The major limitation of this systematic review is that the majority of the data was derived from case reports and case series and not prospective trials. The authors of this current study sought to determine the incidence of complications of running vasopressors through PIVs in patients with circulatory shock in a prospective, observational trial.
Author Conclusion: “The incidence of complications from the administration of vasopressors through a PVC is small and did not result in significant morbidity in this study. Larger prospective studies are needed to better determine the factors that are associated with these complications, and identify patients in whom this practice is safe.”
Clinical Take Home Point: In patients with shock, use of peripheral vasopressors (Norepinephrine and Dopamine) in a large bore IV (18 – 20g) at a proximal site (antecubital fossa or more proximal) run for ≤4hrs or less is a safe option until more central access can be achieved."

AHF in the ED

Academic Emergency Medicine
Martindale J et al. Academic Emergency Medicine 2016; 23(3): 223-242
DOI: 10.1111/acem.12878
"Acute heart failure (AHF) is one of the most common diagnoses assigned to emergency department (ED) patients who are hospitalized. Despite its high prevalence in the emergency setting, the diagnosis of AHF in ED patients with undifferentiated dyspnea can be challenging.
Conclusions
Bedside lung US and echocardiography appear to the most useful tests for affirming the presence of AHF while NPs are valuable in excluding the diagnosis..."

domingo, 11 de febrero de 2018

Scoop & Run

Emergency Physicians Monthly
Emergency Phhysicians Monthly - By Menes K - February 5, 2018 


"When it comes to mass casualty planning, it’s not a game—it’s a philosophy.
When a mass casualty incident occurs, emergency physicians are quickly thrust onto the front lines. That is precisely what happened on October 1st at Sunrise Emergency Department in Las Vegas the night Stephen Paddock opened fire on a music concert, killing 58 people and injuring more than 500. This article, the first in a series on mass casualty incident (MCI) strategies, takes lessons learned from that event in order to highlight tough questions that your institution will need to answer to be prepared for the worst case scenario..."

AF and OAC in the ED

Resultado de imagen de canadian journal cardiology
Atzema C. Canadian Journal of Cardiology 2018, 34 (2): 125-131
"Atrial fibrillation is a frequent reason for presentation to an emergency department (ED), and the number of these visits are increasing. This creates an opportunity to improve the suboptimal rate of oral anticoagulation (OAC) use in patients with atrial fibrillation who are at high risk of stroke. However, there are very few data on whether OAC initiation in the ED, compared with referral to the longitudinal health care provider to initiate it, results in better long-term use. Moreover, for ethical and medicolegal reasons, physicians who initiate a chronic medication are obliged to reassess the patient at a later date, to check for medication side effects and the need for dose adjustment. More research is needed to determine whether OAC should be prescribed in the ED, by a physician who will never see the patient again. Patients who are cardioverted in the ED might be an exception, secondary to the increased risk of stroke after cardioversion. If ED OAC prescribing is associated with better outcomes, these results must be placed into context with the care and outcomes of the other patients in the ED. If there is a net benefit, the findings should be disseminated to practicing emergency physicians, preferably via emergency physician opinion leaders. An implementation science-based approach, which addresses the barriers to ED OAC prescribing (eg, the competing demands of running an ED and lack of guaranteed follow-up care after discharge from an ED), should be used to support prescribing of OAC in the ED. Potential solutions are described."

ATLS 2018

ATLS 2018
ATLS 10th Edition - Trauma Update presented by Dr Michael Woo
Department of Emergency Medicine. University of Ottawa
(Infographic created by Dr Shahbaz Syed)


sábado, 10 de febrero de 2018

Fluid Responsiveness

R.E.B.E.L.EM - February 27, 2017 - By Salim Rezaie
"Background: Fluid resuscitation is a crucial aspect of emergency and critical care. Since the advent of the concept of early goal-directed therapy, we have placed a huge emphasis on aggressive fluid resuscitation in patients with severe sepsis and septic shock. From EGDT to PROCESS/ARISE/PROMISE to Surviving Sepsis Guidelines, we have seen a shift in how fluid resuscitation is monitored, but the idea of aggressive fluid resuscitation is still the crux of our hemodynamic management of these patients. Yet, the FENICE study showed that in 46 countries, there is a “huge variability in the current practice regarding an FC [fluid challenge]…and may reflect the controversies in current guidelines.” (Cecconi 2015)..."

Long Backboard

Logo
emDocs - February 10, 2016 - Author: Joseph J and Bucher J
Edited by: Robertson J and Koyfman  A
"5 Backboard Clinical Pearls
  1. The LBB should not be used as a therapeutic intervention. Achieving full spinal immobilization is not possible and its use has been shown to cause patient harm and no benefit. Instead, spinal motion restriction should be practiced.
  2. LBB use has been shown to cause increased pressure ulcers, decreased respiratory function, increased back pain, and result in a false-positive midline vertebral tenderness. This can result in unnecessary testing, radiation exposure and medical costs.
  3. Penetrating trauma alone does not increase the risk of cervical spine injury and these patients should never be immobilized.
  4. Attempting spinal motion restriction should not delay life-saving interventions or delay transport to definitive care.
  5. Consider RN-directed removal of backboards in the emergency department to avoid complications of prolonged, unnecessary immobilization."

Agitation

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emDocs - February 5, 2018 - Authors: Long B and Gottlieb M - Edited by: Koyfman A
"This edition will provide some background on the agitation in the ED, important conditions to consider, ED evaluation, and interventions to control agitation."

EDACS vs. HEART

EMLoN Logo
Emergency Medicine Literature of Note - February 9, 2018 - By Ryan Radecki 
"The world has been obsessed over the past few years with the novelty of clinical decision rules for the early discharge of chest pain. After several years of battering the repurposed Thrombolysis in Myocardial Infarction (TIMI) score, History, Electrocardiogram, Age, Risk factors and Troponin (HEART) became ascendant, but there are several other candidates out there.
One of these is Emergency Department Assessment of Chest pain Score (EDACS), which is less well-known, but has reasonable face validity. It does a good job identifying a “low-risk” cohort, but is more complicated than HEART. There is also a simplified version of EDACS that goes ahead and eliminates some of the complicated subtractive elements of the score. This study pits these various scores head-to-head in the context of conventional troponin testing, as well..."

sábado, 3 de febrero de 2018

Radiografia abdominale

header-sito-sfondo-2000
EMPills - 1 Feb 2017 - Alessandro Riccardi
"...Cosa amiamo della radiografia addominale?
Perché i medici di emergenza di quasi tutto il mondo, di fronte a qualsiasi dolore addominale, ordinano una radiografia?
Il Royal College of Radiologist ha pubblicato le linee guida per le indicazioni al’esecuzione della radiografia addominale:
  • un dolore addominale acuto sospetto per addome acuto che richiede ricovero ospedaliero e valutazione chirurgica
  • un dolore addominale sospetto per perforazione o occlusione
  • una riacutizzazione di una patologia infiammatoria intestinale
  • una massa addominale palpabile (in determinate circostanze, indicazione relativa)
  • una sospetta colica renale, un’ematuria o una insufficienza renale (in determinate circostanze, indicazione relativa)
  • una ritenzione-ingestione di un corpo estraneo
  • una ferita penetrante"

IV Lidocaine for pain

Mayo Clinic
EMBlog Mayo Clinic - February 2, 2018 - By Daniel Cabrera 
Author: Lucas Oliveira J. e Silva 
"Lidocaine is a local anesthetic agent of the amide type that has been described as containing analgesic, anti-hyperalgesic and anti-inflammatory properties. It has a short half-life (60 to 120 minutes) and its side effects are often predictable. Due to its short half-life, toxicity symptoms at lower doses are generally transient, although its analgesic effect might last more than expected. Lidocaine for pain control, administered by intravenous (IV) injection, has been studied in various settings, including the operating room for management of perioperative pain and outpatient clinics for treatment of neuropathic pain. Its use in the Emergency Department (ED), however, has only recently gained attention after emerging evidence for the management of pain of renal colic patients in the ED..."

The BLUE Protocol

Home
Emergency Medicine. 2018 January;50(1): 38-40 - Author(s): Smith T., Taylor T., Meer J
"Acute dyspnea, with or without hypoxia, is a common patient presentation in the ED, and can be the result of a myriad of mainly cardiac, pulmonary, and metabolic conditions—many of which are life-threatening. Therefore, it is crucial to determine or narrow the diagnosis promptly and initiate appropriate treatment. Focused ultrasound of the lungs can provide important information that can change a patient’s clinical course within minutes of initial evaluation..."

martes, 30 de enero de 2018

Metabolic Sepsis Resuscitation

PulmCrit (EM Crit)

PulmCrit (EM Crit) - January 29, 2018 - By Josh Farkas
  • "The ADRENAL trial showed that stress-dose steroids are fairly safe, have no mortality benefit, and accelerate clinical improvement.
  • ADRENAL shows that steroid offers meaningful patient-centered benefit to patients on anydose of vasopressor (not solely patients on high-dose vasopressor).
  • Treatment for septic shock involves immediate initiation of numerous therapies to stabilize the patient as rapidly as possible. It makes sense to initiate steroid promptly, rather than withholding it until the patient is failing to respond to high doses of vasopressor.
  • Metabolic sepsis resuscitation with hydrocortisone, ascorbic acid, and thiamine remains controversial. By demonstrating the safety and efficacy of hydrocortisone, the ADRENAL study provides indirect support for this combination."

Antithrombotic Therapy in VTE

An online community of practice for Canadian EM physicians
Canadi EM -  By Eric Tseng - January 30, 2018
"Main Messages
  • Both LMWH/Warfarin and DOACs are reasonable first-line treatments for acute VTE.
  • DOACs have similar efficacy to Warfarin in the treatment of VTE, and have a favourable safety profile with less major bleeding and intracranial hemorrhage.
  • Decisions about anticoagulant therapy must take into account efficacy, bleeding risk, comorbidity, patient preference, and cost."

Acute Ischemic Stroke

Resultado de imagen de stroke aha
Powers W at al.  Stroke. 2018; STR.0000000000000158
Originally published January 24, 2018
"Background and PurposeThe purpose of these guidelines is to provide an up-to-date comprehensive set of recommendations for clinicians caring for adult patients with acute arterial ischemic stroke in a single document. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators. These guidelines supersede the 2013 guidelines and subsequent updates."

sábado, 27 de enero de 2018

Hyperkalemia

Logo
emDocs - January 25, 2018 - Author: Singh M - Edited by: Santistevan J and Long B
"What are the main ECG pointers for hyperkalemia?
  • Though it is good to know the classic ECG progression of hyperkalemia, do not be fooled by a normal or nonspecific ECG in hyperkalemia.
    • The relationship between serum potassium and ECG manifestation is not cut and dry as we are taught. Don’t get into a false sense of security…treat the patient in front of you!
    • Keep hyperkalemia in the differential diagnosis for a patient with an ECG showing a very wide QRS complex
  • Keep in mind the differential of a “peaked” T-wave:
    • Hyperkalemia
    • Hyperacute T-waves from ischemia
    • De Winter’s T-waves
    • Benign Early Repolarization
  • Hyperkalemia is a great mimicker – think about it in your STEMI-mimics, bradyarrhythmias, tachyarrhythmias, AV blocks, etc., especially if the ECG is not adding up on your interpretation."

IV vs IO in OHCA

R.E.B.E.L.EM - January 25, 2018 
Article: Kawano T et al. Intraosseous vascular access is associated with lower survival and neurologic recovery among patients with out-of-hospital cardiac arrest. Ann Emerg Med 2018. PMID: 29310869
"Clinical Question: Is intraosseous access associated with lower rates of good neurologic outcomes after cardiac arrest in comparison to intravenous access?
Background: Placement of vascular access for administration of resuscitation drugs and fluids is a common procedure in the management of out of hospital cardiac arrest (OHCA). While intravenous (IV) placement has been the standard approach for decades, intraosseous (IO) access is rapid and safe and may be the preferred approach due to fact that the bone marrow does not collapse during shock states as peripheral veins often do. Despite it’s advantages, there are concerns about IO placement because of the potential for drugs to pool in the marrow and not circulate. Prior studies have shown an association with tibial IO placement and decreased rate of ROSC though no association with worse neurologic outcomes (Feinstein 2017).
Authors Conclusions:
“In adult out-of-hospital cardiac arrest patients, intraosseous vascular access was associated with poorer neurologic outcomes than intravenous access.”
Our Conclusions: This study demonstrates an association only between IO access and worse neurologic outcomes. However, the study is rife with bias secondary to it’s design and thus, cannot be used to advise clinical practice. A well-done, randomized trial is needed.
Potential to Impact Current Practice: This study should not impact clinical practice. If vascular access is desired in an OHCA patient, the most rapid technique should be used and this will be dependent on the provider. Additionally, it should be stressed that obtaining access is not a critical step in OHCA management as no medication has been shown to improve meaningful outcomes (i.e. neurologically intact survival)
Bottom Line: This study should not influence providers to select one vascular access method over another in the resuscitation of OHCA. If vascular access is desired, use the most rapid approach."

lunes, 22 de enero de 2018

Parkinson’s disease in the ED

Logo
emDocs - Jan 22, 2018 - Authors: Baluzy M and Riddell J 
Edited by: Koyfman A and Long B
"Take-Home Messages
  • Drug-induced parkinsonism may result from the use of anti-dopaminergic agents. These include neuroleptics and antiemetics. Cessation of these medications can produce significant improvement in the patient’s motor symptoms.
  • Motor fluctuations and dyskinesias are common. Search for underlying causes including infections, GI disorders, metabolic disturbances, or recent stressors such as surgery. Complications include rhabdomyolysis, thromboembolic disease and respiratory failure. Benzodiazepines may help acutely and the patient’s home medications will need to be adjusted.
  • The evaluation of acute psychosis also involves searching for precipitating causes but may be secondary to the disease process itself and the use of dopaminergic medications. Benzodiazepines should be used for psychosis with agitation because neuroleptics may worsen motor symptoms. Dosage adjustments can improve symptoms but should be done with a neurologist. If neuroleptics are required, quetiapine and clozapine are recommended.
  • Autonomic dysfunction includes urinary retention, constipation, and orthostatic hypotension. All are treated with usual measures, but persistent or severe orthostatic hypotension may require further treatment with volume expanders or vasopressors.
  • Parkinsonism-hyperpyrexia syndrome is a rare complication that is caused by acute dopamine withdrawal. It presents similarly to NMS with fever, altered mental status, autonomic instability, and worsening parkinsonism. Treatment includes supportive care, reinstitution of dopamine agonist, and adjunctive medications such as bromocriptine and dantrolene."

domingo, 21 de enero de 2018

CRYOSTAT-2

St.Emlyn's

Fibrin/platelet mesh
"You might be aware that an exciting new trial has started called Cryostat-2. This is exciting as it has the potential to improve patient outcomes, but also because it will involve all the Major Trauma Centres in England and 8 international centres, meaning it is an international, multi-centre, randomised controlled trial.
Why?
Bleeding accounts for 40% of all deaths from trauma, many within hours of injury. A recent NIHR Programme Grant for Applied Research found that approximately 7,780 people nationally suffer major haemorrhage each year, of whom an estimated 2,800 will die, at a total cost of nearly £150m to the NHS. Fibrinogen is the key pro-coagulant factor needed for stable clot formation and the earliest clotting protein to fall during active major bleeding. 25% of all trauma patients have abnormal blood clotting, which causes higher rates of major haemorrhage and four fold increased risk of death. This is . As what we know as Acute Traumatic Coagulopathy (ATC) and the Trauma-Induced Coagulopathy (TIC). To clarify the difference, ATC is the coagulopathy that has been shown to occur as a result of tissue damage and the shock process, whereas TIC is ATC plus the effects of resuscitation efforts and inflammation. We know from research, the primary clotting abnormalities in trauma are increased clot breakdown and low fibrinogen levels. The CRASH-2 trial has shown that early treatment with tranexamic acid prevents clot breakdown and reduces mortality from trauma haemorrhage. The results of a national observational trauma transfusion study found cryoprecipitate is administered late during the MHP, on average three hours after arrival. Cryostat-1 showed that early replacement of fibrinogen with cryoprecipitate is able to rapidly restore fibrinogen levels and may halve mortality from trauma haemorrhage. Following on from this work, CRYOSTAT-2 will evaluate whether early administration of high-dose cryoprecipitate, in addition to standard major haemorrhage therapy, improves survival from traumatic bleeding..."

Corticoisteroids for sore throat

The Skeptics Guide to Emergency Medicine
SGEM#203 - January 15th, 2018
"Clinical Question: Are corticosteroids effective and safe as an adjunct treatment for sore throat in addition to standard care compared with standard care alone? 
SGEM Bottom Line: Steroids appear to provide a modest benefit to patients presenting to the emergency department with a sore throat."

3 Must-Read from 2017

Medscape Logo
Medscape - By Amal Mattu - January 19, 2018
"The 2017 calendar year had many outstanding articles focused on high-risk topics that directly relate to emergency medicine clinical practice. As in past years, I solicited my colleagues for their opinions on the best and most useful journal publications of the year. I received dozens of selections to consider that ranged from deadly conditions, such as myocardial infarction and stroke, to more benign everyday conditions, such as pharyngitis.
I narrowed the selections to articles that provided (1) practical, immediately useful recommendations and (2) would help critically ill patients in the emergency department (ED). Given the space limitations, I again have chosen only three articles.
I'll make the usual disclaimer that these are not necessarily the best articles from a methodological standpoint, but they are practice-changing and focus on high-risk conditions where lives are at stake. This year, I also chose articles that have not received much fanfare at conferences I've attended or on social media. My summaries will be brief, and I encourage readers to seek further details from the articles themselves to learn best how to incorporate the information into your clinical practice..."

Tintinalli Year in Review

Emergency Physicians Monthly
By Judith Tintinalli - January 2, 2018
"2017 was, shall we say, complicated. Here are the issues that dominated our headlines and will continue to drive conversations in 2018..."

Corticosteroids in Septic Shock

Venkatesh. NEJM 2018; published on line first 19th January 2018 DOI: 10.1056/NEJMoa1705835
The Bottom Line - January 20, 2018 - By David Slessor
"The Bottom Line
  • In mechanically ventilated patients with septic shock, low dose hydrocortisone administered via an infusion for up to 7 days does not reduce or increase mortality at 90 days
  • Secondary outcomes demonstrated that patients in the hydrocortisone group had a reduced time to resolution of shock, reduced duration of ICU but not hospital stay, reduced time to cessation of mechanical ventilation and a reduction in the use of blood transfusion. Adverse events were low, but significantly increased in the hydrocortisone group"

viernes, 19 de enero de 2018

Doble antiagregación

urgenciasdeponiente - Enero 17, 2018
Grupo de Trabajo sobre el tratamiento antiagregante plaquetario doble en la enfermedad coronaria de la Sociedad Europea de Cardiologia (ESC) y la European Association for Cardio-Thoracic Surgery (EACTS)
Revista española de cardiología, ISSN 0300-8932, Vol. 71, Nº. 1, 2018, págs. 42-42

Lidocaine for Renal Colic

The Skeptics Guide to Emergency Medicine
SGEM#202 - January 9th, 2018 - By Tony Seupaul
"Clinical Question: In emergency department patients with renal colic, is IV lidocaine as or more effective than IV narcotics for pain control?
SGEM Bottom Line: Based on this study, lidocaine cannot be recommended for the treatment of renal colic."