EM Journal Update Journal Reviews

Effect of Intranasal Ketamine Vs Fentanyl on Pain Reduction for Extremity Injuries in Children: The Prime Randomized Clinical Trial

Pain is typically under-treated in children. Intranasal administration of analgesics has the benefits of rapid, needleless administration and a more rapid onset compared to oral administration. Ketamine is used frequently by the intravenous or intramuscular route for procedural sedation due to its efficacy and safety.
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April 12th, 2019 Leave a Comment

PECARN: Febrile Neonate Decision Rule Derivation and Internal Validation

The evaluation and management of febrile neonates remains controversial. Approximately, 10% of these patients will have a serious bacterial infection (SBI). Identification of the febrile neonate at low risk for serious bacterial infection could allow for a reduction in the rates of lumbar puncture, unnecessary antibiotics and hospital admission. The approach to these patients should evolve as the epidemiology changes and new diagnostic tests become available.
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Acute Kidney Injury After Computed Tomography: A Meta-analysis

Imaging is one of the most important diagnostic modalities that physicians utilize. In 2013 alone, over 70 million CT scans were performed. Contrast-enhanced imaging can aid in diagnosing certain pathology and improve image quality. There has historically been a concern for post-contrast acute kidney injury (AKI), which is generally considered an increase in creatinine or a decrease in glomerular filtration rate hours to days after contrast administration.
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Accuracy of the Age-Adjusted Quick SOFA Score in Children

The sepsis 3 guidelines recommended the use of the Sepsis Related Organ Failure Assessment (SOFA) score for early identification of sepsis in adults (Singer 2016, PMID: 26903338). An abbreviated version of SOFA (Quick SOFA or qSOFA) includes variables available at the bedside in the ED (systolic BP, respiratory rate and mental status). The 2017 pediatric surviving sepsis guidelines acknowledge that there is insufficient evidence to endorse a specific sepsis trigger tool and recommend that each institution develop their own recognition bundle (Amer College Critical Care 2017,
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Tags: , , February 13th, 2019 Leave a Comment

Predicting Escalated Care in Infants With Bronchiolitis

Bronchiolitis is the most common lower respiratory tract infection and the most common cause of admission in infants. Approximately 10% will require some airway support. The ability to identify those at risk for escalation of care would allow for appropriate disposition decisions.
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Tags: , , , , September 13th, 2018 Leave a Comment

Edoxaban in Cancer-Associated VTE

This post is cross-posted on REBEL EM

Venous thromboembolism (VTE) occurs frequently in patient with cancer. Treatment in this group entails a number of challenges including a higher rate of thrombosis recurrence and a higher risk of bleeding. Standard therapy at this time for both symptomatic and asymptomatic VTE is with low-molecular-weight heparin (LMWH) based on results from the CLOT trial (Lee 2003).
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Tags: , , September 4th, 2018 Leave a Comment

STONE Study – Efficacy of Tamsulosin in Ureteral Colic

Ureteric (renal) colic is a common, painful condition encountered in the Emergency Department (ED). Sustained contraction of smooth muscle in the ureter as a kidney stone passes the length of the ureter leads to pain. The majority of stones will pass spontaneously (i.e. without urologic intervention). For over a decade, calcium channel blockers (i.e. nifedipine) and,
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Tags: , August 30th, 2018 Leave a Comment

Comparison of IM Midazolam, Olanzapine, Ziprasidone and Haloperidol for Sedation

Emergency providers frequently care for agitated patients ranging from restlessness to verbally and physically aggressive. Agitation is a symptom, not a diagnosis and these patients require careful evaluation to rule in or out serious medical conditions. Unfortunately, the agitation itself often obstructs this evaluation and places the patient, other patients and staff at risk. While verbal de-escalation can be effective in select cases,
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