EM Journal Update Journal Reviews

Tags: , February 9th, 2022 Leave a Comment

Prehospital Narrow Pulse Pressure Predicts Need for Resuscitative Thoracotomy and Emergent Intervention After Trauma

Prehospital trauma team activation criteria allow for prompt mobilization of personnel and resources. Prehospital hypotension is one of those criteria. Pulse pressure is the difference between systolic and diastolic blood pressure. This is variously defined as a difference of 30-40 mmHg. A narrow pulse pressure occurs due to compensatory increased systemic vascular resistance in the setting of decreased cardiac output.
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Tags: , January 24th, 2022 Leave a Comment

Validation of Septic Knee Monoarthritis Prediction Rule in a Lyme Disease Endemic Area

Children with knee monoarthritis from Lyme disease and septic arthritis can have similar presentations. The early disseminated stage of Lyme disease, when knee monoarthritis would typically present, occurs 3-5 weeks post tick bite and a history of tick bite may not be present. In addition, synovial fluid cell counts do not distinguish between septic and Lyme arthritis and bacterial cultures and Lyme disease serology may take several days to result.
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Tags: June 4th, 2021 Leave a Comment

Sodium bicarbonate therapy for patients with severe metabolic acidaemia in the intensive care unit (BICAR-ICU): a multicentre, open-label, randomised controlled, phase 3 trial

Acute acidemia is common in critically ill adult patients. Use of sodium bicarbonate infusion for the treatment of severe metabolic acidemia is controversial and understudied.
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Tags: August 31st, 2020 Leave a Comment

Performance of Novel High-Sensitivity Cardiac Troponin I Assays for 0/1-Hour and 0/2- to 3-Hour Evaluations for Acute Myocardial Infarction: Results From the HIGH-US Study

A strategy of high-sensitivity cardiac troponins over short time intervals for the diagnosis of acute myocardial infarction has been recommended in European cardiology guidelines. It is unclear if the European strategy is generalizable to the US population. A strategy that identifies low risk patients early can lead to limited further diagnostic testing, ED length of stay,
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Pulmonary Complications of Opioid Overdose Treated with Naloxone

Pulmonary complications after opioid overdose include: non-cardiogenic pulmonary edema, aspiration pneumonia/pneumonitis and acute respiratory distress syndrome. Multiple mechanisms have been proposed for these complications. These complications have been described in opioid overdose both with and without Naloxone administration. The purpose of the study was to determine if higher doses of Naloxone are associated with an increased risk of pulmonary complications after opioid overdose.
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Tags: January 31st, 2020 Leave a Comment

Lidocaine-Epinephrine-Tetracaine Gel is More Efficient than EMLA and Mepivacaine Injection During Skin Repair in Children: A Prospective, Propensity Score Matched Two-Center Study

Lacerations are a common cause of visits to the pediatric emergency department. Laceration repair can be a traumatizing experience. The use of topical anesthetics may obviate the need for infiltrative anesthetics. This could result in less patient pain, may improve the rate of successful laceration repair and decrease the need for procedural sedation.
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Tags: , , December 5th, 2019 Leave a Comment

Early Subthreshold Aerobic Exercise for Sport-Related Concussion: A Randomized Clinical Trial.

Recommendations that “rest is best” for concussions are based on animal research and consensus opinion. Recent evidence suggests that strict limitation of activity may not be beneficial. A small clinical trial (n=88) of pediatric patients with acute concussion randomized patients to “strict rest” for 5 days and “usual care” defined as 1-2 days of rest and then a gradual return to activities.
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Tags: , November 22nd, 2019 Leave a Comment

Effects of Tranexamic Acid on Death, Disability, Vascular Occlusive Events and Other Morbidities in Patients with Acute Traumatic Brain Injury (CRASH-3): A Randomised, Placebo-Controlled Trial

Head trauma is a leading cause of trauma related morbidity and mortality worldwide. Tranexamic acid (TXA) inhibits fibrinolysis and can decrease ongoing hemorrhage. In the CRASH-2 Trial, TXA given within 3 hours of injury was shown to decrease mortality from major extracranial injury (CRASH 2 Investigators, Lancet. 2010. PMID: 20554319). A subgroup analysis of the CRASH 2 study that included 270 patients who met criteria for trauma with concern for hemorrhage and a GCS <
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