So here we are with some of the grabs from around and about in the world of EM. Another to follow soon.
Infograph of Note..
This one is in the repository, but a great reminder of how to spot that impending occlusion as it could be happening.
Here is a great little tip for those hard of hearing. So the stethoscope may not be dead! Meant for all you POCUS fans out there!
Optimise your airway!
Lactate…is it a myth!?
Papers and Blogs!
Get your loops in…Now!!
Rebel EM have taken a look at the REALITY-AHF study (below). An interesting one looking at the association between time to loop diuretic treatment and clinical outcomes in patients presenting with acute heart failure. It’s an interesting study and is well analysed by the rebel EM team. The authors found early treatment with loop diuretics was associated with lower in-hospital mortality, but there are lots of confounders unaccounted for (e.g. mainstay treatments such as CPAP and nitrates).
Hot to trot!
Another interesting breakdown of a study comes from the skeptics guide to EM. They looked at Sundén-Cullberg et al’s paper on fever in the emergency department and its prediction of survival in patients with septic shock. The take home from the paper is that patients presenting with features of severe sepsis and septic shock without fever have a higher associated mortality rate than those with fever in the ED. It may be of some use in resource allocation and does challenge the perception that fever is a marker of acuity in sepsis.
See their blog below.
Rebel EM were on it as well:
Their take is here
Tips for pricks!
We’ve all struggled with paediatric cannulation. There are some useful tips to consider from a songs or stories article back in 2015 that you may find helpful.
You may also want to consider the use of US to help you. See our section here.
Cock the leg Matron!
Pelvic XR is a frequently used part of the initial assessment of a trauma victim. Should we be performing pelvic XR in the awake, alert blunt trauma patient? A study from Bolt et al suggests that among GCS 15 patients, a painless straight leg raise can exclude pelvic fractures.
It’s a Top Gun Treatment…or is it?
Oral dexamethasone for croup is a standard accepted practice in the ED. What about for asthma exacerbations? Standard treatment can involve a short course of oral prednisolone. Cronin JJ et al looked at giving a single dose of oral dexamethasone in acute asthma exacerbations and found that it was non-inferior to three days of oral prednisolone.
Trauma in Kids…easy as A,B,C,B,E…F!!!??
A nice run through of the trauma primary survey in paediatrics from RCEM learning. Looks at some of the differences from the adult and the child primary survey with thoughts as to the different injuries and their implications.
Do they need abdo imaging or not…
It’s all a pain in the….limbs!?
A recent paper from Chang et al looked at acute extremity pain in the ED and whether single dose ibuprofen and paracetamol was different to combinations with weak opiates. They found no significant difference in pain reduction at 2 hours between opiate and non-opiate combinations. An interesting thought and helps add to the evidence base for treating acute pain in the ED.
So are we going to be scanning all drunks?! Necks as well as heads?!
Can you clear the c-spine of an intoxicated patient with a normal CT? This paper from Martin et al found that for intoxicated patients undergoing CT C-spine, the CT had a 100% NPV for identifying unstable images. They suggest that CT based clearance in intoxicated patients appears to be safe and prevents unnecessary prolonged immobilisation. Worth a look.
They’ll be twitchin’ if you don’t!
Do you routinely check and correct calcium in the major haemorrhage patient? This EMJ paper from Kyle et al reviewed the military data. Trauma patients undergoing massive transfusion are at high risk of hypocalcaemia. They highlight that aggressive management of these patient with IV calcium during transfusion may be needed and should be considered.
See the Osmosis take on hypocalcaemia!
The good old C-spine clearance thing!
Which c-spine clearance criteria do you use? Canadian c-spine rules and NEXUS criteria are among the most common. There is some debate around applying the NEXUS criteria to geriatric populations. Especially as the Canadian rules mandate radiography for anyone 65 or over, which in practice usually means a CT. Tran et al looked at validating the NEXUS criteria in low-risk elderly fallers. They found a NPV of 100% with low risk elderly using the NEXUS criteria. Although the concern around the subjective nature of some of the criteria remain, this paper is interesting and may help support some people in their decision making.
See the Canadian C-spine rule calculator here:
That’s all for now…same again next time!
Written by: Dr Dan Weston
Edited by: Dr Jonny Wilkinson