Text Summary

1. Perry JJ, Sivilotti MLA, Sutherland J, Hohl CM, Émond M, Calder LA, et al. Validation of the Ottawa Subarachnoid Hemorrhage Rule in patients with acute headache. Canadian Medical Association Journal. 2017 Nov 12;189(45):E1379–85.
   – Validation of the previously derived Ottawa Subarachnoid Rule.
   –  Rule consists of 6 components: symptoms of neck pain or stiffness, Age ≥40 years old, witnessed loss of consciousness, onset during exertion, thunderclap headache, limited neck flexion on exam.
   – Rule performs with 100% sensitivity, specificity of 13.6%,ready for primetime !
2. Powers WJ, Rabinstein AA, Ackerson T, et al. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. January 2018.
   – New recommendations regard indications for endovascular therapy:
   – Age >18
   – Treatment within 6 hours (note, expanded stroke code windows)
   – IC/M1 occlusion
   – NIHSS >6, ASPECTS >6
   – Baseline mRS 0-1
3. Binks MJ, Holyoak RS, Melhuish TM, Vlok R, Bond E, White LD. Apneic oxygenation during intubation in the emergency department and during retrieval: A systematic review and meta-analysis. The American Journal of Emergency Medicine. 2017 Oct;35(10):1542–6. – Apneic oxygenation during intubation decreases hypoxemia and increases first pass success
4. Atzema CL, Austin PC. Rate Control With Beta-blockers Versus Calcium Channel Blockers in the Emergency Setting: Predictors of Medication Class Choice and Associated Hospitalization. Baumann BM, editor. Academic Emergency Medicine. 2017 Nov 10;24(11):1334–48.- 2x MDs chose CCB over BB, but those who received CCB had higher hospitalization rate (49% vs 39%)
5. Buxbaum JL, Quezada M, Da B, Jani N, Lane C, Mwengela D, et al. Early Aggressive Hydration Hastens Clinical Improvement in Mild Acute Pancreatitis. Am J Gastroenterol. 2017 May;112(5):797–803. Acute mild pancreatitis without SIRS, given 20cc/kg RL bolus + 3cc/kg/hr (versus 10cc/kg bolus + 1.5 cc/kg/hr). At 36 hours, 70% (versus 42%) had biochemical and clinical resolution
6. Eagles D, Perry JJ, Sirois MJ et al. Timed Up and Go predicts functional decline in older patients presenting to the emergency department following minor trauma. Age Ageing. 2017 Mar 1;46(2):214-218. – >30sec, 8.9X functional decline in 3 and 6 months.
7. van der Hulle T, Cheung WY, Kooij S, Beenen LFM, van Bemmel T, Van Es J, et al. Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): a prospective, multicentre, cohort study. The Lancet. 2017 Jul;390(10091):289–97.
   – Components of YEARS = Clinical signs of DVT, OR hemoptysis, OR PE most likely Dx.
   – D-Dimer threshold = 1000, unless any YEARS positive, then cut-off = 500.
   – 14% reduction in CT-PEs, no significant increase in missed PEs.
   – Multiple study biases, not sure this is ready for practice.
8. Hofmann R, James SK, Jernberg T, et al. Oxygen Therapy in Suspected Acute Myocardial Infarction. N Engl J Med. 2017;377(13):1240-1249. doi:10.1056/NEJMoa1706222.
   – Patients were randomized to ambient air versus 6L O2 via facemask.
   – No difference in all cause mortality.
   – Previous evidence suggested O2 may do harm, this supports the idea that it has no benefit, and is validation of the 2015 AHA guidelines.
9. Ni Y-N, Luo J, Yu H, Liu D, Liang B-M, Liang Z-A. The effect of high-flow nasal cannula in reducing the mortality and the rate of endotracheal intubation when used before mechanical ventilation compared with conventional oxygen therapy and noninvasive positive pressure ventilation. A systematic review and meta-analysis. The American Journal of Emergency Medicine. 2017 Jul 28. – High flow nasal cannula decreases intubation (compared to NIPPV) and ICU mortality (for hypoxic patients)
10. Ratwani RM, Fong A, Puthumana JS, Hettinger AZ. Emergency Physician Use of Cognitive Strategies to Manage Interruptions. YMEM. American College of Emergency Physicians; 2017 Nov 1;70(5):683–7. – MDs mostly engage with interruption right away instead of rejecting or delaying the interruptions
11. Euglycemic diabetic ketoacidosis (Peters, Ogawa, Hine, Hayami, Munro)
    – Multiple emerging case reports of euglycemic DKA with SGLT-2 inhibitors.
    – In Canada, specifically, worry about Invokana.
    – Important to check VBG/Ketones/Beta-hydroxybutyrate: a single glucose may otherwise miss this diagnostic entity.
12. Hayward GN, Hay AD, Moore MV, Jawad S, Williams N, Voysey M, et al. Effect of Oral Dexamethasone Without Immediate Antibiotics vs Placebo on Acute Sore Throat in Adults. JAMA. American Medical Association; 2017 Apr 18;317(15):1535–43.- Dex 10mg in those without immediate antibiotics, had higher complete resolution (NNT 12) at 48 hours, but no difference in # of bad days or time off
13. Linden JA, Grimmnitz B, Hagopian L, Breaud AH, Langlois BK, Nelson KP, et al. Is the Pelvic Examination Still Crucial in Patients Presenting to the Emergency Department With Vaginal Bleeding or Abdominal Pain When an Intrauterine Pregnancy Is Identified on Ultrasonography? A Randomized Controlled Trial. Annals of Emergency Medicine. 2017 Sep. – After demonstration of IUP on US, pelvic exam did not change outcomes in 30 days but underpowered study. Most patients did not want pelvic exam
14. 1. Frizell A, Fogel N, Steenblik J, Carlson M, Bledsoe J, Madsen T. Prevalence of pulmonary embolism in patients presenting to the emergency department with syncope. Am J Emerg Med. February 2018. doi:10.1016/j.ajem.2017.07.090
       – These authors found the prevalence of PE in syncope patients to actually be 1.4%.
    2. Oqab Z, Ganshorn H, Sheldon R. Prevalence of pulmonary embolism in patients presenting with syncope. A systematic review and meta-analysis. The American Journal of Emergency Medicine. 2017 Sep.
       – Pooled prevalence of PE in syncope patients was 0.8% in ED patients and 1.0% in admitted patients.
       – Further demonstrating that the PESIT trial had many biases/criticisms.
       – Prevalence of PE in syncope patients is not high.
15. Aycock RD, Westafer LM, Boxen JL, Majlesi N, Schoenfeld EM, Bannuru RR. Acute Kidney Injury After Computed Tomography: A Meta-analysis. Annals of Emergency Medicine. 2017 Aug 12. – No evidence contrast causes declining renal function
16. Heytens S, De Sutter A, Coorevits L, Cools P, Boelens J, Van Simaey L, et al. Women with symptoms of a urinary tract infection but a negative urine culture: PCR-based quantification of Escherichia coli suggests infection in most cases. Clinical Microbiology and Infection. 2017 Sep;23(9):647–52. Urine culture only positive in 80% with UTI symptoms, 90% with -ve culture with +ve PCR. Treat if symptoms. (<65, simple UTI)

15. Hay AD, Little P, Harnden A, Thompson M, Wang K, Kendrick D, et al. Effect of Oral Prednisolone on Symptom Duration and Severity in Nonasthmatic Adults With Acute Lower Respiratory Tract Infection: A Randomized Clinical Trial. JAMA: The Journal of the American Medical Association. 2017 Aug 22;318(8):721–30.
    – Prednisone versus placebo for non-asthmatic adults with wheeze
    – No significant treatment effort for duration/severity of LRTI, reduction in cough or decrease in symptom severity.
    – No benefit to steroids in LRTI.
16. Zahed R, Mousavi Jazayeri MH, Naderi A, Naderpour Z, Saeedi M. Topical Tranexamic Acid Compared With Anterior Nasal Packing for Treatment of Epistaxis in Patients Taking Antiplatelet Drugs: Randomized Controlled Trial. Runyon MS, editor. Academic Emergency Medicine. 2017 Dec 9;6:24. – At 10 min, 71% of patients with 500mg topical TXA has stopped bleeding vs traditional packing (29%), also less rebleed at 1 week.
17. Moharamzadeh P, Ojaghihaghighi S, Amjadi M, Rahmani F, Farjamnia A. Effect of tranexamic acid on gross hematuria: A pilot randomized clinical trial study. The American Journal of Emergency Medicine. 2017 Dec;35(12):1922–5. – 500mg TXA instilled in bladder (clamped x 10 min during CBI), needed less CBI volume (9L versus 12) to clear
18. Appelboam A et al. Postural Modification to the Standard Valsalva Manoeuvre for Emergency Treatment of Supraventricular Tachycardias (REVERT): A Randomised Controlled Trial. Lancet 2015
    – Patients were randomized to standard valsalva, versus postural modification to standard valsalva.
    – Primary outcome of return to sinus rhythm in 1 minute.
    – Modified valsalva was significantly more successful (43 vs 17%) – NNT of 4.
19. Boehm K, Keyes D, Mader L, Moccia M. First Report of Survival in Refractory Ventricular Fibrillation After Dual-Axis Defibrillation and Esmolol Administration. WestJEM. 2016 Nov 1;17(6):762–5. El Tawil C, Mrad S, Khishfe BF. Double sequential defibrillation for refractory ventricular fibrillation. Am J Emerg Med. 2018;35(12):1985.e3-e1985.e4. doi:10.1016/j.ajem.2017.09.009. – Consider DSB in refractory V F arrest
20. Abbasi S, Bidi N, Mahshidfar B, Hafezimoghadam P, Rezai M, Mofidi M, et al. Can low-dose of ketamine reduce the need for morphine in renal colic? A double-blind randomized clinical trial. The American Journal of Emergency Medicine. 2017 Aug 14. – 0.15mg/kg ketamine decreases pain and morphine use at 10 and 30 min, but no info re: length of stay
21. AK C, PE B, Esses D, DP B, Baer J. Effect of a single dose of oral opioid and nonopioid analgesics on acute extremity pain in the emergency department: A randomized clinical trial. JAMA. 2017;318(17):1661-1667.
    – Double blind RCT on adult patients with acute extremity pain.
    – All patients received acetaminophen and were randomized to ibuprofen (400 mg), oxycodone (5mg), hydrocodone (5mg) or codeine (300 mg).
    – There were no differences in pain reduction at 2 hours.
22. Friedman BW, Irizarry E, Solorzano C, Khankel N, Zapata J, Zias E, et al. Diazepam Is No Better Than Placebo When Added to Naproxen for Acute Low Back Pain. Annals of Emergency Medicine. 2017 Aug;70(2):169–176.e1.
23. Friedman BW, Cisewski D, Irizarry E, Davitt M, Solorzano C, Nassery A, et al. A Randomized, Double-Blind, Placebo-Controlled Trial of Naproxen With or Without Orphenadrine or Methocarbamol for Acute Low Back Pain. YMEM. American College of Emergency Physicians; 2017 Oct 26;:1–14.
24. Figueiredo EG, Teixeira MJ. Trial of Pregabalin for Acute and Chronic Sciatica. N Engl J Med. 2017 Jun 15;376(24):2396.
    – No diff in pregabalin for pain relief
25. Chou R, Deyo R, Friedly J, Skelly A, Hashimoto R, Weimer M, et al. Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med. 2017 Feb 14;166(7):493. acute pain: acupuncture and spinal manipulation. Chronic pain: yoga, tai-chi, CBT, relaxation

References:

1. Perry JJ, Sivilotti MLA, Sutherland J, Hohl CM, Émond M, Calder LA, et al. Validation of the Ottawa Subarachnoid Hemorrhage Rule in patients with acute headache. Canadian Medical Association Journal. 2017 Nov 12;189(45):E1379–85.
2. Goyal M, Demchuk AM, Menon BK, Eesa M, Rempel JL, Thornton J, et al. Randomized Assessment of Rapid Endovascular Treatment of Ischemic Stroke. N Engl J Med. 2015 Feb 11.
3. Binks MJ, Holyoak RS, Melhuish TM, Vlok R, Bond E, White LD. Apneic oxygenation during intubation in the emergency department and during retrieval: A systematic review and meta-analysis. The American Journal of Emergency Medicine. 2017 Oct;35(10):1542–6.
4. Pavlov I, Medrano S, Weingart S. Apneic oxygenation reduces the incidence of hypoxemia during emergency intubation: A systematic review and meta-analysis. The American Journal of Emergency Medicine. 2017 Aug;35(8):1184–9.
5. Atzema CL, Austin PC. Rate Control With Beta-blockers Versus Calcium Channel Blockers in the Emergency Setting: Predictors of Medication Class Choice and Associated Hospitalization. Baumann BM, editor. Academic Emergency Medicine. 2017 Nov 10;24(11):1334–48.
6. Buxbaum JL, Quezada M, Da B, Jani N, Lane C, Mwengela D, et al. Early Aggressive Hydration Hastens Clinical Improvement in Mild Acute Pancreatitis. Am J Gastroenterol. 2017 May;112(5):797–803.
7. Righini M, Van Es J, Exter Den PL, Roy P-M, Verschuren F, Ghuysen A, et al. Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study. JAMA: The Journal of the American Medical Association. 2014 Mar 19;311(11):1117–24.
8. van der Hulle T, Cheung WY, Kooij S, Beenen LFM, van Bemmel T, Van Es J, et al. Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): a prospective, multicentre, cohort study. The Lancet. 2017 Jul;390(10091):289–97.
9. Ni Y-N, Luo J, Yu H, Liu D, Liang B-M, Liang Z-A. The effect of high-flow nasal cannula in reducing the mortality and the rate of endotracheal intubation when used before mechanical ventilation compared with conventional oxygen therapy and noninvasive positive pressure ventilation. A systematic review and meta-analysis. The American Journal of Emergency Medicine. 2017 Jul 28.
10. Ratwani RM, Fong A, Puthumana JS, Hettinger AZ. Emergency Physician Use of Cognitive Strategies to Manage Interruptions. YMEM. American College of Emergency Physicians; 2017 Nov 1;70(5):683–7.
11. Rawla P, Vellipuram AR, Bandaru SS, Pradeep Raj J. Euglycemic diabetic ketoacidosis: a diagnostic and therapeutic dilemma. Endocrinology, Diabetes & Metabolism Case Reports. 2017 Sep 4.
12. Hayward GN, Hay AD, Moore MV, Jawad S, Williams N, Voysey M, et al. Effect of Oral Dexamethasone Without Immediate Antibiotics vs Placebo on Acute Sore Throat in Adults. JAMA. American Medical Association; 2017 Apr 18;317(15):1535–43.
13. Linden JA, Grimmnitz B, Hagopian L, Breaud AH, Langlois BK, Nelson KP, et al. Is the Pelvic Examination Still Crucial in Patients Presenting to the Emergency Department With Vaginal Bleeding or Abdominal Pain When an Intrauterine Pregnancy Is Identified on Ultrasonography? A Randomized Controlled Trial. Annals of Emergency Medicine. 2017 Sep.
14. Oqab Z, Ganshorn H, Sheldon R. Prevalence of pulmonary embolism in patients presenting with syncope. A systematic review and meta-analysis. The American Journal of Emergency Medicine. 2017 Sep.
15. Aycock RD, Westafer LM, Boxen JL, Majlesi N, Schoenfeld EM, Bannuru RR. Acute Kidney Injury After Computed Tomography: A Meta-analysis. Annals of Emergency Medicine. 2017 Aug 12.
16. Heytens S, De Sutter A, Coorevits L, Cools P, Boelens J, Van Simaey L, et al. Women with symptoms of a urinary tract infection but a negative urine culture: PCR-based quantification of Escherichia coli suggests infection in most cases. Clinical Microbiology and Infection. 2017 Sep;23(9):647–52.
17. Hay AD, Little P, Harnden A, Thompson M, Wang K, Kendrick D, et al. Effect of Oral Prednisolone on Symptom Duration and Severity in Nonasthmatic Adults With Acute Lower Respiratory Tract Infection: A Randomized Clinical Trial. JAMA: The Journal of the American Medical Association. 2017 Aug 22;318(8):721–30.
18. Zahed R, Mousavi Jazayeri MH, Naderi A, Naderpour Z, Saeedi M. Topical Tranexamic Acid Compared With Anterior Nasal Packing for Treatment of Epistaxis in Patients Taking Antiplatelet Drugs: Randomized Controlled Trial. Runyon MS, editor. Academic Emergency Medicine. 2017 Dec 9;6:24.
19. Moharamzadeh P, Ojaghihaghighi S, Amjadi M, Rahmani F, Farjamnia A. Effect of tranexamic acid on gross hematuria: A pilot randomized clinical trial study. The American Journal of Emergency Medicine. 2017 Dec;35(12):1922–5.
20. Boehm K, Keyes D, Mader L, Moccia M. First Report of Survival in Refractory Ventricular Fibrillation After Dual-Axis De brillation and Esmolol Administration. WestJEM. 2016 Nov 1;17(6):762–5.
21. Tawil M D El C, D SMM, D BFKM. American Journal of Emergency Medicine. American Journal of Emergency Medicine. Elsevier Inc; 2017 Sep 30;:1–2.
22. Abbasi S, Bidi N, Mahshidfar B, Hafezimoghadam P, Rezai M, Mofidi M, et al. Can low-dose of ketamine reduce the need for morphine in renal colic? A double-blind randomized clinical trial. The American Journal of Emergency Medicine. 2017 Aug 14.
23. Tang Y, Kang J, Zhang Y, Zhang X. Influence of greater occipital nerve block on pain severity in migraine patients: A systematic review and meta-analysis. The American Journal of Emergency Medicine. 2017 Nov;35(11):1750–4.
24. Friedman BW, Irizarry E, Solorzano C, Khankel N, Zapata J, Zias E, et al. Diazepam Is No Better Than Placebo When Added to Naproxen for Acute Low Back Pain. Annals of Emergency Medicine. 2017 Aug;70(2):169–176.e1.
25. Friedman BW, Cisewski D, Irizarry E, Davitt M, Solorzano C, Nassery A, et al. A Randomized, Double-Blind, Placebo-Controlled Trial of Naproxen With or Without Orphenadrine or Methocarbamol for Acute Low Back Pain. YMEM. American College of Emergency Physicians; 2017 Oct 26;:1–14.
26. Figueiredo EG, Teixeira MJ. Trial of Pregabalin for Acute and Chronic Sciatica. N Engl J Med. 2017 Jun 15;376(24):2396.
27. Chou R, Deyo R, Friedly J, Skelly A, Hashimoto R, Weimer M, et al. Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med. 2017 Feb 14;166(7):493.