Repeat CT for anticoagulated patients with mild TBI: Necessary or Pointless?

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The Article:
Mild brain injury and anticoagulants
Campiglio, L. et al. Neurol Clin Pract. 2017 Aug;7(4):296-305.

The Big Take-away:
Repeat head CT for patients with mild brain injuries who are taking anticoagulation is unnecessary and expensive.

 

 

So, a patient arrives in your emergency room saying she had a fall at home. Not a particularly bad fall, but a fall nonetheless. She says she was walking into the bathroom and slipped on some water. She reached for the sink, but couldn’t grab it ...

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ED Prevalence of C. Diff Infection

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The Article:

Abrahamian, Fredrick M., et al. “Clostridium difficile Infection Among US Emergency Department Patients With Diarrhea and No Vomiting.” Annals of Emergency Medicine (2017).

The Idea:

C. Diff infection has increasingly become a source of morbidity and mortality, especially for patients recently hospitalized or treated with antibiotics. Diarrhea, however, is a relatively common chief complaint, and emergency departments require more data to guide testing and treatment. This study narrowed its focus to patients with diarrhea but not vomiting, ...

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Early Aggressive Hydration Hastens Clinical Improvement in Mild Acute Pancreatitis

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The Article:

 

Early Aggressive Hydration Hastens Clinical Improvement in Mild Acute Pancreatitis. Buxbaum, Quezada Michael et. al. American Journal of Gastroenterology 2017; 112:797

 

Background:

 

Pancreatitis is one of the leading causes of hospitalization due to gastrointestinal disease in the USA. There are no pharmacological agents that have been shown to impact the course of acute pancreatitis and treatment is mainly supportive. Fluid resuscitation is recommended for pancreatitis based on animal models. It is important to note that increased hematocrit (Hct), blood urea nitrogen ...

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Managing Esophageal Coin Foreign Body in Pediatric Patients

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Article:
IS THERE A NEED FOR REPEAT RADIOLOGIC EXAMINATION OF CHILDREN WITH ESOPHAGEAL COIN FOREIGN BODY?

Dedhia, K., et al, Otolaryngol Head Neck Surg 156(1):173, January 2017

Background:
The swallowing of coins accounts for more than 80 percent of all foreign body ingestions. It is generally accepted that coins that pass into a child’s stomach will traverse the rest of the GI tract uneventfully while a coin in the esophagus has a higher likelihood for complication. Coins that do not pass into ...

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IV Fluid Prophylaxis Against Contrast-Induced Nephropathy?

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The Article:  Prophylactic hydration to protect renal function from intravascular iodinated contrast material in patients at high risk of contrast-induced nephropathy (AMACING): a prospective, randomised, phase 3, controlled, open-label, non-inferiority trial. Nijssen, Estelle C et al. The Lancet, Volume 389, Issue 10076

The Idea:
Contrast-induced nephropathy (CIN) has historically been considered the 3rd most common cause of acute kidney injury (AKI) in patients admitted to the hospital.  It is thought to increase in-hospital morbidity and mortality, although it usually resolves and leaves ...

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Pyuria and Urine Cultures in Patients with Acute Renal Colic

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The Study:

Dorfman M, Chan SB, Hayek K, and Hill C. “Pyuria and Urine Cultures in Patients with Acute Renal Colic.” J Emerg Med. Oct 2016;51(4): 358-264.

 

Background:

It is unknown how frequently patients presenting with renal colic and pyuria have a urinary tract infection versus sterile pyuria. There are no previous studies on the rate of pyuria in renal colic and prior studies on urinary tract infection rates in these patients have not been performed in the emergency department patient. There are ...

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Acute Kidney Injury After CT

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The Article:

Aycock, Ryan D., et al. “Acute Kidney Injury After Computed Tomography: A Meta-analysis.” Annals of Emergency Medicine (2017).

The Idea:

Computed tomography (CT) is an important imaging modality used in the diagnosis of a variety of disorders. Imaging quality and diagnostic accuracy are improved with use of IV contrast material. There has long been a concern for potential renal injury with use of IV contrast. The goal of this study was to compare the risk ...

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Treatment for Hyperemesis

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Article: Treatment for Hyperemesis Gravidarum and Nausea and Vomiting in Pregnancy: A systematic Review. JAMA 2016
Idea: what actually works, and is safe for use in hyperemesis gravidarum?
The study: This was a database search; 67 RCTs, 11 non-randomized patients with nausea and vomiting in pregnancy and how they were treated. Outcomes were symptomatic relief.
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Effect of Cephalexin Plus Trimethoprim-Sulfamethoxazole vs Cephalexin Alone on Clinical Cure of Uncomplicated Cellulitis: A Randomized Clinical Trial

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“Effect of Cephalexin Plus Trimethoprim-Sulfamethoxazole vs Cephalexin Alone on Clinical Cure of Uncomplicated Cellulitis: A Randomized Clinical Trial” JAMA. 2017;317(20):2088-2096.

http://jamanetwork.com/journals/jama/fullarticle/2627970

Background:

Skin infections are common complaints in emergency departments in the United States, especially with the rise of MRSA infections, considered the most common cause of purulent infections. In contrast, cellulitis without evidence of purulent drainage is predominantly caused by beta-hemolytic streptococci. The Infectious Disease Society of America practice guideline recommends treating uncomplicated cellulitis with anti-microbial coverage against only streptococci. ...

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Errors in Diagnosis of Spinal Epidural Abscess in the Era of Electronic Health Records

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The Article:

Errors in Diagnosis of Spinal Epidural Abscess in the Era of Electronic Health Records. Bhise V et al. Am J Med 2017 Aug; 130:957

The Idea: 

  • Spinal Epidural Abscess is a difficult diagnosis to make; delayed diagnosis is associated with significant M&M
  • There has not been a large EMR study conducted yet demonstrating reasons for diagnostic delay
  • Can we demonstrate diagnostic delay in a nationwide EMR database and identify the factors behind diagnostic delay in order to develop strategies to ...
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