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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Antibiotics for Simple Dental Pain?

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The Article:

Gottlieb M, Khishfe B. “Are antibiotics necessary for dental pain without overt infection.” Ann Emerg Med. 2017 Jan;69(1):128-130.

The Idea:

Dental pain is a common complaint seen in the emergency department and frequently results in prescriptions for antibiotics as well as analgesics. Is there any evidence that the addition of an antibiotic to pain medication in non-infected dental pain adds benefit?

The Study:

Review of 2 small randomized controlled trials. The authors did a Pubmed search for studies that specifically looked at antibiotics ...

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Antibiotics and Risk of Community-Associated C. difficile Infection

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The Article: Brown, KA, et al. “Meta-Analysis of Antibiotics and the Risk of Community-Associated Clostridium difficile Infection” Antimicrobial Agents and Chemotherapy 2013;57:2326-2332.

Bottom line: Outpatient clindamycin, fluoroquinolones, cephalosporins, monobactams, and carbapenems are associated with high risk of C. diff infection. Outpatient macrolides, sulfonamides and trimethoprim, and penicillins are associated with lower risk of C. diff infection. Outpatient tetracycline use is NOT associated with significant risk of C. diff infection.

The Idea: Incidence of community-acquired ...

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Temple EM shines at World Academic Congress of EM

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The INDUSEM World Academic Congress of Emergency Medicine was held in Sri Lanka on October 8-15, 2017.

Temple Emergency Medicine faculty, residents and former residents had a major presence at this renowned interional conference:

 

Image result for indusem wacem

WACEM 2017 (World Academic Congress of Emergency Medicine) in Sri Lanka

(A Level One International Meeting Dedicated to Emergency, Trauma & Disaster Medicine)

 

Lectures:

 

“The Hanging Victim.” Fundamentals of Resuscitation in Trauma Symposium.  Blue Water Hotel Sri Lanka.  October 13, ...

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DOACs Update Part II

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This is Part II in a series.

Part I

BLEEDING COMPLICATIONS

Studies have shown that there is a similar or increased rate of occurrence of gastrointestinal bleeding in patients taking DOACs when compared to warfarin9. Decreased rates of intracranial hemorrhage (ICH), smaller hematoma size, and decreased hematoma expansion have been noted in patients taking DOACs versus those taking warfarin 10,11, 12. Studies show no difference in morbidity or mortality in patients taking DOACs versus warfarin for patients with ...

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