Category Archives: Papers of the week

Important studies / research papers relevant to Emergency Medicine

Intensive Ambulance-Delivered Blood Pressure Reduction in Hyperacute Stroke.

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Intensive Ambulance-Delivered Blood- Pressure Reduction in Hyperacute Stroke   Li, Y. Lin, J. Yang, C.S. Anderson, C. Chen, F. Liu, L. Billot, Q. Li, X. Chen, X. Liu, X. Ren, C. Zhang, P. Xu, L. Wu, F. Wang, D. Qiu, M. Jiang, Y. Peng, C. Li, Y. Huang, X. Zhao, J. Liang, Y. Wang, X. Wu, Xiaoyun Xu, G. Chen, D. Huang, Y. Zhang, L. Zuo, G. Ma, Y. Yang, J. Hao, Xiahong Xu, X. Xiong, Y. Tang, Y. Guo, J. Yu, S. Li, S. He, F. Mao, Q. Tan, S. Tan, N. Yu, R. Xu, M. Sun, B. Li, J. Guo, L. Liu, H. Liu, M. Ouyang, L. Si, H. Arima, P.M. Bath, G.A. Ford, T. Robinson, E.C. Sandset, J.L. Saver, N. Sprigg, H.B. van der Worp, and L. Song, for the INTERACT4 investigators*                                               N Engl J Med 2024;390:1862-72. May 16 2024

Background                                                                                                        Treatment of acute stroke, before a distinction can be made between ischemic and haemorrhagic types, is challenging. Whether very early blood-pressure control in the ambulance improves outcomes among patients with undifferentiated acute stroke is uncertain

 

Rocuronium ≤1.5 mg/kg versus >1.5 mg/kg and inadequate paralysis in prehospital and retrieval intubation: A retrospective study Clare Hayes-Bradley MBBS

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Rocuronium ≤1.5 mg/kg versus >1.5 mg/kg and inadequate paralysis in prehospital and retrieval intubation: A retrospective study

Clare Hayes-Bradley MBBS, BSc, Madelaine Tarrant MBChB, BSc

First published: 01 June 2022

https://doi.org/10.1111/1742-6723.14008

 

Findings

High dose Rocuronium leads to lower rates of inadequate relaxation Continue reading →

paper of the week

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Effect of a Diagnostic Strategy Using an Elevated and Age-Adjusted D-Dimer Threshold on Thromboembolic Events in Emergency Department Patients With Suspected Pulmonary Embolism

JAMA. 2021;326(21):2141-2149. doi:10.1001/jama.2021.20750

 Overview

  • Combination of PERC, YEARS and age adjusted DDimer has been reviewed regarding the use of advacnced imaging and detection of PE in comparison to the classical pathway (definition below)

Bottom line

  • Inclusion of YEARS criteria in workup of VTE patients can be valuable to reduce chest imaging
  • This study is not specific for pregnant patients, further clinical trials will be required

Continue reading →

Intranasal Topical Application of Tranexamic Acid in Atraumatic Anterior Epistaxis

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Original paper

 

 

 

Findings

  • Intranasal topical TXA is associated with a lower rate of need for anterior nasal packing and a shortened stay in the ED

Bottom line

  • Topical TXA for epistaxis is slowly gaining traction despite recent negative study (NoPAC)
  • This RCT fits author’s own experience- ineffective for posterior bleeding, delayed presentations or traumatic epistaxis, but no harm and better tolerated than balloon tamponade device (RapidRhino etc)

Continue reading →

Efficacy of empiric abx for septic olecranon bursitis without aspiration in ED

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Findings

  • In this series, 84% of patient was discharged from ED, 55.3% with antibiotic. Only 1.5% had elbow aspiration in ED. 88% had resolution at follow-up.

Bottom line

  • Author concluded that aspiration in ED is not necessary even when septic bursitis is suspected, and most can be managed with outpatient antibiotic
  • Performing a CRP blood test, and/or referral to orthopedic service, is associated with admission and antibiotic administration
    Continue reading →