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

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
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Ketamine vs Midazolam/ Haloperidol for acute agitation

Original paper here

What is this study about

  • Authors hypothesized that given intramuscularly, Ketamine would work quicker (and safer) when compare to traditional benzodiazepine and antipsychotic medication.
  • This is a RCT based on ED patients at a Canadian hospital in Vancouver
  • Although ED diagnosis is not stated, the age of these patients and prior history suggest primary mental health disorder and drug/ alcohol plays a big role in their acute agitated state.

Bottom line

  • Study is underpowered due to COVID-19 outbreak. In this RCT ketamine is about 3x faster to produce clinical effect compared to study drug. Lack of statistical evidence due to underpowered study, and lack of reporting of subsequent outcome (need for redosing, emergent phenomenon) limits the application of this study to day-to-day clinical practice.
  • Choice of chemical sedation for acutely agitated patient in the ED, is still determined by individual clinician preference and familiarity.

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Conservative versus Interventional Treatment for Spontaneous Pneumothorax

Conservative versus Interventional Treatment for Spontaneous Pneumothorax

Bottom line

Conservative management of stable unilateral, spontaneous primary pneumothorax, is not inferior to Seldinger drain, with lower risk of serious adverse events.

Majority of patient with unilateral primary spontaneous pneumothorax is safe for conservative management and discharge at 4 hrs, after a repeat CXR

High fragility index due to lost to follow-up means data is not statistically robust

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