June Abstracts

• Here are the June abstracts broken down for you. There's some interesting facts to make note of.
• Goldman, R.D., et al, Ped Emerg Care 22(1):18, January 2006: Last time we’ll address this point (and I don’t see it as a problem in our ED or in dealing with our surgeons), pain meds in the ED doesn’t affect the diagnosis of pediatric abdominal pain.
• The ASSENT-4 PCI Investigators Lancet 367:569, February 18, 2006: Facilitated PCI (i.e. G2b3a + PCI) in this study TNKase was used- these patients do much worse than patients who solely have PCI. This is a very negative study in terms of adverse outcomes (stroke, etc) with number need to harm 15, number needed to kill 50. The bottom line is if a patient is going for a PCI don’t administer G2b3a prior to it. A very important study to know about. It was done by the drug sponsor though and their thought is they’ll try giving ½ dose and hope that works.
• Keeley, E., et al, Lancet 367:579, February 18, 2006: Another meta-analysis that demonstrates no difference in TIMI flow rate, but higher bleeding rates, mortality, deleterious cardiovascular outcomes, (bad stuff) in facilitated PCI. Ergo, I’m not going to be asking cardiologists if they want G2b3a’s to be added if I think they need or are going to the cath lab.
• Jimenez, N., et al, Anesth Analg 102:411, 2006 A needless injector system for topical anesthesia (J-Tip) vs EMLA in IV sticks and blood draws showed significantly decreased pain. This is a relatively inexpensive system $2.15 per unit. It makes a loud pop prior to its use (CO2 driven system). It might be something to use as a trial in the ED in our peds population.
• Shibata, T., et al, Clin J Pain 22(2):193, February 2006: It’s possible to have a SAH from vertebrobasilar dissection. You need to do an MRI/MRA to diagnosis it and it can happen with seat-belt injuries, chiropractic manipulation, etc. Typically sudden onset headaches with possibly transient neuro deficits. Dissections can have stuttering neuro systems and are unilateral.
• Bonsu, B.K., et al, Ped Infect Dis J 25(1):8, January 2006: Traumatic LP’s in determining meningitis- don’t dismiss WBC’s in tube #4 (even if it’s traumatic and has high RBC’s). Treat it as meningitis.
• Deng, Y.Z., et al, Neurology 66:306, February 2006: tPA in ischemic CVA had worse outcomes (death and neuro deficits). 9.3 vs 2% mortality. 25% more bad outcomes in survivors. Either way, results that don’t support the use of tPA and show patients do worse with it.
• O'Donnell, J.J., et al, Stroke 37:452, February 2006: Nobody should give heparin in ischemic stroke. This is the bottom line and important to know.
• Gill, M., et al, Acad Emerg Med 13(2):158, February 2006: The use of Provigil in ED docs after their night shifts to keep them awake during conferences in the morning. This made them a little more alert, but had harder time falling asleep later that day.
• Kothari, C.L., et al, Ann Emerg Med 47(2):190, February 2006: Women suffering from domestic violence are often seen in the ED for other CC’s.
• Meltzer, E.O., et al, J Allergy Clin Immunol 116:1289, December 2005: Treating rhinosinusitis with Nasonex (inhaled steroids0 may make symptoms a little better. This is a flawed study however and the patients weren’t significantly better.
• Foucault, C., et al, J Infect Dis 193:474, February 1, 2006: Using ivermectin in the treatment of body lice with one pill. A nice, easy treatment.
• Moser, J.D., et al, Ann Pharmacother 40:45, January 2006: The bioavailability of Phenergan PO is only 25%. Ergo, they recommend using a smaller IV dose that sedates less and may still be effective.
• Taylor, M., et al, J Ped Surg 40:1912, December 2005: Most appys do ok if you wait until the morning for surgery if you give them IVF, Abx and pain meds. The perforation rate wasn’t higher and outcomes weren’t worse. This was an underpowered study and not randomized, but supports this option for our surgeons
• Barrett, T.W., et al, Ann Emerg Med 47(2):129, February 2006: If someone has a cervical spine injury, they have a higher risk of having significant thoracic vertebral injury. You’ll need to CT the cervical and thoracic spine.
• Chana, R., et al, Injury 37(2):185, February 2006: The use of MRI in evaluating occult femoral neck fractures. If you’re concerned about the possibility and they have negative plain films, consider the CT or MRI. These patients can ambulate as well (been documented in the literature) so don’t use that fact as excluding the possibility of that happening.
• Spiller, H.A., et al, J Emerg Med 30(1):1, January 2006: In patients with Tylenol OD, they were given NAC and one dose of delayed charcoal (after 4 hours). These patients actually did better. This is a small, non-randomized study however.
• Walls, R.M., et al, Ann Emerg Med 46(5):409, November 2005: A review that demonstrated that obtaining blood cultures prior to Abx in pneumonia doesn’t have any benefit or evidence. This is a critique of Joint Commission’s pneumonia’s guidelines. Also of note, Pfizer sponsored the American Thoracic Society’s position on CAP (which became the basis for the Joint Commission’s guidelines).
• Zehtabchi, S., et al, Injury 37(1):46, January 2006: The use of serial hematocrits in trauma patients to determine major injuries. The bottom line is a significant drop in the HCT (greater than 5) over 4 hours is important. With regards to IVF’s causing a diluting effect, it only caused the HCT to drop 3 points (vs 1.5).
• That's it for this month's abstracts. Be on the look out for LLSA info.