October Abstracts

• McNamara, R.L., et al, J Am Coll Card 47(11):2180, June 6, 2006: Median door-to-balloon time was 102 minutes. They demonstrated a direct correlation b/w door-balloon time and outcome. Mortality went up with every 30 minutes increments. However, this was not a randomized study and all CP's started within 6 hours.
• Daniels, L.B., et al, Am Heart J 151:999, May 2006: They looked at the direct correlation b/w BNP and obesity. BMI is inversely related, so you need a lower-cut off for obese individuals. Nice oh by the way, but nothing that changes my practice.
• Murray, H., et al, Can J Emerg Med 8(4):251, July 2006: The use of BNP in the evaluation of acute dyspnea in the ED. First of all there's no difference b/w BNP and pro-BNP. Different cut-off values, but essentially the same test. They performed a retrospective chart review testing the efficacy of BNP in dx'ing CHF. The bottom line is BNP will overcall CHF and your clinical skills will be just as good (if not better) as the BNP test. If you think it's CHF, it's going to be CHF and the test won't help. BNP is only sometimes useful in patients who you're not sure and only then it MIGHT help. I really never order this test anymore unless someone else wants the results.
• Battaglia, M., et al, Arch Intern Med 166:1073, May 22, 2006: A meta-analysis again looking at BNP in the dx of CHF. It's only 80% accurate as a test. If you're going to treat a pt as if they have CHF, don't bother w/ getting the test. Especially if you're going to treat them the same way regardless of the results.
• Singer, A.J., et al, Acad Emerg Med 13(6):623, June 2006: They used a laser to help pretreat skin before IV cannulation in adult and peds. This "laser" (attached to ill-tempered sea bass) seems to work.
• Hallstrom, A., et al, JAMA 295(22):2620, June 14, 2006: Studied the difference b/w manual CPR and a device that provides mechanical piston compressions. They actually showed that it was worse vs. manual CPR and they stopped the study early. Another study showed a positive effect w/ the device.
• Pizon, A.F., et al, J Emerg Med 30(4):367, May 2006: A chart review looking at meningitis over the last 10 years. The classic triad wasn't there frequently. Be careful of post-up NSG patients. Nothing horribly exciting from the study. It's becoming more uncommon in immunocompetant pts.
• Hoffman, J.R., Emerg Med Australasia 18(3):215, June 2006: An editorial looking at the use of thrombolytics in ischemic CVA. There have been malpractice suits against docs for NOT giving tPA. Of course the medical research hasn't shown a benefit, but actually worse outcomes when given. There may eventually be legislation forcing "stroke centers" to give tPA or not be deemed as such. The bottom line is that there isn't any good evidence that it shows benefit. It probably does more harm than good.
• Willmot, M., et al, Hypertension 47:1209, June 2006: Transdermal glyceryl trinitrate lowers BP, but didn't affect outcomes in acute ischemic or hemorrhagic CVA. A small study and they didn't measure CPP. Nothing here that would change your management.
• Birbeck, G.L., et al, Neurology 66:1527, May 2006: They looked at the effect of a stroke team at specialty hospitals/centers. Number needed to treat was 1 for every 50. Having a stroke team might not do anything except making sure they receive the appropriate treatment under the correct circumstances. This was a survey however.
• Banks, J., et al, JAMA 295(17):2037, May 3, 2006: An oh-by-the-way study, but we spend more than twice on health care per person in the US vs. England, however, over all socioeconomic classes, we have much sicker people. Even though we have lower smoking rates, etc. the US does worse on all levels.
• Garbutt, J., et al, Pediatrics 117(6):e1087, June 2006: If you're going to trx peds AOM w/ Abx, regular dose Amox 45 mg/kg/d (not high-dose) unless you have a very good reason.
• Manes, G., et al, Am J Gastroenterol 101(6):1348, June 2006: An Italian study that looked at early, prophylatic Abx in the management of acute pancreatitis. There were no differences in major outcomes (death, sepsis, etc).
• Kennedy, K.P., et al, Br J Urol 97(5):903, May 2006: Dietary tips for prevention of kidney stones. PO hydration is the biggest factor (drink lots). Decreasing calcium doesn't change anything. Unless you're eating large amounts of oxalate foods, it shouldn't make a difference.
• Huttner, H.B., et al, Stroke 37:1465, June 2006: A small chart review that at prothrombin complex concentrates (PCCS) vs. Vit K or FFP in acute intracranial hemorrhage. Outcomes were poor in all groups. There didn't show a benefit in any group.
• Kumar, A., et al, Crit Care Med 34(6):1589, June 2006: Shortening the time of Abx in septic patients (thus by definition hypotensive). The survival decreased by 7.6% with each hour that passed in delay to Abx. Nothing horribly surprising.
• Cooper, W.O., et al, N Engl J Med 354(23):2443, June 8, 2006: The use of ACE inhibitors during the first trimester of pregnant females. There was a three-fold increase in CNS and cardiac abnormalities. Thus if it's a female who may be or is pregnant, get them off ACE inhibitors.
• Caird, M.S., et al, J Bone Joint Surg 88A(6):1251, June 2006: A decision tree in determining toxic synovitis vs. septic arthritis in peds hips. What's interesting is that 17.5% that had none of the criteria had septic arthritis. If in doubt, tap the joint.
• Rivero-Arias, O., et al, Spine 31(12):1381, May 20, 2006: PT didn't change outcome in LBP (simple musculo-skeletal) strain.
• Mularski, R.A., et al, J Gen Intern Med 21(6):607, June 2006: Using the pain scale as a "5th" vital sign didn't change outcome. People would still be hurting and they'd document the pain scale, but meds didn't come aflowin'...
• Heres, S., et al, Am J Psych 163(2):185, February 2006: A startling (sarcasm) study that showed that drug company sponsored studies may not depict accurate results, cause bias, etc.
• Kim, M.K., et al, Ped Emerg Care 22(6):397, June 2006: They looked at vomiting of corticosteroids during an asthma exacerbation. 17.7% blew chunks after generic prednisolone vs. 5.4% w/ Orapred.
• Putland, M., et al, Ann Emerg Med 47(6):559, June 2006: Chart review looking at adverse effects of IV epi for asthma exacerbation. Major adverse effects in 3.5% but no long term consequences (maybe just b/c they were sick asthmatics). Still use it w/ caution and be wary of possible effects.
• Levitan, R.M., et al, Ann Emerg Med 27(6):548, June 2006: Laryngeal view during intubation using BURP (Back, up, right) technique vs. Sellick maneuver vs. bimanual laryngoscopy. Bimanual was the best for getting glottic view. This means you have the scope in your let hand and you move the cartilage yourself w/ your right hand, once you find the spot have an assistant hold it in position.
• Stein, P.D., et al, N Engl J Med 354(22):2317, June 1, 2006: The use of a multi-slice CT scanner is better at finding a PE than single-slice CT scanners. CT venograms can miss up to 14% of PE's. If the CT chest is negative and you have a high-index of suspicion, get the duplex LE U/S as well looking for DVT.
• Matthews, S., Br J Radiology 79:441, May 2006: Use of CT chest to r/o PE in pregnant females. V/Q scans have higher radiation to the fetus than a CT chest. Bottom line is if you need to evaluate for PE, get the CT chest. Better that mom gets the radiation than the fetus.
• Martin, D.R., et al, Lancet 367:1712, May 27, 2006: You get 10-20 mSv of radiation with each CT. This translates into a risk for leukemia or lymphoma in 1 in a 1000 due to the radiation. Other estimates have it at 1:2000. Either way, some stats for your patients and your own edification.