Saturday, April 28, 2007

March Abstracts

  • Ogawa, A., et al, Circ J 70:1372, November 2006: Japanese study looking at pro-BNP in suspected ACS w/o CHF. They compared it to traditional cardiac markers. pro-BNP was much higher in NSTEMI vs STEMI pts. Poorly constructed study w/ lots of data mining. Nothing here should change your management.
  • LeMay, M.R., et al, Am J Emerg Med 8(6):401, November 2006: Pre-hospital EKG interpretation of EMT's in Ottawa w/ theoretical administration of thrombolytics. They would have overtreated some cases and only saved 44 minutes on average. Since we prefer PCI, nothing here will alter much.
  • Bradley, E.H., et al, N Engl J Med 355(22):2308, November 30, 2006: Yale study looking at door-to-balloon time. Average time across the nation was 100 minutes. You can improve your steps by having a single page operator, cath staff required to be present by 20 minutes, an in-house cardiologist, the ED doc can call the cath team in and real-time feedback to the ED.
  • Chung, T., et al, Am Heart J 152:949, November 2006: They examined the utility of BNP in the ED for patients w/ dyspnea. BNP testing was worse in pts w/ a h/o of CHF vs. those w/ a new history. Again, my personal approach is history, physical exam, CXR and the clinical picture will provide all the info you need for whether it's CHF. I don't order this test anymore.
  • Bursi, F., et al, JAMA 296(18):2209, November 8, 2006: Systolic vs. diastolic dysfunction in pts w/ CHF. Diastolic failure will have decent EF but poor filling of the chambers due to wall resistance. They performed an echo and almost 1/2 of pts w/ CHF didn't have systolic dysfunction (greater than 50%). BNP was mean of 380 in systolic and 183 in diastolic failure. 6 month mortality was 16% for both groups.
  • Busch, M., et al, Acta Anaesthesiol Scand 50:1277, 2006: Induced therapeutic hypothermia for out-of-hospital cardiac arrest who got a spontaneous return of circulation. Small group (N: 27), cooled to 33 degrees for 12 hours. Slightly more than half survived (but no mention of neuro outcome). Median time to receive target temp was 7.5 hours.
  • Blaivas, M., et al, J Emerg Med 31(4):407, November 2006: At the Medical College of Georgia, they taught nurses how to use an U/S to enable IV access for difficult pts for obtaining an IV. They had 89% of success rate utilizing the SonoSite. Something we may want to look at (Evan...)
  • Humm, A.M., et al, J Neurol Neurosurg Psych 77(11):1267, November 2006: Carotid sinus hypersensitivity as a cause of syncope. Defined by asystole greater than 3 secs and/or drop in SBP by 50. This is a technically difficult dx to make. Only 1 in 40 of pts b/w 40-60 had a positive test. Over 80 yrs old, 40% had it (but did it cause the syncope?). Either way, it's not worthwhile to make it a routine test to determine whether it caused the syncope.
  • Baden, E.Y., et al, Can J Emerg Med 8(6):393, November 2006: IV dexamethasone prior to discharge for ED pts w/ benign H/A. They've been treated and are ready to go home. Treated w/ either placebo or Decadron 10 mg IV. 58% of pts w/ placebo still had a H/A as follow-up but only 10% of Decadron pts still had a headache. Something to consider to help prevent bounceback.
  • Earnshaw, S.R., et al, Stroke 37:2751, November 2006: Use of NovoSeven for the treatment of ICH. This is expensive stuff $10,000 for the large dose, $5000 for medium dose, $2500 for small dose. The most cost-effective dose was w/ the middle dose (80 mcg/kg). I'm still not sold on this medicine, but you'll be hearing more and more for different uses (trauma, etc).
  • Cooper, J., et al, Ann Emerg Med 48(4):459, October 2006: Clinical risk for assessing self-harm. Prior history of attempt, prior psych dx, current psych dx, or current use of benzo during this episode all are positive risk factors for completing suicide w/in 6 months. All 22 pts who completed suicide had one of these criteria.
  • Hennerici, M.G., et al, Lancet 368:1871, November 25, 2006: Placebo or Ancrod for pts w/ ischemic stroke. Ancrod is taken from pit vipers and helps decrease thrombus formation. Ancrod wasn't better than tPA, but coincidentally has performed better than tPA when you review results b/w different studies. Nothing new to take here.
  • Meurer, L.N., et al, Ann Fam Med 4(5):410, September/October 2006:
  • Earnshaw, S.R., et al, Stroke 37:2751, November 2006: Medical College of Wisconsin study that looked at all pts who had some sort of medical injury due to trx, error, etc. However when corrected for baseline mortality risk, the magnitude of error is much lower than previously stated.
  • Rossignol, J.F., et al, Aliment Pharm Ther 24(10):1423, November 2006: Use of Nitazoxanide for treatment of gastroenteritis. It shortens the course by one day. Nothing that we'd really use here or change treatment.
  • Bartlett, J.G., Ann Intern Med 145(10):758, November 21, 2006: C-diff is now the most common cause of diarrhea in the US (when identified). More virulent strains and complications now then in prior years. PPI's increase the risk. Fluoroquinolones and cephalosporins are the most common Abx that cause it.
  • Springhart, W.P., et al, J Endourol 20(10):713, October 2006: There was no difference in pts w/ renal colic b/w those who received no IVF or those who got large boluses. Interesting of note.
  • Turrentine, M.A., Obstet Gyn 107(2, Part 1):310, February 2006: Pts who were on Coumadin and took a one time dose of Diflucan had a 1/3 elevation of their INR. Only 6 patients and no significant bleed.
  • Shapiro, N., et al, Ann Emerg Med 48(5):583, November 2006: Patients with end-organ dysfunction do worse. However pts w/ SIRS didn't do worse. The bottom line is if you have shock, you're going to do worse.
  • Micek, S.T., et al, Crit Care Med 34(11):2707, November 2006: Before and after study of utilizing septic shock order sets in a hospital based on the Surviving Sepsis Campaign. 30 vs. 48% mortality and 3 days shorter time in the hospital. May simply be due to more aggressive IVF and early/appropriate Abx. Sponsored by the company that makes Xigris.
  • Tamir, E., et al, J Emerg Med 31(4):403, November 2006: For patients who are ambulating after MVC, do you need T/L/S spine xrays? No pts out of 1100 had a significant finding. Poor study, but probably not unrealistic.
  • Dalton, J.D., et al, Ann Emerg Med 48(5):615, November 2006: Randomized trial for adults w/ ankle sprains to Tylenol vs. Ibuprofen. There was no difference b/w the two groups.
  • Friedman, B.W., et al, J Emerg Med 31(4):365, November 2006: No change in pts receiving IM dose of corticosteroids for non-radicular LBP.
  • Tindall, A., et al, Emerg Med J 23:883, November 2006: Skin-wrinkle test for nerve injury in pediatric or non-cooperative pts. W/ autonomic nerve injury, they won't have wrinkles on their hand after wet. Nothing I'd use in the ED.
  • Bisset, L., et al, Br Med J 333:939, November 2006: Treatment of lateral epicondylitis (tennis elbow). Steroids work early but the effects change quickly and ultimately doesn't help.
  • Walsh, K.E., et al, Pediatrics 118(5):1872, November 2006: After implementation of computer order entry systems in pediatrics, 20% of errors were due to the computer system. Many studies show that they systems have lots of associated risks w/ them and while they may help w/ efficiency to a degree, there are lots of unintended consequences.
  • Psaty, B.M., et al, JAMA 295(23):2787, June 21, 2006: When doctors are involved in "seeding studies" (studies never meant to be published, but gain acceptance on formulary, pay the doc, get them to prescribe drugs, etc), not only do the docs involved, but their partners end up prescribing whatever pharmaceutical is involved.
  • Boyd, J.J., et al, Acta Anaesthesiol Scand 50(10):1266, November 2006: For heroin OD's who received pre-hospital narcan and signed out AMA, they had no adverse effects. If they're going to need narcan, they'll need it in the first hour. They state that if you follow a heroin OD for at least one hour and they do fine, they're safe for d/c.
  • Salo, D., et al, J Emerg Med 31(4):371, November 2006: RCT of continuous Alb SVN vs continuous Alb SVN + Atrovent for the trx of acute asthma. Adding atrovent really doesn't change anything in acute asthma (more beneficial in COPD). They were using 15 mg of Albuterol as part of the continuous trx.
  • Tsai, W.K., et al, Am J Emerg Med 24(7):795, November 2006: Pig-tail vs large-caliber chest tubes for spontaneous PTX. Use of the pig-tails is just as well and didn't cause significant problems down the line.
  • Cohen-Kerem, R., et al, Clin Ped 45:828, November 2006: OTC cold remedies for peds pts hasn't shown to be of benefit, but family docs love giving it and pediatricians as well (but not so much).
  • Turkcuer, I., et al, Am J Emerg Med 24(7):763, November 2006: Turkish study showing U/S is better than x-rays at finding wood or rubber FB in soft tissues. Since we have a SonoSite and 24 hr U/S, better to use that than the needless x-ray for non-metallic FB's.
  • Ott, M., et al, J Trauma 61(3):607, September 2006: Guess what, trauma pts get lots of radiation (probably more than we should). Try to be judicious when ordering x-rays, CT's, etc.
That's it...


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