Aromatherapy Versus Oral Ondansetron for Antiemetic Therapy Among Adult Emergency Department Patients: A Randomized Controlled Trial – Annals of Emergency Medicine (link to abstract – $ for full-text)
Commentaries: Practice Changing: Inhaled Isopropyl Alcohol Superior to Oral Ondansetron as an Antiemetic – NEJM Journal Watch (free) AND Wake Up And Smell the Isopropyl – Emergency Medicine Literature of Note (free)
Related guideline: 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association / American Stroke Association (free PDF) AND Summary for ED-relevant care: 2018 AHA/ASA Ischemic Stroke Updates – emDocs (free)
“In routine clinical practice, endovascular treatment for patients with acute ischemic stroke is at least as effective and safe as in the setting of a randomized controlled trial”.
N-Terminal Pro–B-Type Natriuretic Peptide in the Emergency Department – Journal of the Americana College of Cardiology (link to abstract – $ for full-text)
Related review: BNP in the emergency department: The evidence – First10EM (free)
“In acutely dyspneic patients seen in the ED setting, age-stratified NT-proBNP cutpoints may aid in the diagnosis of acute HF. An NT-proBNP <300 pg/ml strongly excludes the presence of acute HF”.
A free, online resource on the principles and interventions needed to reduce healthcare associated infections, with suggested control measures across different resource levels.
Summary for ED-relevant care: 2018 AHA/ASA Ischemic Stroke Updates – emDocs (free)
Original guideline: 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association (free PDF)
Commentary with key points to remember: European Position Paper on Spontaneous Coronary Artery Dissection – American College of Cardiology, Latest in Cardiology (free)
Fluid therapy in neurointensive care patients: ESICM consensus and clinical practice recommendations – Intensive Care Medicine (free for a limited period) (via @luiscamacho02)
Editorial: Escalating Inhaled Glucocorticoids to Prevent Asthma Exacerbations (free for a limited period)
Trial 1: Quintupling Inhaled Glucocorticoids to Prevent Childhood Asthma Exacerbations – The New England Journal of Medicine (free for a limited period)
Trial 2: Quadrupling Inhaled Glucocorticoid Dose to Abort Asthma Exacerbations – The New England Journal of Medicine (free for a limited period)
Colistin alone versus colistin plus meropenem for treatment of severe infections caused by carbapenem-resistant Gram-negative bacteria: an open-label, randomised controlled trial – The Lancet (link to abstract – $ for full-text)
“Combination therapy was not superior to monotherapy”.
Source: Critical Care Reviews Newsletter
“Balanced crystalloids may be superior to saline in critically ill patients — but not in patients hospitalized outside an ICU” (from Physician’s First Watch)
Hydrocortisone plus Fludrocortisone for Adults with Septic Shock – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary: Hydrocortisone-fludrocortisone cuts deaths in septic shock – The Hospitalist (free)
News release: Responding to inflight medical emergencies can be stressful for doctors – CMAJ News (free)
Impact of treatment delay on mortality in ST-segment elevation myocardial infarction (STEMI) patients presenting with and without haemodynamic instability: results from the German prospective, multicentre FITT-STEMI trial – European Heart Journal (free)
Commentaries: 3% rise in deaths for every 10 min delay in restoring blood flow after heart attack – OnMedica (free) AND Treatment Delay and Mortality in STEMI With Shock – American College of Cardiology, Latest in Cardiology (free)
Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy: American Society of Clinical Oncology and Infectious Diseases Society of America Clinical Practice Guideline Update – Journal of Clinical Oncology (free)
Related guidelines: Diagnosis and empirical treatment of fever of unknown origin (FUO) in adult neutropenic patients: guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO) (free) AND Management of febrile neutropaenia: ESMO Clinical Practice Guidelines (free) AND Guideline for the Management of Fever and Neutropenia in Children With Cancer and Hematopoietic Stem-Cell Transplantation Recipients: 2017 Update (free)
Policy Statement: Pediatric Medication Safety in the Emergency Department – American Academy of Pediatrics (free)
Commentaries: Recommendations Issued on Reducing Pediatric Medication Errors in the ED – NEJM Physician’s First Watch (free) AND Policy statement outlines ways to improve pediatric medication safety – 2 Minute Medicine (free)
Original article: Interventions for paracetamol (acetaminophen) overdose – Cochrane Library (link to abstract – $ for full-text)
Effect of the Pulmonary Embolism Rule-Out Criteria on Subsequent Thromboembolic Events Among Low-Risk Emergency Department Patients: The PROPER Randomized Clinical Trial – JAMA (link to abstract – $ for full-text)
Commentaries: Pulmonary Embolism Rule-out Criteria non-inferior to usual care for patients at low-risk for pulmonary embolism – 2 Minute Medicine (free) AND EM Nerd-The Case of the Diagnostic Absurdity (free) AND Using PERC & Sending Home Pulmonary Emboli For Fun and Profit – Emergency Literature of Note (free)
Related articles: Stress cardiomyopathy of the critically ill: Spectrum of secondary, global, probable and subclinical forms – Indian Heart Journal (free) AND Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy – New England Journal of Medicine (free) AND The challenge of Takotsubo syndrome: heterogeneity of clinical features – Swiss Medical Weekly (free) AND Clinical Management of Takotsubo Cardiomyopathy – Circulation Journal (free)
“Reproducibility in Critical Care trials from NEJM, Lancet, JAMA. Bottom line:
-Attempt to reproduce previous findings: 42%
-Original studies reported larger effects
Commentaries: Infective Endocarditis Vegetation Size vs. Embolic Risk – American College of Cardiology, Latest in Cardiology (free) AND Larger Endocarditis Vegetations More Likely to Embolize, Kill – MedPage Today (free registration required)
Clinical Guidelines Synopsis: Management of ARDS in Adults – JAMA (free)
Related Review: Acute Respiratory Distress Syndrome: Advances in Diagnosis and Treatment – JAMA (free)
Related: Infographic: ATLS Trauma Update 2018
Prophylactic haloperidol in this population with elevated risk of delirium did not reduce mortality or any of the 15 prespecified secondary outcomes, including delirium incidence, 28-day delirium-free and coma-free days, duration of mechanical ventilation, and ICU and hospital length of stay.
Among patients with low risk acute coronary syndrome, stress echocardiography, cardiovascular magnetic resonance, and exercise electrocardiograms resulted in fewer invasive referrals for coronary angiography than coronary computed tomographic angiography, without apparent impact on the future risk of myocardial infarction. Similarly, for outpatients with suspected stable angina, an initial strategy based on functional testing might be preferable, resulting in fewer referrals for invasive coronary angiography and revascularization, without a statistically significant difference in the future risk of MI.
“The review confirms small benefits on symptom relief, namely shortening duration of symptoms by half a day on average. However, there is little evidence to support any belief that use of NIs reduces hospital admission or the risk of developing confirmed pneumonia”. (from Cochrane)
New-Onset Atrial Fibrillation After PCI or CABG for Left Main Disease: The EXCEL Trial – Journal of the American College of Cardiology (link to abstract – $ for full-text)
Commentaries: One in Five CABG Patients Develop New-Onset Atrial Fibrillation: EXCEL – TCTMD (free) AND Post-operative AFib common in CABG, linked to future stroke, death – Cardiovascular Business (free)
Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine – New England Journal of Medicine (link to abstract – $ for full-text)
Commentaries: No benefit of sodium bicarbonate or acetylcysteine for prevention of complications after angiography: The PRESERVE trial – 2 Minute Medicine (free) AND Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine – NEJM Resident 360 (free)
“Among patients at high risk for renal complications who were undergoing angiography, there was no benefit of intravenous sodium bicarbonate over intravenous sodium chloride or of oral acetylcysteine over placebo for the prevention of death, need for dialysis, or persistent decline in kidney function at 90 days or for the prevention of contrast-associated acute kidney injury”.
Source: Antiarrhythmics: multinational consensus recommendations – Univadis (free registration required)
Commentary: New Guidelines for Treating Checkpoint Inhibitor Toxicities – Medscape (free registration required)
Relate guideline: Managing toxicities associated with immune checkpoint inhibitors: consensus recommendations from the Society for Immunotherapy of Cancer (SITC) Toxicity Management Working Group (free) AND Review: New drugs, new toxicities: severe side effects of modern targeted and immunotherapy of cancer and their management – Critical Care (free)
Original article: Effectiveness and cost-effectiveness of serum B-type natriuretic peptide testing and monitoring in patients with heart failure in primary and secondary care: an evidence synthesis, cohort study and cost-effectiveness model – Health Technology Assessment (free)
Prognostic Accuracy of the Quick Sequential Organ Failure Assessment for Mortality in Patients With Suspected Infection: A Systematic Review and Meta-analysis – Annals of Internal Medicine (link to abstract – $ for full-text)
Commentaries: For mortality prediction, qSOFA has poor sensitivity, moderate specificity, review finds – ACP Hospitalist (free) AND Systemic inflammatory response syndrome criteria may be more sensitive than quick sequential organ failure assessment for predicting mortality in patients with suspected infection – 2 Minute Medicine (free)
Press release: Hydroxyethyl-starch solutions for infusion to be suspended (free)
Original article: Effect of treatment delay on the effectiveness and safety of antifibrinolytics in acute severe haemorrhage: a meta-analysis of individual patient-level data from 40 138 bleeding patients – The Lancet (free) AND Invited Commentary: Tranexamic acid: is it about time? (free)
“It is now clearer that every 15-minute delay after the first hour can reduce survival by about 10%”.
Original article: Prolonged versus short-term intravenous infusion of antipseudomonal β-lactams for patients with sepsis: a systematic review and meta-analysis of randomised trials – The Lancet Infectious Diseases (link to abstract – $ for full-text)
Author Interview: Prevalence of Pulmonary Embolism in Patients With Syncope (free)
Related reviews: Toxicities of chimeric antigen receptor T cells: recognition and management – Blood (free) AND Toxicity and management in CAR T-cell therapy – Molecular Therapy Oncolytics (free) AND New drugs, new toxicities: severe side effects of modern targeted and immunotherapy of cancer and their management – Critical Care (free)
Commentaries: Fluid Overload Boosts Mortality in Critically Ill Children – Medscape (free registration required)
Commentaries: More stroke patients eligible for crucial treatments under new guidelines – American Heart Association News (free) AND More stroke patients may receive crucial treatments under new guideline – AHA/ASA Newsroom (free)
“A new guideline for treating acute ischemic stroke recommends an increased treatment window for mechanical clot removal from six hours to up to 24 hours in certain patients with clots in large vessels”. (from AHA/ASA Newsroom)
Commentaries: Brain-scan guided emergency stroke treatment can save more lives – NIH News Releases (free) AND Study confirms late clot extraction can save brain cells of stroke victims – Reuters (free) AND New Findings Could Save Lives of More Stroke Patients – The New York Times (10 articles per month are free)
Related article: Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary: Delays Raise Death Risk in Kids with Status Epilepticus – MedPage Today (free registration required)
“These findings may change the perception of acute seizure and status epilepticus treatment, tentatively converting it into an extremely time-sensitive emergency that is similar to stroke or other cardiovascular events”.
Commentaries: The Definitive Word on Steroids in Septic Shock – Emergency Medicine Literature of Note (free) AND Adrenal – The Bottom Line (free)
“For the primary outcome, there was no statistically significance difference in mortality at 90 days – 27.9% in the hydrocortisone cohort, and 28.8% with placebo. Looking at secondary outcomes, the results here tended to favor hydrocortisone – a slightly faster resolution of shock, shorter ICU stays, and, oddly, decreased transfusion requirements”. (from Emergency Medicine Literature of Note Blog)
Commentaries in the same issue: Evidence-Based Guidelines for Fatigue Risk Management in Emergency Medical Services: A Significant Step Forward and a Model for Other High-Risk Industries (free) AND What an Evidence-based Guideline for Fatigue Risk Management Means for Us: Statements From Stakeholders (free) AND Proposed Performance Measures and Strategies for Implementation of the Fatigue Risk Management Guidelines for Emergency Medical Services (free) AND Evidence-Based Guidelines for Fatigue Risk Management in Emergency Medical Services: A Step in the Right Direction Toward Better Sleep Health (free)
Critical Care Reviews Book 2018 (free PDF)
“The Critical Care Reviews Book summarizes, critiques and puts in context the biggest trials of the year”.
Source: Critical Care Reviews Newsletter
Related guidelines: 2017 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations Summary – Resuscitation (free) 2017 American Heart Association Focused Update on Adult Basic Life Support and Cardiopulmonary Resuscitation Quality (free PDF) AND 2017 American Heart Association Focused Update on Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality (free PDF)
Related: Antipsychotic use in elderly patients and the risk of pneumonia – Expert Opinion on Drug Safety (free) AND Antipsychotic drug exposure and risk of pneumonia: a systematic review and meta-analysis of observational studies – Pharmacoepidemiology & Drug Safety (free)
Original article: Drug-eluting stents versus bare-metal stents for acute coronary syndrome – Cochrane Library (free)
“The current review suggests that using DES rather than BMS may reduce the need for future coronary procedures but there is no evidence that it saves lives or reduces major cardiovascular events”.
Chemical venous thromboembolism prophylaxis in neurosurgical patients: an updated systematic review and meta-analysis – Journal of Neurosurgery (link to abstract – $ for full-text)
Chemical venous thromboembolism prophylaxis seems to be effective and safe in neurosurgical patients.
Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischaemia (TARDIS): a randomised, open-label, phase 3 superiority trial – The Lancet (free)
Commentaries: Learning from TARDIS: time for more focused trials in stroke prevention – The Lancet (free) AND Triple Antiplatelets for Reducing Dependency After Ischaemic Stroke – TARDIS – American College of Cardiology, Latest in Cardiology (free)
“Among patients with recent cerebral ischaemia, intensive antiplatelet therapy did not reduce the incidence and severity of recurrent stroke or TIA, but did significantly increase the risk of major bleeding. Triple antiplatelet therapy should not be used in routine clinical practice”.
Original article: An Interpretable Machine Learning Model for Accurate Prediction of Sepsis in the ICU – Critical Care Medicine (link to abstract – $ for full-text)
Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial – The Lancet (link to abstract – $ for full-text)
Commentary: Endoscopic vs Surgical Step-Up Approach for Treating Infected Necrotizing Pancreatitis – PracticeUpdate (free registration required)
Original article: Early warning systems and rapid response to the deteriorating patient in hospital: A systematic realist review – Journal of Advanced Nursing (link to abstract – $ for full-text)
Malnutrition Diagnosis during Adult Inpatient Hospitalizations: Analysis of a Multi-Institutional Collaborative Database of Academic Medical Centers – Journal of the Academy of Nutrition and Dietetics (link to abstract – $ for full-text)
Original article: Effect of Routine Low-Dose Oxygen Supplementation on Death and Disability in Adults With Acute Stroke: The Stroke Oxygen Study Randomized Clinical Trial – JAMA (link to abstract – $ for full-text)
Related guideline: BTS Guideline for oxygen use in healthcare and emergency settings – British Thoracic Society (free)
Original article: Age of Red Cells for Transfusion and Outcomes in Critically Ill Adults – New England Journal of Medicine (link to abstract – $ for full-text)
See related meta-analysis: Timely Use of Probiotics in Hospitalized Adults Prevents Clostridium difficile Infection
“Based on this systematic review and meta-analysis of 31 randomized controlled trials including 8672 patients, moderate certainty evidence suggests that probiotics are effective for preventing C. difficile-associated diarrhea”
Unanticipated difficult airway management in children – the consensus statement of the Paediatric Anaesthesiology and Intensive Care Section and the Airway Management Section of the Polish Society of Anaesthesiology and Intensive Therapy and the Polish Society of Neonatology. Anaesthesiology Intensive Therapy (free PDF)
Source: Critical Care Reviews Newsletter
Antimicrobial resistance and antibiotic stewardship programs in the ICU: insistence and persistence in the ﬁght against resistance. A position statement from ESICM/ESCMID/WAAAR round table on multi-drug resistance – Intensive Care Medicine (free for a period)
Source: Critical Care Reviews Newsletter
Source: Critical Care Reviews Newsletter
Managing Mental Health Emergencies in the ED – American Nurse Today, via Medscape (free registration required)
Clinical Presentation, Diagnosis, and Radiological Findings of Neoplastic Meningitis – Cancer Control, via Medscape (free registration required)
Original article: Nebulised hypertonic saline solution for acute bronchiolitis in infants – Cochrane Library (link to abstract – $ for full-text) (via @CochraneUK see Tweet with Infographic)
Meta-Analysis of Culprit-Only Versus Multivessel Percutaneous Coronary Intervention in Patients with ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Disease – American Journal of Cardiology (link to abstract – $ for full-text)
Related Systematic Review: Complete versus culprit-only revascularisation in ST elevation myocardial infarction with multi-vessel disease – Cochrane Library (free) AND Summary How should we deal with non-culprit lesions during a STEMI? A mid-night conundrum – Evidently Cochrane (free)
Related review: Management of Acute Alcohol Withdrawal Syndrome in Critically Ill Patients – Pharmacotherapy (free)
Related systematic review: Patient Outcomes Associated With Phenobarbital Use With or Without Benzodiazepines for Alcohol Withdrawal Syndrome: A Systematic Review – Hospital Pharmacy (link to abstract – $ for full-text)
Early Recurrence and Major Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation Treated With Non–Vitamin‐K Oral Anticoagulants (RAF‐NOACs) Study – Journal of the American Heart Association (free)
“Composite rates of recurrence and major bleeding were 12.4% in patients who initiated NOACs within 2 days after acute stroke, 2.1% in those who initiated NOACs between 3 and 14 days, and 9.1% in patients who initiated NOACs >14 days after acute stroke. Future randomized studies to assess timing of initiation and choice of agent in patients with acute stroke and AF are warranted”.
Related: Corticosteroids for Pneumonia: Ready for Primetime? – emDocs (free)
“Corticosteroid therapy reduced mortality and morbidity in adults with severe CAP; the number needed to treat for an additional beneficial outcome was 18 patients (95% CI 12 to 49) to prevent one death. Corticosteroid therapy reduced morbidity, but not mortality, for adults and children with non-severe CAP”
Topical Tranexamic Acid Compared With Anterior Nasal Packing for Treatment of Epistaxis in Patients Taking Antiplatelet Drugs: Randomized Controlled Trial – Academic Emergency Medicine (link to abstract – $ for full-text)
Commentary: Topical TXA in Epistaxis – R.E.B.E.L.em (free)
All-cause mortality and major cardiovascular outcomes comparing percutaneous coronary angioplasty versus coronary artery bypass grafting in the treatment of unprotected left main stenosis: a meta-analysis of short-term and long-term randomised trials – OpenHeart (free)
“PCI is associated with a reduction in the risk of major cardiovascular outcomes at short-term follow-up in patients with LMCA stenosis; but at long term, MACCE rate is increased for PCI”
Commentaries: Pharmacomechanical Thrombolysis for Deep-Vein Thrombosis – NEJM Resident 360 (free) AND Pharmacomechanical Thrombolysis for DVT – American College of Cardiology, Latest in Cardiology (free)
Pharmacomechanical thrombolysis did not result in lower risk of post-thrombotic syndrome and was associated with higher risk of major bleeding.