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Pearl(s): If the nitrite and LE results are concordant (both + or both – ), the test is accurate ~90% of the time. Leuk esterase has a lower PPV (higher FP rate) than nitrites, especially in low prevalence populations and in the ER In general, nitrites have better PPV but lower NPV Give everyone aRead more

Article Citation: McCullough PA, Nowak RM, McCord J, Hollander JE, et al. B-type natriuretic peptide and clinical judgment in emergency diagnosis of heart failure: analysis from Breathing Not Properly (BNP) Multinational Study. Circulation. 2002 Jul 23;106(4):416-22. PMID: 12135939 What we already know about the topic: BNP (Brain or B-type Natriuretic Peptide) is now routinely used to support theRead more

PEARL: Antipyretics (NSAIDS or acetaminophen) are not associated with improved 28-day ICU mortality in septic patients. CONTEXT: Septic patients often have fevers. Someone always wants to lower the fever with acetaminophen. For conscious, non-intubated patients, this often helps them feel less terrible. Is it of any mortality benefit? Does it harm them? STUDY: Authors forRead more

Aspirin and Head Trauma: More Dangerous Than You Think B.L.U.F: In one retrospective study of patients who fell from standing, aspirin was associated with double the rate of traumatic ICH compared to warfarin use. CONTEXT: We know to treat minor closed head trauma in patients taking anti-coagulants seriously because of their association with ICH evenRead more

Current FDA dosing for Toradol is 30mg IV and 60mg IM in patients < 65 years old.  But is that necessary? Let’s look at this randomized controlled trial: Motov S et al. Comparison of intravenous ketorolac at three single-dose regimens for treating acute pain in the emergency department: a randomized controlled trial. Ann Emerg MedRead more

Article Citation: Holzer M, et al. “Mild Therapeutic Hypothermia to Improve the Neurologic Outcome After Cardiac Arrest”. The New England Journal of Medicine. 2002. 346(8):549-556. What we already know about the topic: prelim studies demonstrated that lowering brain temp s/p cardiac arrest improves neurologic recovery. Why this study is important: Hypoxemic brain injury is the mostRead more

Of course your asthma patients with acute bronchitis will get some steroids….but what about your non-asthmatic patients?  Evidence shows that most patients with acute bronchitis do not need steroids. What’s the evidence? Study: double-blinded RCT of 401 patients with lower respiratory tract infection symptoms (wheezing) without history of asthma or COPD treated at different familyRead more

A study done by some of our favorite residents and attendings says there is a debate! They surveyed physician sonographers at 6 conferences in 3 academic medical centers in NY.  Each person was given 20 seconds per slide to determine whether each of the 15 video clips of patients in cardiac arrest were standstill orRead more

Is one dose of PO dexamethasone enough or do you need to send your adult asthmatic patient home on a 5 day oral prednisone course? A noninferiority study published in Annals of Emergency Medicine in 2016 says maybe it doesn’t matter. What was the study? Adult ED patients ages 18-55 were randomized to receive eitherRead more

Article Citation: Stiell IG, Wells GA, Vandemheen KL, Clement CM, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001 Oct 17;286(15):1841-8. What we already know about the topic: More than a million patients treated annually in EDs around the country for blunt trauma and possible c-spine injury andRead more