The American journal of emergency medicine
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Review Meta Analysis
Fascia iliaca block for hip fractures in the emergency department: meta-analysis with trial sequential analysis.
Fascia iliaca block (FICB) has been used to reduce pain and its impact on geriatric patients with hip fractures. ⋯ FICB is associated with significant pain relief both at rest and on movement lasting up to 4 h as well as a reduction in opioid requirement and associated nausea and vomiting in geriatric patients with hip fracture. However, the quality of evidence is low and additional trials are necessary.
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Comparative Study
Pulmonary embolism and COVID-19: A comparative analysis of different diagnostic models performance.
Pulmonary embolism (PE) is a common complication of SARS-CoV-2 infection. Several diagnostic prediction rules based on pretest probability and D-dimer have been validated in non-COVID patients, but it remains unclear if they can be safely applied in COVID-19 patients. We aimed to compare the diagnostic accuracy of the standard approach based on Wells and Geneva scores combined with a standard D-dimer cut-off of 500 ng/mL with three alternative strategies (age-adjusted, YEARS and PEGeD algorithms) in COVID-19 patients. ⋯ None of the diagnostic prediction rules are reliable predictors of PE in COVID-19. Our data favour the use of a D-dimer threshold of 500 ng/mL, considering that higher thresholds increase specificity but limits this strategy as a screening test.
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Acute heart failure (HF) exacerbation is a serious and common condition seen in the Emergency Department (ED) that has significant morbidity and mortality. There are multiple clinical decision tools that Emergency Physicians (EPs) can use to reach an appropriate evidence-based disposition for these patients. ⋯ This article discusses evidence-based disposition of patients in acute decompensated HF presenting to the ED. Knowledge of these factors and risk tools can assist emergency clinicians in determining appropriate disposition of patients with HF.
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Given the dramatic increase in critically ill patients who present to the emergency department for care, along with the persistence of boarding of critically ill patients, it is imperative for the emergency physician to be knowledgeable about recent developments in resuscitation and critical care medicine. This review summarizes important articles published in 2020 that pertain to the resuscitation and care of select critically ill patients. ⋯ Furthermore, the emergency physician should not administer tranexamic acid to patients with acute gastrointestinal bleeding or administer the combination of vitamin C, thiamine, and hydrocortisone for patients with septic shock. Finally, the emergency physician should titrate vasopressor medications to more closely match a patient's chronic perfusion pressure rather than target a mean arterial blood pressure of 65 mmHg for all critically ill patients.
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Multicenter Study
Clinical prediction rule of termination of resuscitation for out-of-hospital cardiac arrest patient with pre-hospital defibrillation given.
To derive a clinical prediction rule of termination of resuscitation (TOR) for out-of-hospital cardiac arrest (OHCA) with pre-hospital defibrillation given. ⋯ The 2-criteria TOR rule for OHCA patients with pre-hospital defibrillation had a high specificity and PPV for predicting death on or before ED arrival.