The American journal of emergency medicine
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Randomized Controlled Trial Multicenter Study
Risk factors for trimethoprim and sulfamethoxazole-resistant Escherichia coli in emergency department patients with urinary tract infections.
While trimethoprim-sulfamethoxazole (TMP-SMX) is recommended as one of the first-line empiric therapies for treatment of acute uncomplicated cystitis, institutions that observe resistance rates exceeding 20% for Escherichia coli (E. coli) should utilize alternative empiric antibiotic therapy per the Infectious Diseases Society of America (IDSA). Identifying risk factors associated with TMP-SMX resistance in E. coli may help guide empiric antibiotic prescribing for urinary tract infections (UTIs). ⋯ TMP-SMX should likely be avoided as first-line therapy for UTI in patients who have recurrent UTIs, genitourinary abnormalities, or have previously received TMP-SMX within the past 90 days. The use of an ED-specific antibiogram should be considered for assessing local resistance rates in this population.
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Review Meta Analysis
Analgesic efficacy of nitrous oxide in adults in the emergency department: A meta-analysis of randomized controlled trials.
Nitrous oxide (N2O) has a rapidly analgesic effect, but evidence regarding its role in managing pain in adults in the emergency department (ED) is conflicting. The purpose of this meta-analysis is to investigate the analgesic efficacy and safety of N2O in adults in ED. ⋯ The present meta-analysis suggested that N2O could provide better analgesia than placebo and similar analgesia to other methods with more vomiting and dizziness in adults in ED.
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Review Meta Analysis
The association between pregnancy and COVID-19: A systematic review and meta-analysis.
The purpose of this study was to compare and determine whether there were any differences in clinical outcomes between pregnant and non-pregnant women who had been infected with COVID-19. ⋯ Our results suggest that pregnant women with COVID-19 have a significantly higher probability of being hospitalized to the ICU and ventilation than non-pregnant women with COVID-19. To avoid these adverse outcomes, pregnant women should take precautions (for example, reduce going out, maintain social distance, and wear a mask) to avoid COVID-19 infection. Finally, additional research into the fetal outcomes is required to better investigate the impact of COVID-19 on pregnancy.
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Hemophilia is a bleeding disorder due to coagulation pathway factor deficiency that is associated with significant morbidity and mortality. ⋯ Emergency physician knowledge of hemophilia, including the presentation, evaluation, and management, can improve the care of these patients.
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Multicenter Study Comparative Study
Comparison of 4F-PCC and aPCC time to administration and outcomes for oral anticoagulant-related ICH.
Intracranial hemorrhages (ICHs) are associated with increased morbidity and mortality. Use of oral anticoagulants are a potential risk factor for ICH, and reversal of the anticoagulant with agents such as Four-Factor Prothrombin Complex Concentrate (4F-PCC) or Activated Prothrombin Complex Concentrate (aPCC) is vital to prevent hematoma expansion. The objective of the study was to the compare the time to administration and outcomes of 4F-PCC or aPCC in patients with ICH taking an oral anticoagulant. ⋯ In patients with ICH taking oral anticoagulants, there was no significant difference in the time to administration between 4F-PCC and aPCC. More prospective randomized controlled trials are warranted to determine an ideal reversal time to improve patient outcomes.