Jan 27, 2023
This podcast, Dr. Lucas Dingman and Dr. Cady Welch, emergency medicine physicians with EMPAC and Ridgeview, discuss six articles on various topics related to emergency medicine, as part of this first ED journal review.
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SHOW NOTES:
*See the attachment for additional
information.
- DINAMO study &
diverticulitis
- Multicenter, randomized, open
label, non-inferiority trial (Nov.2016 - Jan.2020)
- 480 randomized participants and put into two groups
- Results: admission to hospitals, ED revisits, no complications,
no major significant findings
- Nonantibiotic outpatient treatment of mild acute diverticulitis
is safe and effective and is not inferior to current standard
treatment.
Study
#2:
Anterior–Lateral
Versus Anterior–Posterior Electrode Position for Cardioverting
Atrial Fibrillation
- EPIC Atrial Fibrilation ( EPIC
AF)
- Two positions for pad placement
for cardioverting patients
- Multicenter, randomized, open label trial
- 467 randomized patients, scheduled for elective cardioversion
- Results: 50% successful conversion to normal sinus rhythm after
one biphasic shock, many patients needed multiple shocks to
cardioconvert (4-5 shocks).
- AHA Guidelines: pad placement for AF and VF, treatment
recommendations
- Anterior-lateral electrode positioning was more effective than
anterior-posterior electrode positioning for biphasic cardioversion
of atrial fibrillation. There were no significant differences in
any safety outcome.
- Poiseuille's law and chest
tubes - and involves components of rate of flow, radius of the
tube, change in pressure and viscosity.
- 120 participants - 8 years and
older, traumatic hemothorax or pneumothorax, hemodynamically stable
patient only
- Treatment arm: 14 Fr cook catheter used (seldinger techique,
anterior axillary or midaxillary line)
- Control arm: 28-32 Fr. chest tube placed (standard way - 4th-5th
intercostal, midaxillary line)
- Results: Failure rate of the tube, repeat hemothorax requiring
intervention, drainage outputs at different designated times, total
chest tube days, insertion complications, ventilator days, ICU
length of days, hospital length of stay
- Patients had better experience with percutaneous catheter
- Hemlich valve
- Study discussed looks specifically at hemothoraces which require
drainage of blood and chest tubes connected to traditional pleuro
vac chamber
- Small caliber 14 Fr PCs are equally as effective as 28- to 32-Fr
chest tubes in their ability to drain traumatic HTX with no
difference in complications. Patients reported better IPE scores
with PCs over chest tubes, suggesting that PCs are better
tolerated.
- Single center, placebo
controlled, blinded, randomized trial
- Sample: 120 healthy adults, median age 40 years old presenting to
ED with chief complaint of nausea/vomiting
- Change in nausea score at 30 min. (drop in mm on VAS)
- Mean nausea baseline = 50
- Limitations: fairly young healthy participants, difficult to
blind (can smell difference)
- Among ED patients with acute nausea and not requiring immediate
IV access, aromatherapy with or without ondansetron provides
greater nausea relief than oral ondansetron alone.
- YEARS criteria with age
adjusted vs only age adjusted
- Cluster, randomized, crossover, non-inferiority trial to
determine if YEARS plus age-adjusted could be used to rule out PE,
age 18 or older, not pregnant
- Sample size: 1414 patients within 18 EDs, PERC positive
- Outcome: PE diagnosed in 100 patients, no missed PEs with
patients with YEARS score of "0",
- Among ED patients with suspected PE, the use of the YEARS rule
combined with the age-adjusted D-dimer threshold in PERC-positive
patients, compared with a concential diagnostic strategy, did not
result in an inferior rate of thromboembolic events.
- Randomized, single masked study
(providers were masked), controlled clinical trial, non-inferiority
study design, single center study
- Participants: children - aged 8 weeks to 3 years, moderately
dehydrated (dehydration score greater than 3, but less than 7)
- Outcomes: Successful rehydration at 4 hours, hospitalization
rate, time to initiation of treatment, repeat ED visits within 72
hrs
-Results: no difference between the groups with succesful
rehydration at 4 hours
- Limitations: small sample size
- Oral rehydration therapy (ORT) is as good as intravenous fluid
therapy (IVF) in rehydration of moderately dehydration children due
to gastroenteritis. In addition, the study found that less time was
required to intiate ORT when compared with IVF in the ED. Patients
treated with ORT had fewerer hospitalizations. Results of the study
suggested that ORT be the initial treatment of choice for
moderately dehydrated children less than three years old with
gastroeneritis.
Thanks to Dr. Lucas Dingman and Dr. Cady Welch for their knowledge and contribution to this podcast.
Please check out the additional show notes for more information/resources.