Emergency Medicine Update April 2012

Here’s an overview of this month’s EMU in a highly abbreviated, but still informative form – so you know what to look for. You’ll need to read the full update for all the analysis, criticisms, debates and (of course) the humour.

So, what are you waiting for?

To read the entire update you can download the original MS word document version here, or you can subscribe to EMU directly via email by sending a message to:
jbleibmd AT yahoo.com

Also, remember to check out previous editions of EMU on LITFL here.

So, what’s in this month’s EMU?

  • IV erythromycin speeds up gastric emptying… the possibilities are boundless (Ann Emerg Med 57(6)582)
  • Thrombolysis for iliofemoral DVTs — remember post-thrombotic syndrome. (ibid 590) Hypertonic saline inhalations and a dexamethasone IV/epinephrine inhalation may help in bronchiolitis.(AJRCCM 183(10)1284)
  • 1 in 6 children in the US with asthma exacerbations gets antibiotics — they don’t need them! (Peds  127 (6)1174)
  • Could 100% sensitivity and specificity for ultrasound determination of esophAgeal vs endotracheal intubtion be too good to be true? ( J Ultrasound Med 30(5)671)
  • Use high energy (doesn’t cause harm) biphasic shocks for defibrillation (Resusc 82(6)647)
  • Early attempts at prognostician are hit-and-miss for cardiac arrest patients treated with hypothermia (Resuc 82(6)653)
  • Which antiarrhythmic used in resuscitation has been proven to work? None (ibid 82(6)665)
  • Soft palate impalement injuries can usually be managed conservatively.. yet 32% still went to the OR… (J Oral Max Surg 69(6)e147)
  • Strokes in young adults… Cause known in <50% but carotid dissection should make you nervous about TPA use (Neuop 76(23)1983)
  • The PE paper of the month (Chest 139(6)1294)
  • Too high PO2 may cause harm post-resuscitation.. Wean O2 whenever possible (Circ  123(23)2717)
  • Ruling out of serious infections by blood tests is – as Greg Henry says- the refuge of the intellectually destitute (BMJ 342:Jun 8)
  • Outpatient settings are a hotbed for malpractice suits… probably due to systems factors (JAMA 305(23)2464)
  • Triage doesn’t identify sick patients very well (Ann Emerg Med 58(2)137)
  • Anyone can use ultrasound to safely get peripheral IV access (AJEM 29(5)496)
  • Sedation of the elderly is safe (AJEM 29(5)541)
  • MRSA from pets… stop kissing your dog! ( (Vector Borne Zoonotic Dis 11(6)617 and Epid Infect 138(5)195)
  • You are about to witness a murder… (of Cerebro Vasc Dis 31(2)170).
  • Diagnostic decision making: the last refuge for general practitioners? (Soc Scie Med 73(3)375)
  • A proposal for reducing malpractice suits (J Law Med Ethics 39(3)539)
  • The mystery of hiccups — causes and treatments (Can Fam Phys 57(6)672)
  • More on honey.. for wounds and burns (Am J Clin Derm 12(3)181)
  • Letters from Yoav Aronson and Dr Shapiro
  • Brief discussion of airway issues with Scott Weingart and Chris Nickson
  • Part 2 of the EMU essay on movement disorders based on Arch Neuro 68(6) 719).
  • And, finally, the MUST READ recap of the funniest journal articles of the year!

… and what’s not in this month’s EMU?

EMU tends to steer clear of two of the big guns — Annals of Emergency Medicine and the New England Journal of Medicine — because most people see these journals and they’re covered elsewhere. For instance there are these audio productions:

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