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This episodes reviews the treatment of acute ischemic priapism, focusing the guidelines from the American Urological Association.
Apple Podcasts, Spotify, Listen Here
This episodes reviews the treatment of acute ischemic priapism, focusing the guidelines from the American Urological Association.
Apple Podcasts, Spotify, Listen Here
In this episode, we review a new consensus guideline from the American College of Emergency Physicians (initially developed with the American Academy of Ophthalmology) on the use of topical anesthetics in corneal abrasions.
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The American Heart Association (AHA) released new clinical practice guidelines on atrial fibrillation (AF). This episode reviews the emergency medicine-related guidelines.
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The Association for the Advancement of Blood & Biotherapies (AABB) released 2023 International Red Blood Cell Transfusion Guidelines. This podcast reviews the guidelines as well as a recently released trial evaluating restrictive versus liberal transfusion strategy in patients with myocardial infarction. Carson et al. Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia. NEJM 2023. DOI: 10.1056/NEJMoa2307983.
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The American College of Emergency Physicians (ACEP) just released a clinical policy on the management of emergency department patients presenting with severe agitation. This podcast reviews the clinical policy. We previously covered parenteral agents and a small trial of ketamine in this podcast. The policy committee was unable to make any Level A recommendations due to limitations in included studies. The recommendations the clinical policy committee was able to make are based largely on class II studies. This field of research is limited by few direct, head-to-head comparisons of medications using similar doses via the same route, resulting in some indirect evidence and conclusions.
Disclosure: Lauren Westafer is a member of the ACEP Clinical Policy Committee but the views and opinions represented in this post/podcast are hers alone and do not represent those of the ACEP Clinical Policy Committee.
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Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally invasive way of providing resuscitative aortic occlusion in severe hemorrhage to gain temporary hemorrhage control as a bridge to definitive procedures. Despite initial enthusiasm for widespread use, there are minimal data suggesting significant mortality benefit. A joint statement from the American College of Surgeons Committee on Trauma (ACS COT) and the American College of Emergency Physicians (ACEP) regarding the clinical use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) states: “No current, high-grade evidence clearly demonstrates REBOA improves outcomes or survival compared to standard treatment of severe hemorrhage.” However, “REBOA is less invasive than resuscitative thoracotomy and in skilled hands may be more rapidly applied as compared with resuscitative thoracotomy.” As a result, Jansen et al. undertook a pragmatic RCT to investigate the use of REBOA in trauma. In this podcast we review the trial and contextualize the results as emergency physicians.
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Alcohol-related emergency department (ED) visits are common – estimated to be comprise nearly 4% of all ED visits and up to 6% of hospitalizations. Historically, EDs have had little engagement in harm reduction around alcohol use disorder (AUD) and provision of medication for AUD. Often efforts to help patients with dangerous or harmful alcohol consumption have encouraged abstinence-only, or referral to detoxification centers. However, recent studies have demonstrated the feasibility of ED-initiated medication for AUD, specifically naltrexone (Anderson ES et al. Ann Emerg Med. 2021 Dec;78(6):752-758. PMID: 34353648. Murphy et al. Ann Emerg Med. 2023 Apr;81(4):440-449 PMID: 36328851).
Example emergency department algorithm below, also see UCSF protocol
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The role of steroids in pneumonia is controversial. Steroids were found to reduce mortality in COVID-19 patients requiring at least supplemental oxygen but are not associated with a mortality benefit in influenza. In 2019, the Infectious Disease Society of America recommended against the routine use of steroids in hospitalized patients with community-acquired pneumonia (CAP) while the Society for Critical Care Medicine recommends steroids in these patients. Studies of steroids in pneumonia continue to have mixed results (e.g. ESCAPe found no benefit in their trial of a continuous infusion of methylprednisolone in severely ill patients with CAP). In this podcast episode, we review a new multicenter randomized trial of hydrocortisone in severe CAP.
References:
Apple Podcasts, Spotify, Listen Here
References:
Apple Podcast, Spotify, Listen Here
Although antibiotics have been the cornerstone of treatment of diverticulitis, recommendations have pivoted away from this routine practice. This episode reviews the literature and guideline recommendations for the treatment of acute, uncomplicated diverticulitis.
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