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2016 ALiEM CRI Must Reads

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40 papers 0 to 25 followers 2016 Must Read Articles per ALiEM CRI
By Vidya Eswaran EM Resident at Northwestern University
Matthew W Semler, David R Janz, Robert J Lentz, Daniel T Matthews, Brett C Norman, Tufik R Assad, Raj D Keriwala, Benjamin A Ferrell, Michael J Noto, Andrew C McKown, Emily G Kocurek, Melissa A Warren, Luis E Huerta, Todd W Rice
RATIONALE: Hypoxemia is common during endotracheal intubation of critically ill patients and may predispose to cardiac arrest and death. Administration of supplemental oxygen during laryngoscopy (apneic oxygenation) may prevent hypoxemia. OBJECTIVES: To determine if apneic oxygenation increases the lowest arterial oxygen saturation experienced by patients undergoing endotracheal intubation in the intensive care unit. METHODS: This was a randomized, open-label, pragmatic trial in which 150 adults undergoing endotracheal intubation in a medical intensive care unit were randomized to receive 15 L/min of 100% oxygen via high-flow nasal cannula during laryngoscopy (apneic oxygenation) or no supplemental oxygen during laryngoscopy (usual care)...
February 1, 2016: American Journal of Respiratory and Critical Care Medicine
Daren M Beam, Zachary P Kahler, Jeffrey A Kline
OBJECTIVES: The study hypothesis was that a target-specific anticoagulant would allow successful home treatment of selected patients with deep vein thrombosis (DVT) and pulmonary embolism (PE) diagnosed in two urban emergency departments (EDs). METHODS: A protocol was established for treating low-risk DVT or PE patients with rivaroxaban and clinic, follow-up at both 2 to 5 weeks, and 3 to 6 months. Patients were determined to be low-risk by using a modified version of the Hestia criteria, supplemented by additional criteria for patients with active cancer...
July 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Paulina Salminen, Hannu Paajanen, Tero Rautio, Pia Nordström, Markku Aarnio, Tuomo Rantanen, Risto Tuominen, Saija Hurme, Johanna Virtanen, Jukka-Pekka Mecklin, Juhani Sand, Airi Jartti, Irina Rinta-Kiikka, Juha M Grönroos
IMPORTANCE: An increasing amount of evidence supports the use of antibiotics instead of surgery for treating patients with uncomplicated acute appendicitis. OBJECTIVE: To compare antibiotic therapy with appendectomy in the treatment of uncomplicated acute appendicitis confirmed by computed tomography (CT). DESIGN, SETTING, AND PARTICIPANTS: The Appendicitis Acuta (APPAC) multicenter, open-label, noninferiority randomized clinical trial was conducted from November 2009 until June 2012 in Finland...
June 16, 2015: JAMA: the Journal of the American Medical Association
Dion Stub, Karen Smith, Stephen Bernard, Ziad Nehme, Michael Stephenson, Janet E Bray, Peter Cameron, Bill Barger, Andris H Ellims, Andrew J Taylor, Ian T Meredith, David M Kaye
BACKGROUND: Oxygen is commonly administered to patients with ST-elevation-myocardial infarction despite previous studies suggesting a possible increase in myocardial injury as a result of coronary vasoconstriction and heightened oxidative stress. METHODS AND RESULTS: We conducted a multicenter, prospective, randomized, controlled trial comparing oxygen (8 L/min) with no supplemental oxygen in patients with ST-elevation-myocardial infarction diagnosed on paramedic 12-lead ECG...
June 16, 2015: Circulation
Robert Pickard, Kathryn Starr, Graeme MacLennan, Thomas Lam, Ruth Thomas, Jennifer Burr, Gladys McPherson, Alison McDonald, Kenneth Anson, James N'Dow, Neil Burgess, Terry Clark, Mary Kilonzo, Katie Gillies, Kirsty Shearer, Charles Boachie, Sarah Cameron, John Norrie, Samuel McClinton
BACKGROUND: Meta-analyses of previous randomised controlled trials concluded that the smooth muscle relaxant drugs tamsulosin and nifedipine assisted stone passage for people managed expectantly for ureteric colic, but emphasised the need for high-quality trials with wide inclusion criteria. We aimed to fulfil this need by testing effectiveness of these drugs in a standard clinical care setting. METHODS: For this multicentre, randomised, placebo-controlled trial, we recruited adults (aged 18-65 years) undergoing expectant management for a single ureteric stone identified by CT at 24 UK hospitals...
July 25, 2015: Lancet
D Isacson, A Thorisson, K Andreasson, M Nikberg, K Smedh, A Chabok
PURPOSE: The aim of this study was to evaluate outpatient, non-antibiotic management in acute uncomplicated diverticulitis with regard to admissions, complications, and recurrences, within a 3-month follow-up period. METHODS: A prospective, observational study in which patients with computer tomography-verified acute uncomplicated diverticulitis were managed as outpatients without antibiotics. The patients kept a personal journal, were contacted daily by a nurse, and then followed up by a surgeon at 1 week and 3 months...
September 2015: International Journal of Colorectal Disease
Brian E Grunau, Matthew O Wiens, Brian H Rowe, Rachel McKay, Jennifer Li, Tae Won Yi, Robert Stenstrom, R Robert Schellenberg, Eric Grafstein, Frank X Scheuermeyer
STUDY OBJECTIVE: Corticosteroids (steroids) are often used to mitigate symptoms and prevent subsequent reactions in emergency department (ED) patients with allergic reactions, despite a lack of evidence to support their use. We sought to determine the association of steroid administration with improved clinical outcomes. METHODS: Adult allergy-related encounters to 2 urban EDs during a 5-year period were identified and classified as "anaphylaxis" or "allergic reaction...
October 2015: Annals of Emergency Medicine
Paul R Mouncey, Tiffany M Osborn, G Sarah Power, David A Harrison, M Zia Sadique, Richard D Grieve, Rahi Jahan, Sheila E Harvey, Derek Bell, Julian F Bion, Timothy J Coats, Mervyn Singer, J Duncan Young, Kathryn M Rowan
BACKGROUND: Early, goal-directed therapy (EGDT) is recommended in international guidelines for the resuscitation of patients presenting with early septic shock. However, adoption has been limited, and uncertainty about its effectiveness remains. METHODS: We conducted a pragmatic randomized trial with an integrated cost-effectiveness analysis in 56 hospitals in England. Patients were randomly assigned to receive either EGDT (a 6-hour resuscitation protocol) or usual care...
April 2, 2015: New England Journal of Medicine
Mayank Goyal, Andrew M Demchuk, Bijoy K Menon, Muneer Eesa, Jeremy L Rempel, John Thornton, Daniel Roy, Tudor G Jovin, Robert A Willinsky, Biggya L Sapkota, Dar Dowlatshahi, Donald F Frei, Noreen R Kamal, Walter J Montanera, Alexandre Y Poppe, Karla J Ryckborst, Frank L Silver, Ashfaq Shuaib, Donatella Tampieri, David Williams, Oh Young Bang, Blaise W Baxter, Paul A Burns, Hana Choe, Ji-Hoe Heo, Christine A Holmstedt, Brian Jankowitz, Michael Kelly, Guillermo Linares, Jennifer L Mandzia, Jai Shankar, Sung-Il Sohn, Richard H Swartz, Philip A Barber, Shelagh B Coutts, Eric E Smith, William F Morrish, Alain Weill, Suresh Subramaniam, Alim P Mitha, John H Wong, Mark W Lowerison, Tolulope T Sajobi, Michael D Hill
BACKGROUND: Among patients with a proximal vessel occlusion in the anterior circulation, 60 to 80% of patients die within 90 days after stroke onset or do not regain functional independence despite alteplase treatment. We evaluated rapid endovascular treatment in addition to standard care in patients with acute ischemic stroke with a small infarct core, a proximal intracranial arterial occlusion, and moderate-to-good collateral circulation. METHODS: We randomly assigned participants to receive standard care (control group) or standard care plus endovascular treatment with the use of available thrombectomy devices (intervention group)...
March 12, 2015: New England Journal of Medicine
Olvert A Berkhemer, Puck S S Fransen, Debbie Beumer, Lucie A van den Berg, Hester F Lingsma, Albert J Yoo, Wouter J Schonewille, Jan Albert Vos, Paul J Nederkoorn, Marieke J H Wermer, Marianne A A van Walderveen, Julie Staals, Jeannette Hofmeijer, Jacques A van Oostayen, Geert J Lycklama à Nijeholt, Jelis Boiten, Patrick A Brouwer, Bart J Emmer, Sebastiaan F de Bruijn, Lukas C van Dijk, L Jaap Kappelle, Rob H Lo, Ewoud J van Dijk, Joost de Vries, Paul L M de Kort, Willem Jan J van Rooij, Jan S P van den Berg, Boudewijn A A M van Hasselt, Leo A M Aerden, René J Dallinga, Marieke C Visser, Joseph C J Bot, Patrick C Vroomen, Omid Eshghi, Tobien H C M L Schreuder, Roel J J Heijboer, Koos Keizer, Alexander V Tielbeek, Heleen M den Hertog, Dick G Gerrits, Renske M van den Berg-Vos, Giorgos B Karas, Ewout W Steyerberg, H Zwenneke Flach, Henk A Marquering, Marieke E S Sprengers, Sjoerd F M Jenniskens, Ludo F M Beenen, René van den Berg, Peter J Koudstaal, Wim H van Zwam, Yvo B W E M Roos, Aad van der Lugt, Robert J van Oostenbrugge, Charles B L M Majoie, Diederik W J Dippel
BACKGROUND: In patients with acute ischemic stroke caused by a proximal intracranial arterial occlusion, intraarterial treatment is highly effective for emergency revascularization. However, proof of a beneficial effect on functional outcome is lacking. METHODS: We randomly assigned eligible patients to either intraarterial treatment plus usual care or usual care alone. Eligible patients had a proximal arterial occlusion in the anterior cerebral circulation that was confirmed on vessel imaging and that could be treated intraarterially within 6 hours after symptom onset...
January 1, 2015: New England Journal of Medicine
Sandra L Peake, Anthony Delaney, Michael Bailey, Rinaldo Bellomo, Peter A Cameron, D James Cooper, Alisa M Higgins, Anna Holdgate, Belinda D Howe, Steven A R Webb, Patricia Williams
BACKGROUND: Early goal-directed therapy (EGDT) has been endorsed in the guidelines of the Surviving Sepsis Campaign as a key strategy to decrease mortality among patients presenting to the emergency department with septic shock. However, its effectiveness is uncertain. METHODS: In this trial conducted at 51 centers (mostly in Australia or New Zealand), we randomly assigned patients presenting to the emergency department with early septic shock to receive either EGDT or usual care...
October 16, 2014: New England Journal of Medicine
Lars B Holst, Nicolai Haase, Jørn Wetterslev, Jan Wernerman, Anne B Guttormsen, Sari Karlsson, Pär I Johansson, Anders Aneman, Marianne L Vang, Robert Winding, Lars Nebrich, Helle L Nibro, Bodil S Rasmussen, Johnny R M Lauridsen, Jane S Nielsen, Anders Oldner, Ville Pettilä, Maria B Cronhjort, Lasse H Andersen, Ulf G Pedersen, Nanna Reiter, Jørgen Wiis, Jonathan O White, Lene Russell, Klaus J Thornberg, Peter B Hjortrup, Rasmus G Müller, Morten H Møller, Morten Steensen, Inga Tjäder, Kristina Kilsand, Suzanne Odeberg-Wernerman, Brit Sjøbø, Helle Bundgaard, Maria A Thyø, David Lodahl, Rikke Mærkedahl, Carsten Albeck, Dorte Illum, Mary Kruse, Per Winkel, Anders Perner
BACKGROUND: Blood transfusions are frequently given to patients with septic shock. However, the benefits and harms of different hemoglobin thresholds for transfusion have not been established. METHODS: In this multicenter, parallel-group trial, we randomly assigned patients in the intensive care unit (ICU) who had septic shock and a hemoglobin concentration of 9 g per deciliter or less to receive 1 unit of leukoreduced red cells when the hemoglobin level was 7 g per deciliter or less (lower threshold) or when the level was 9 g per deciliter or less (higher threshold) during the ICU stay...
October 9, 2014: New England Journal of Medicine
Rebecca Smith-Bindman, Chandra Aubin, John Bailitz, Rimon N Bengiamin, Carlos A Camargo, Jill Corbo, Anthony J Dean, Ruth B Goldstein, Richard T Griffey, Gregory D Jay, Tarina L Kang, Dana R Kriesel, O John Ma, Michael Mallin, William Manson, Joy Melnikow, Diana L Miglioretti, Sara K Miller, Lisa D Mills, James R Miner, Michelle Moghadassi, Vicki E Noble, Gregory M Press, Marshall L Stoller, Victoria E Valencia, Jessica Wang, Ralph C Wang, Steven R Cummings
BACKGROUND: There is a lack of consensus about whether the initial imaging method for patients with suspected nephrolithiasis should be computed tomography (CT) or ultrasonography. METHODS: In this multicenter, pragmatic, comparative effectiveness trial, we randomly assigned patients 18 to 76 years of age who presented to the emergency department with suspected nephrolithiasis to undergo initial diagnostic ultrasonography performed by an emergency physician (point-of-care ultrasonography), ultrasonography performed by a radiologist (radiology ultrasonography), or abdominal CT...
September 18, 2014: New England Journal of Medicine
Evan S Schwarz, Brian G Cohn
No abstract text is available yet for this article.
January 2015: Annals of Emergency Medicine
Christopher L Moore, Scott Bomann, Brock Daniels, Seth Luty, Annette Molinaro, Dinesh Singh, Cary P Gross
OBJECTIVE: To derive and validate an objective clinical prediction rule for the presence of uncomplicated ureteral stones in patients eligible for computed tomography (CT). We hypothesized that patients with a high probability of ureteral stones would have a low probability of acutely important alternative findings. DESIGN: Retrospective observational derivation cohort; prospective observational validation cohort. SETTING: Urban tertiary care emergency department and suburban freestanding community emergency department...
March 26, 2014: BMJ: British Medical Journal
Marc Righini, Josien Van Es, Paul L Den Exter, Pierre-Marie Roy, Franck Verschuren, Alexandre Ghuysen, Olivier T Rutschmann, Olivier Sanchez, Morgan Jaffrelot, Albert Trinh-Duc, Catherine Le Gall, Farès Moustafa, Alessandra Principe, Anja A Van Houten, Marije Ten Wolde, Renée A Douma, Germa Hazelaar, Petra M G Erkens, Klaas W Van Kralingen, Marco J J H Grootenboers, Marc F Durian, Y Whitney Cheung, Guy Meyer, Henri Bounameaux, Menno V Huisman, Pieter W Kamphuisen, Grégoire Le Gal
IMPORTANCE: D-dimer measurement is an important step in the diagnostic strategy of clinically suspected acute pulmonary embolism (PE), but its clinical usefulness is limited in elderly patients. OBJECTIVE: To prospectively validate whether an age-adjusted D-dimer cutoff, defined as age × 10 in patients 50 years or older, is associated with an increased diagnostic yield of D-dimer in elderly patients with suspected PE. DESIGN, SETTINGS, AND PATIENTS: A multicenter, multinational, prospective management outcome study in 19 centers in Belgium, France, the Netherlands, and Switzerland between January 1, 2010, and February 28, 2013...
March 19, 2014: JAMA: the Journal of the American Medical Association
Donald M Yealy, John A Kellum, David T Huang, Amber E Barnato, Lisa A Weissfeld, Francis Pike, Thomas Terndrup, Henry E Wang, Peter C Hou, Frank LoVecchio, Michael R Filbin, Nathan I Shapiro, Derek C Angus
BACKGROUND: In a single-center study published more than a decade ago involving patients presenting to the emergency department with severe sepsis and septic shock, mortality was markedly lower among those who were treated according to a 6-hour protocol of early goal-directed therapy (EGDT), in which intravenous fluids, vasopressors, inotropes, and blood transfusions were adjusted to reach central hemodynamic targets, than among those receiving usual care. We conducted a trial to determine whether these findings were generalizable and whether all aspects of the protocol were necessary...
May 1, 2014: New England Journal of Medicine
Sameer Mal, Shelley McLeod, Alla Iansavichene, Adam Dukelow, Michael Lewell
STUDY OBJECTIVE: Noninvasive positive-pressure ventilation (NIPPV) is increasingly being used by emergency medical services (EMS) for treatment of patients in respiratory distress. The primary objective of this systematic review is to determine whether out-of-hospital NIPPV for treatment of adults with severe respiratory distress reduces inhospital mortality compared with "standard" therapy. Secondary objectives are to examine the need for invasive ventilation, hospital and ICU length of stay, and complications...
May 2014: Annals of Emergency Medicine
Niklas Nielsen, Jørn Wetterslev, Tobias Cronberg, David Erlinge, Yvan Gasche, Christian Hassager, Janneke Horn, Jan Hovdenes, Jesper Kjaergaard, Michael Kuiper, Tommaso Pellis, Pascal Stammet, Michael Wanscher, Matt P Wise, Anders Åneman, Nawaf Al-Subaie, Søren Boesgaard, John Bro-Jeppesen, Iole Brunetti, Jan Frederik Bugge, Christopher D Hingston, Nicole P Juffermans, Matty Koopmans, Lars Køber, Jørund Langørgen, Gisela Lilja, Jacob Eifer Møller, Malin Rundgren, Christian Rylander, Ondrej Smid, Christophe Werer, Per Winkel, Hans Friberg
BACKGROUND: Unconscious survivors of out-of-hospital cardiac arrest have a high risk of death or poor neurologic function. Therapeutic hypothermia is recommended by international guidelines, but the supporting evidence is limited, and the target temperature associated with the best outcome is unknown. Our objective was to compare two target temperatures, both intended to prevent fever. METHODS: In an international trial, we randomly assigned 950 unconscious adults after out-of-hospital cardiac arrest of presumed cardiac cause to targeted temperature management at either 33°C or 36°C...
December 5, 2013: New England Journal of Medicine
David E Newman-Toker, Kevin A Kerber, Yu-Hsiang Hsieh, John H Pula, Rodney Omron, Ali S Saber Tehrani, Georgios Mantokoudis, Daniel F Hanley, David S Zee, Jorge C Kattah
OBJECTIVES: Dizziness and vertigo account for about 4 million emergency department (ED) visits annually in the United States, and some 160,000 to 240,000 (4% to 6%) have cerebrovascular causes. Stroke diagnosis in ED patients with vertigo/dizziness is challenging because the majority have no obvious focal neurologic signs at initial presentation. The authors sought to compare the accuracy of two previously published approaches purported to be useful in bedside screening for possible stroke in dizziness: a clinical decision rule (head impulse, nystagmus type, test of skew [HINTS]) and a risk stratification rule (age, blood pressure, clinical features, duration of symptoms, diabetes [ABCD2])...
October 2013: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
2016-02-21 16:02:14
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