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For this topic, they summarize a few articles – mostly following a prospective derivation study in which hopping/percussion/coughing was 93% sensitive and 100% specific for appendicitis. Unfortunately, the test performance didn’t quite hold up – sensitivity ranging from 72% to 89%, depending on age group, and highly variable specificities.
In APPAC II, the “how best” question involves whether the initial treatment for uncomplicated appendicitis (no perforation, appendicolith, or tumor) need be intravenous, or whether a completely oral antibiotic strategy is noninferior.
In this case series, which represented only 49 of 1,296 patients with acute agitation, intramuscular ketamine was used as second- or third-line therapy behind droperidol and benzodiazepines. Target dosing was 4-6 mg/kg, similar to procedural sedation.
Treatment evidence regarding venous thromboembolism is not particularly sparse – except what to do about calf VTE. The most robust evidence is three decades old, and of little use for generalizing to modern diagnostic methods and direct oral anticoagulants. This, then, is the CACTUS trial – a randomized, double-blind, placebo-controlled trial examining the need for…
Ryan P. Radecki, MD MS FACEP FACEM is a specialist in Emergency Medicine at Christchurch Hospital in New Zealand, former AHRQ Patient Safety and Quality Keck Fellow, board-certified in Clinical Informatics, and former IRB Chair at Kaiser Permanente NW.My guests and I cover topics of interest to integrity of scientific research and Emergency Medicine.
Most stress tests were exercise or pharmacologic stress ECG, with the minority stress echocardiograms or myocardial perfusion imaging. Patients undergoing testing were not devoid of risk factors: an average age of 55 years, most were overweight, and over half had at least one risk factor for coronary artery disease.
However, then, it is likely the patients with elevated lactate levels received more aggressive treatment than if the treating clinicians were blinded to the result. The effect of this would be a mortality benefit in the population with elevated lactate, worsening the apparent test characteristics.
Ryan P. Radecki, MD MS FACEP FACEM is a specialist in Emergency Medicine at Christchurch Hospital in New Zealand, former AHRQ Patient Safety and Quality Keck Fellow, board-certified in Clinical Informatics, and former IRB Chair at Kaiser Permanente NW.My guests and I cover topics of interest to integrity of scientific research and Emergency Medicine.
The Valsalva maneuver’s effectiveness for supraventricular tachycardia is, essentially, the reason adenosine exists. With rates of non-pharmacologic cardioversion merely 5-20%, it’s not absent of value, but hardly reliable.So, I appreciate these authors innovation in trialling a new, improved Valsalva maneuver. The comparator in this study was the “traditional” maneuver, as applied via ...
Saving Lives with Lifesaving Devices. Automated electronic defibrillators are quite useful in many cases of out-of-hospital cardiac arrest – specifically, those so-called “shockable rhythms” in which defibrillation is indicated. Ventricular fibrillation, if treated with only bystander conventional cardiopulmonary resuscitation, has dismal ...