January 2018

10) Barnett ML, Olenksi AR, Jena AB. Opioid Prescribing by Emergency Physicians

and Risk of Long-Term Use. N Engl J Med. 2017 May 11;376(19):1896. doi:

10.1056/NEJMc1703338. PubMed PMID: 28489999.

This interview was recorded at the RCEM Annual Scientific Conference in Liverpool in October 2017

9) Hinson JS, Ehmann MR, Fine DM, Fishman EK, Toerper MF, Rothman RE, Klein EY.

Risk of Acute Kidney Injury After Intravenous Contrast Media Administration. Ann

Emerg Med. 2017 May;69(5):577-586.e4. doi: 10.1016/j.annemergmed.2016.11.021.

Epub 2017 Jan 25. PubMed PMID: 28131489.

• May 2017 RCEM Learning Podcast

Authors:

• Jeff Kline
• Andy Neill

Codes: HMP2

Jeff Kline is an Emergency Medicine and Thrombosis Physician and Researcher in the USA.

He has a massive research portfolio but is perhaps most famous for the PERC Rule

We talked about if and when to pull the trigger on empiric lysis in suspected PE before definitive imagine. This could be the shocked patient or a patient in cardiac arrest

The Courtney Clinical Decision Rule:

If witnessed arrest, age <65 and initial rhythm of PEA then a 50% chance of autopsy proven PE so consider empiric lysis.

Courtney DM, Kline JA. Prospective use of a clinical decision rule to identify

pulmonary embolism as likely cause of outpatient cardiac arrest. Resuscitation.

2005 Apr;65(1):57-64. PubMed PMID: 15797276.

ECG changes to suggest massive PE:

Marchick MR, Courtney DM, Kabrhel C, Nordenholz KE, Plewa MC, Richman PB,

Smithline HA, Kline JA. 12-lead ECG findings of pulmonary hypertension occur more

frequently in emergency department patients with pulmonary embolism than in

patients without pulmonary embolism. Ann Emerg Med. 2010 Apr;55(4):331-5. doi:

10.1016/j.annemergmed.2009.07.025. Epub 2009 Sep 19. PubMed PMID: 19766353.

8) Hughes KE, Lewis SM, Katz L, Jones J. Safety of Computer Interpretation of

Normal Triage Electrocardiograms. Acad Emerg Med. 2017 Jan;24(1):120-124. doi:

10.1111/acem.13067. PubMed PMID: 27519772.

7) Rehrer MW, Liu B, Rodriguez M, Lam J, Alter HJ. A Randomized Controlled

Noninferiority Trial of Single Dose of Oral Dexamethasone Versus 5 Days of Oral

Prednisone in Acute Adult Asthma. Ann Emerg Med. 2016 Nov;68(5):608-613. doi:

10.1016/j.annemergmed.2016.03.017. Epub 2016 Apr 22. PMID: 27117874.

Authors:

• Charlotte Davies

Codes: HAP33

There are two types of patient we could see with myasthenia gravis – those that know they have it, and that don’t. We need to be careful what drugs we give those who know they have it – what antibiotics do we give these patients?

The 2012 Medications and Myasthenia Gravis (A Reference for Health Care Professionals) says it best:

“Nearly every antibiotic ever studied has demonstrated some deleterious effect or has been the subject of a clinical report suggesting exacerbation of MG.

If a patient requires antibiotic treatment for an infection, then the appropriate drugs should be utilized.

When managing patients with neuromuscular junctional disease, it simply behooves the clinician to remain alert to the potential for clinically significant adverse effects, especially if the patient becomes weaker in the setting of antibiotic use.”

So yes…gentamicin is on many sepsis guidelines. And yes, it can make myasthenia worse…but yes…. … we should probably still give it. And then speak to neurology.

In patients with known myasthenia, 20% of them could go on to get a myasthenic crisis- acute respiratory failure resulting from myasthenia gravis that requires mechanical ventilation.

We might also unmask myasthenia in patients who don’t know they’ve got it…

References:

• An Update on MG – Post Grad Medical Journal
• EM news Myasthenia
• LITFL – Myasthenia
• Myasthenia in the ICU – Neurology, Neurosurgery and Psychiatry
• Drugs that can exacerbate MG – Annals of EM
• Easily Missed – MG, BMJ
• EM DOCS – Myasthenia
• Myasthenia – Neurohospitalist
• ALIEM – Antibiotics and MG
• Emergency Medicine Ireland
• The Ice Test
• A scary image of the pathophysiology

6) Dhooria S, Sehgal IS, Agarwal R. Early, Goal-Directed Therapy for Septic Shock

– A Patient-Level Meta-Analysis. N Engl J Med. 2017 Sep 7;377(10):995. doi:

10.1056/NEJMc1708979. PMID: 28877021

5) Nagurney JM, Fleischman W, Han L, Leo-Summers L, Allore HG, Gill TM. Emergency

Department Visits Without Hospitalization Are Associated With Functional Decline

in Older Persons. Ann Emerg Med. 2017 Apr;69(4):426-433.  PMID: 28069299

Authors:

• Nick Beechings
• Nikki Abela

Codes: HAP14

Nick Beechings is a Consultant in Infectious Diseases in the Liverpool of Tropical Medicine.

This interview was recorded at the RCEM Annual Scientific Conference in Liverpool in October 2017

References:

• Travel Health Pro
• Chikungunya
• Tick Borne Encephalitis

4) Friedman BW, Irizarry E, Solorzano C, Khankel N, Zapata J, Zias E, Gallagher

1. Diazepam Is No Better Than Placebo When Added to Naproxen for Acute Low Back

Pain. Ann Emerg Med. 2017 Aug;70(2):169-176.e1. doi:

10.1016/j.annemergmed.2016.10.002. Epub 2017 Feb 7. PMID: 28187918

3) Quick WEE

Kaufman J, Fitzpatrick P, Tosif S, Hopper SM, Donath SM, Bryant PA, Babl FE.

Faster clean catch urine collection (Quick-Wee method) from infants: randomised

controlled trial. BMJ. 2017 Apr 7;357:j1341. doi: 10.1136/bmj.j1341. PubMed PMID:

28389435.

Authors:

• Deb Shelshear
• Nikki Abela

Codes: CAP23

This interview was recorded at the DFTB conference in 2017 in Australia.

2) DETOX2

Hofmann R, James SK, Svensson L, Witt N, Frick M, Lindahl B, Östlund O,

Ekelund U, Erlinge D, Herlitz J, Jernberg T. DETermination of the role of OXygen

in suspected Acute Myocardial Infarction trial. Am Heart J. 2014

Mar;167(3):322-8. doi: 10.1016/j.ahj.2013.09.022. Epub 2013 Dec 19. PMID:

24576515.

1) SAH

Carpenter CR, Hussain AM, Ward MJ, Zipfel GJ, Fowler S, Pines JM, Sivilotti

1. Spontaneous Subarachnoid Hemorrhage: A Systematic Review and Meta-analysis

Describing the Diagnostic Accuracy of History, Physical Examination, Imaging, and

Lumbar Puncture With an Exploration of Test Thresholds. Acad Emerg Med. 2016

Sep;23(9):963-1003. doi: 10.1111/acem.12984. Epub 2016 Sep 6. Review. PubMed

PMID: 27306497

Authors:

• Caroline Leech
• Andy Neill

Codes: CC24

Caroline is an ED and PHEM consultant in Coventry

Compassion Fatigue differs in some important ways from burnout. But it still affects our lives and jobs negatively. Caroline talks through her experience and what we can do to manage it

This interview was recorded at the RCEM Annual Scientific Conference in Liverpool in October 2017

References:

• St Emlyns with Iain & Liz on Burnout
• Hamilton S, Tran V, Jamieson J. Compassion fatigue in emergency medicine: The cost of caring. Emerg Med Australas. 2016 Feb;28(1):100-3. doi:10.1111/1742-6723.12533. Epub 2016 Jan 17. PubMed PMID: 26777437.
• ACEP Compassion Fatigue
• RCEM sustainable careers
• Dasan S, Gohil P, Cornelius V, Taylor C. Prevalence, causes and consequences of compassion satisfaction and compassion fatigue in emergency care: a mixed-methods study of UK NHS Consultants. Emerg Med J. 2015 Aug;32(8):588-94. doi: 10.1136/emermed-2014-203671. Epub 2014 Sep 23. PubMed PMID: 25248545.