2 Minute Medicine ® - Emergency Medicine

1. In this randomized controlled trial, in patients with infarct-relate cardiogenic shock, death from any cause was lower in the group that received the microaxial flow pump compared to the group that received the standard care.  2. The composite safety endpoint occurred in more patients in the microaxial flow pump group than in the standard care group. Evidence Rating Level: 1 (Excellent) Study Rundown: One possible severe complication of ST-segment elevation myocardial infarction (STEMI) is cardiogenic shock, which is associated with a high risk of mortality...

1. In this randomized controlled trial, patients who underwent minimally invasive surgical evacuation of a hematoma followed by medical management had lower disability scores than those who received medical management alone. 2. This effect was attributable primarily to intervention for lobar hemorrhages rather than hemorrhages in the basal ganglia. Evidence Rating Level: 1 (Excellent) Study Rundown: While evacuation of intracranial hematoma has many theoretical benefits, such as intracranial pressure reduction and secondary injury mitigation, randomized controlled trials of both conventional craniotomy and minimally invasive options have demonstrated largely mixed results concerning functional outcomes...

1. Patients in the thrombectomy plus medical care group reported a significantly lower mRS score at the 1-year follow-up compared to those in the medical care alone group. 2. 1-year mortality in the thrombectomy group was lower than in the medical care alone group. Evidence Rating Level: 1 (Excellent) Study Rundown: Endovascular thrombectomy is known to have good clinical outcomes in patients with ischemic stroke. However, limited data exists regarding its long-term efficacy. This randomized controlled trial aimed to compare the safety and efficacy of endovascular thrombectomy plus medical care versus medical care alone in patients with large-vessel occlusion...

1. This retrospective cohort study found that immediate weight-bearing following clavicle fracture fixation in patients with concurrent lower extremity trauma does not impact rates of hardware failure (HWF) or fracture union, compared with non-weight bearing (NWB) patients with isolated clavicular fractures.  Evidence Rating Level : 2 (Good) Clavicle fractures are increasingly treated with open reduction internal fixation (ORIF). Postoperative care often involves 6 weeks of NWB, but in polytrauma cases with lower extremity injuries, NWB is challenging...

1. Duration of organ support or death at 30 days was lower in the conservative oxygenation group compared to the liberal oxygenation group. 2. Prespecified adverse events were also lower in the conservative oxygenation group. Evidence Rating Level: 1 (Excellent) Study Rundown: The optimal systemic oxygenation target for critically ill children remains uncertain, with liberal oxygenation – the standard of care – posing harm. There is no underlying consensus on the optimal oxygenation target for critically ill children...

1. In a cohort of patients with traumatic brain injury, early fixation of extremity fractures within 24 hours of injury was not associated with greater rates of unfavourable functional outcomes at 6 months.  Evidence Rating: 2 (Good)  While extremity fractures are commonly seen in conjunction with traumatic brain injury (TBI), the ideal timing of fixation and definitive treatment of these fractures remain controversial. On one hand, there are those who argue in favour of earlier fixation to promote a shorter recovery course and decreased complication rates...

1. In this randomized controlled trial, tenecteplase administered at 4.5 to 24 hours after stroke onset to patients with an occluded middle cerebral artery (MCA) or internal carotid artery (ICA) was not superior to placebo. 2. Tenecteplase did not differ from placebo with regards to rates of death and symptomatic intracranial hemorrhage. Evidence Rating Level: 1 (Excellent) Study Rundown: Intravenous thrombolysis with tissue plasminogen activators, such as tenecteplase, is the standard of care for ischemic stroke within 4...

1. In a large prospective multicentre diagnostic accuracy study, magnetically guided capsule endoscopy with a detachable string (ds-MCE) demonstrated high accuracy and safety in the detection and grading of esophagogastric varcies in patients with cirrhosis. Evidence Rating: 1 (Excellent) Esophagogastric varices are highly prevalent in patients with cirrhosis and are a major cause of mortality and morbidity. While capsule endoscopy has been proposed as a standard to esophagoduodenoscopy (EGD) in the past, prior studies have demonstrated an inferior accuracy rating compared to EGD, owing to a poor visualization of the esophagus and stomach due to rapid transit times...

1. In those with out-of-hospital cardiac arrest (OHCA) and attempted resuscitation by emergency medical services (EMS) personnel, patients who received epinephrine first had an increased likelihood of 1-month survival, 1-month survival with functional outcomes, and prehospital ROSC, compared with those who received advanced airway management (AAM) first. Evidence Rating Level : 2 (Good) Out-of-hospital cardiac arrest (OHCA) poses a significant public health challenge globally. Emergency medical services (EMS) provide crucial initial care, including interventions like epinephrine administration and advanced airway management (AAM)...

1. In geriatric patients with hip fractures on direct oral anticoagulants (DOACs), surgical treatment within 48 hours of their last preoperative DOAC dose had comparable complication rates and 1-year mortality compared with patients with surgery delayed past 48 hours. 2. Patients who underwent surgical management within 48 hours required fewer transfusions and had decreased length of stay, compared with those who underwent surgery beyond 48 hours.  Evidence Rating Level : 2 (Good) Geriatric hip fractures are associated with 1-year mortality rates as high as 33%...

Incidence and influence factors of venous thromboembolism in traumatic rib fracture patient: a multicenter study : https://read.qxmd.com/read/38395963 1. In patients with traumatic rib fractures, the number of rib fractures was an independent risk factor for venous thromboembolism (VTE). 2. Surgical fixation of isolated rib fractures involving ≥3 ribs reduced the incidence of VTE compared with conservative treatment. Evidence Rating Level :1 (Excellent) Traumatic rib fractures increase VTE risk due to reduced mobility, trauma impact, and treatment interventions...

1. The use of POCUS in an adult inpatient setting improved patient satisfaction with their overall care and perceived  Evidence Rating Level: 3 (Average) Point-of-care ultrasound (POCUS) is a tool used to aid in decision-making at the bedside. While POCUS is used frequently in emergency departments, with increasing use in inpatient settings. Aside from the known diagnostic benefits, recent studies have shown that POCUS has socioemotional benefits as well. There is thought to be a placebo-like “POCUS positive care effect” (PPCE)...

1. In this serial cross-sectional analysis, discharge rates for acute pulmonary embolism (PE) in emergency departments (EDs) in the United States (US) remained constant between 2012 and 2020. 2. No baseline characteristics in patients with acute PE were associated with an increased likelihood of discharge from the ED. Evidence Rating Level: 2 (Good) Study Rundown: Acute PE occurs when there is a disruption of blood flow in the pulmonary artery or its branches due to a thrombus, which often originates in the deep veins...

1. In this randomized controlled trial, high-dose simvastatin did not reduce the need for organ support among critically ill patients with coronavirus disease 2019 (COVID-19). 2. High-dose simvastatin was associated with increased rates of serious adverse events amongst critically ill patients with COVID-19. Evidence Rating Level: 1 (Excellent) Study Rundown: Among critically ill patients who are admitted to hospitals with COVID-19, access to affordable and effective medications continues to remain inequitably distributed around the world...

1. Ketamine was non-inferior to morphine at analgesic pain reduction for out-of-hospital pain management. 2. There was, however, an increased number of adverse events in the ketamine group, though the majority of these were associated with emergence phenomenon and did not require intervention. Evidence Rating Level: 1 (Excellent) Pain is a common symptom experienced outside of the hospital, which is currently being researched to shore up inadequacies, especially for those experiencing traumatic pain. There is much discussion in this research over which analgesic is the best to prescribe for out-of-hospital pain...

1. A joint Inpatient palliative Care (IPC) approach was effective at reducing patients’ time in the intensive care unit (ICU) and hospital overall. Evidence Rating Level: 2 (Good) Patients in the intensive care unit (ICU) would benefit from having an Inpatient Palliative Care (IPC) team to help them through this difficult chapter in their lives. An IPC team usually help patients manage their symptoms and pain along with providing support to them and their families and assisting with communication to ensure realistic expectations...

1. Patients with ST-elevation myocardial infarction (STEMI) with nonobstructive coronary arteries (MINOCA) and MINOCA-mimicking disease demonstrated significantly higher five-year mortality compared to those with traditional obstructive disease underlying MI. 2. Those with STEMI secondary to MINOCA and MINOCA mimickers were also discharged with fewer cardiac medications, and underlying disease was less often diagnosed in these groups. Evidence Rating Level: 2 (Good)         Study Rundown: While myocardial infarction with nonobstructive arteries (MINOCA) has historically been considered low-risk in comparison to STEMI secondary to obstructive disease, there remains some ambiguity in quantifying the relative mortality risk for MINOCA patients (with either coronary artery plaque disruption, epicardial coronary spasm, or coronary embolism/thrombosis) and MINOCA mimickers (takotsubo cardiomyopathy, myocarditis, and nonischemic cardiomyopathy) compared to those with obstructive disease...

1. In this randomized controlled trial, apixaban lowered the risk of stroke or systemic embolism significantly more than aspirin in patients with subclinical atrial fibrillation.  2. Apixaban was associated with a higher risk of major bleeding than aspirin.  Evidence Rating Level: 1 (Excellent) Study Rundown: Symptomatic atrial fibrillation is a leading cause of stroke and stroke-related disability and mortality, for which oral anticoagulants are established prophylactic therapies. Conversely, subclinical atrial fibrillation can be asymptomatic or only produce short-lasting symptoms and is only diagnosed by continuous cardiac rhythm monitoring with a pacemaker or defibrillator...

1. This multicentre, randomized, comparative effectiveness study found that the short-stay unit (SSU) was often as effective as hospitalization in patients with new onset of acute heart failure (AHF) and otherwise low-risk profiles.  2. There was no difference in 30- and 90-day mortality between the SSU and hospitalized patients.  Evidence Rating Level: 1 (Excellent) Patients in acute heart failure (AHF) account for a great deal of healthcare spending, particularly due to hospitalizations that often originate from emergency department (ED) visits...

1. Families randomized to having access to a mobile application that allowed them to communicate needs with intensive care unit (ICU) physicians were found to have reduced unmet palliative care needs compared to usual care. 2. White families were observed to benefit more from the intervention than Black families as measured by the Needs at the End-of-Life Screening Tool (NEST) score. Evidence Level Rating: 1 (Excellent) There is a desperate need for more palliative care specialists globally as evidenced by the burden ICU patients experience...