2 Minute Medicine ® - Emergency Medicine

1. In emergency patients with hip fracture and severe pain, patients randomize to receive early ultrasound-guided femoral nerve block (FNB) were observed with reduced preoperative opioid consumption without delaying time to optimal pain control, compared with standard care.  Evidence Rating Level : 1 (Excellent) Hip fractures are common painful injuries among elderly patients. 50 to 70% of patients experience severe pain, while 40% may receive sub-optimal pain management. While opioids are frequently employed for initial pain management, the prevalence of adverse effects associated with opioid use underscores the necessity for exploring alternative approaches...

1. In this randomized controlled trial, rates of ventilator-associated pneumonia (VAP) were lower in ventilated patients using amikacin as compared to a placebo.  2. This difference was maintained over a 28-day follow-up period in the amikacin group. Evidence Rating Level: 1 (Excellent) Study Rundown: VAP emerges 48 hours or more post-mechanical ventilation via an endotracheal tube or tracheostomy, contributing to escalated antimicrobial usage, resistance, prolonged intensive care unit (ICU) stays, and heightened mortality...

1. In patients with distal femoral periprosthetic fractures (DFPF), patients treated with dual plating (DP) were more likely to be weight-bearing in the twelve-week postoperative period, compared with those treated with distal femoral locking plates (DFLP). 2. Compared with the DFLP group, the DP patients were more likely return to their baseline ambulatory status. Evidence Rating Level : 3 (Average) With an aging population and increasing rates of knee arthroplasty, the incidence of DFPF is expected to grow...

1. Among individuals receiving care in a hospital setting for opioid toxicity in Ontario, Canada, the proportion who received opioid agonist therapy after discharge increased from 1.7% to 5.6% from 2013 to 2020.  Evidence Rating Level: 2 (Good) In this retrospective cohort study, researchers aimed to assess the proportion of patients initiating opioid agonist therapy (OAT), including methadone, buprenorphine-naloxone, or slow-release oral morphine, within 7 days of receiving care in a hospital setting for an opioid overdose...

1. In this matched cohort study, approximately one in three patients who had transient new-onset atrial fibrillation (AF) during hospitalization had recurrent AF within one year.  2. Most study patients with recurrent AF were detected by electrocardiogram (ECG) patch monitor only. Evidence Rating Level: 1 (Excellent) Study Rundown: AF is a common arrhythmia associated with increased risk for stroke, heart failure, and death. AF that occurs transiently with stress often refers to AF that is detected for the first time in patients who have been hospitalized for another medical or surgical condition...

1. In this randomized controlled trial, ventilator-associated pneumonia (VAP) was prevented by employing inhaled amikacin in mechanically ventilated patients exceeding three-day duration. 2. Inhaled amikacin was associated with a reduction in VAP incidence during a 28-day follow-up period. Evidence Rating Level: 1 (Excellent) Study Rundown: VAP typically occurs 48 hours or more post-mechanical ventilation via an endotracheal tube or tracheostomy, contributing to escalated antimicrobial usage, resistance, prolonged intensive care unit (ICU) stays, and heightened mortality...

1. Patients in the thrombectomy group reported significantly greater improvement, with lower mortality at 90 days versus medical management alone. 2. Symptomatic intracranial hemorrhage was comparable between groups. Evidence Rating Level : 1 (Excellent) Study Rundown: Patients with acute ischemic stroke and large vessel infarct benefit from endovascular thrombectomy. However, previous studies have shown clinical benefits using multimodal imaging while non-contrast CT is predominantly used in practice. This randomized controlled trial aimed to assess the efficacy of endovascular thrombectomy in patients with acute ischemic stroke and large vessel occlusion, with patient selection done using non-contrast CT...

1. In this superiority, parallel-group, open-label, multicentre, randomised controlled trial (RCT), point-of-care (POC) polymerase chain reaction (PCR) testing resulted in earlier use of targeted and adequate antibiotics, but did not result in less antibiotic use compared to the standard of care only (SCO). Evidence Rating Level: 1 (Excellent) With increasing rates of antimicrobial resistance worldwide, the topic of antibiotic stewardship is one of importance and developing efficient and effective ways to avoid antibiotic misuse and excessive use is pertinent...

1. In this randomized noninferiority trial, pulsed-field ablation was noninferior to thermal ablation in the treatment of patients with drug-refractory paroxysmal atrial fibrillation.  2. Both pulsed field ablation and thermal ablation had comparative rates of device- and procedure-related serious adverse events. Evidence Rating Level: 1 (Excellent) Study Rundown: Catheter ablation is an increasingly used, effective treatment for drug-resistant atrial fibrillation. Conventional techniques include the use of radiofrequency or cryothermal energy to isolate the pulmonary veins, an important source of arrhythmogenic foci...

1. Operating within 24 hours was non-inferior to operating within 8 hours among patients diagnosed with uncomplicated appendicitis with respect to the risk of appendiceal perforation. 2. There were no reported deaths in either group. Evidence Rating Level: 1 (Excellent) Study Rundown: Appendicectomy, or appendectomy, is the standard treatment for appendicitis, yet no consensus exists on the optimal surgical timing for acute uncomplicated appendicitis. While some studies suggest that longer in-hospital delays may be non-inferior to shorter delays, further research is needed...

1. In this randomized controlled trial, tight versus liberal blood glucose control resulted in similar intensive care unit (ICU) outcomes. 2. There were no differences in 90-day mortality following ICU discharge between tight blood glucose control and liberal blood glucose control strategies. Evidence Rating Level: 1 (Excellent) Study Rundown: Low blood sugar levels are common among patients admitted to the ICU, and have been found to be associated with poor outcomes. Currently, trials investigating the effect of blood sugar levels amongst these patients have shown conflicting results...

1. 30-day mortality was comparable among patients on VA-ECMO and medical therapy alone. 2. VA-ECMO was associated with increased adverse events such as major bleeding and peripheral vascular disease-related ischemia. Evidence Rating Level: 1 (Excellent) Study Rundown: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used with early coronary revascularization in infarct-related cardiogenic shock. However, mixed evidence exists with mortality rates as high as 50%, according to some studies...

1. This retrospective study found that in patients initially presenting with acute appendicitis with appendicolithiasis, the length of hospital stay, age above 65 or between 18-25, hypertension, elevated BMI, and hyponatremia at initial presentation were all predictors of in-hospital appendiceal perforation. Evidence Rating Level: 2 (Good) Among the most common surgical pathologies, appendicitis is a condition which, if left untreated, could potentially result in perforation. A subset of patients presenting with appendicitis also present with appendicolithiasis (calcified deposits in the appendix), which increases the risk of a complicated appendicitis and/or perforation...

1. In this randomized controlled trial, early compared to late blood pressure management following an acute ischemic stroke did not impact the risk of death or functional dependency at 90 days.  Evidence rating level: 1 (Excellent) Researchers aimed to determine whether early treatment of hypertension after an ischemic stroke impacts the risk of death or functional dependency (modified Rankin scale score ≥3). 4810 participants were included in the study, which was conducted in China between June 13, 2018, and July 10, 2022...

1. Generative artificial intelligence (AI) and radiologist reports received comparable ratings of clinical accuracy and report quality, that were significantly greater than teleradiology report ratings.  Evidence Rating Level : 1 (Excellent) Timely diagnostic imaging interpretation in the ED is crucial for patient care. Immediate radiologist interpretation minimizes errors, but some EDs lack consistent radiology services. Generative AI methods may bridge this gap by offering near-instant, fatigue-free interpretations of medical imaging...

1. The fracture reduction quality, functional outcomes, and overall patient satisfaction were comparable between patients in the wide-awake local anesthesia with no tourniquet (WALANT) and balanced anesthesia (BA) groups Evidence Rating Level : 2 (Good) DRF is a common injury that can require surgical intervention. As elderly patients with comorbidities increasingly opt for surgery to achieve quicker recovery and preserved functionality after injury, more suitable anesthetic options are being explored. WALANT offers various benefits including, cost-effectiveness, improved patient satisfaction, and reduced risks associated with systemic anesthesia...

1. In this randomized controlled trial, complete revascularization reduced the risk of myocardial infarction, stroke, or ischemia-driven revascularization at one year in patients with myocardial infarction compared to culprit lesion revascularization.  2. There was no difference in safety outcomes, including acute kidney injury, stroke, or bleeding, between groups. Evidence Rating Level: 1 (Excellent) Study Rundown: The decision process surrounding the management of myocardial infarction in older adults is challenging...

1. In this cohort study, uptake of the 2018 European Society of Cardiology Syncope Guidelines by emergency departments was associated with greater diagnostic yield and accuracy.  Evidence rating level: 2 (Good) Syncope is a common complaint in emergency departments (EDs), accounting for about 1% of all ED visits. Researchers aimed to assess whether the use of the 2018 European Society of Cardiology (ESC) Syncope Guidelines would have an impact on diagnostic accuracy, diagnostic yield, or healthcare costs...

1. The 90-day modified Ranking Scale score was comparable for patients in intravenous thrombolysis plus endovascular treatment versus endovascular treatment alone. 2. Intracranial hemorrhage was less frequent in the endovascular treatment alone group. Evidence Rating Level: 1 (Excellent) Study Rundown : Intravenous thrombolysis before endovascular treatment is the preferred therapy among patients with acute ischemic stroke; however, its utility among patients directly admitted to endovascular treatment centers remains unknown...

1. Levonorgestrel plus piroxicam resulted in significantly fewer pregnancies compared to placebo. 2. There were no changes with respect to menstrual cycle advancement or delay in each group. Evidence Rating Level: 1 (Excellent) Study Rundown : Levonorgestrel is a commonly used emergency contraceptive; however, its therapeutic benefits require it to be used prior to ovulation. Whether or not the addition of a cyclo-oxygenase inhibitor, such as piroxicam, could enhance the efficacy of emergency contraception beyond the ovulatory window remains unclear...