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Rebaked Morsel: Pediatric Buckle and Greenstick Forearm Fractures

Pediatric EM Morsels

Buckle Fractures: Evolving literature Multiple prospective studies have been performed using single posterior slabs, splints, braces and soft bulky bandages (Davidson, 2001. West, 2005. Plint, 2006.

Fractures 286
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Cerebral Edema and Diabetic Ketoacidosis: Rebaked

Pediatric EM Morsels

Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema. 2001 Jan 25;344(4):264-9. Is your patient hyperglycemic, acidotic, with ketonuria? Then we’ve likely got DKA. Triple bag, triple bag, triple bag! The Pediatric Emergency Medicine Collaborative Research Commitee. PMID: 12461495.

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Adjunctive Methylene Blue in Septic Shock?

RebelEM

Without larger studies and a patient centered outcome, the addition of methylene blue within 24 hours of septic shock should still not be part of a general approach but rather an adjunct in specific circumstances (i.e. NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9% 95% CI 15.4 NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9%

Shock 145
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Intensive blood glucose control in the ICU is not helpful (TGC-FAST trial)

PulmCCM

Hyperglycemia is associated with worse outcomes in the ICU (and in medical patients generally), so correcting it must improve outcomes … right?

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An Herbal Hope: Is XBJ A Game-Changer in Sepsis Management?

RebelEM

This varies from the 2001 definition, which used SIRS criteria and was thought to overly focus on inflammation. Secondary Outcome Results: ICU mortality: placebo 20.0% The primary outcome was patient oriented. Many of the secondary outcomes were changed well after most of the data was acquired. vs. XBJ 14.4%

Sepsis 96
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The Needle Vs. The Knife for Spontaneous Pneumothorax: A Closer Look at the EXPRED Study

RebelEM

Outcomes: Primary Outcome: Pulmonary expansion 24 hours after the procedure. Secondary Outcomes: Pulmonary expansion 7 days after the procedure. Blinding the outcome assessors to the initial assessment reduces the risk of measurement bias, enhancing the objectivity of the results.

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Older cardiology trials were often hugely positive. Newer cardiology trials not so much

Stop and Think

The puzzle : older trials found big gains in major outcomes (death) and newer trials struggle to show incremental gains in composite endpoints, such as one of many causes of hospitalization. Circa 2001. Yes, hospitalizations for heart failure are 29% lower with the drug. This endpoint represents only 10% of total hospitalizations.