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SGEM#469: You Take My Breath Away – D-dimer for Ruling out PE in High-Risk Patients

The Skeptics' Guide to EM

There is a need to right size testing such that we do not miss clinically important PEs without exposing very low risk patients to risks of imaging (ionizing radiation, contrast, allergic reaction, cost, and misdiagnosis). Intervention: Age-adjusted or standard (<500) cut off for d-dimer Comparison: None Outcome:

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EM@3AM: Leukopenia

EMDocs

0000000000000305 Kazumi Y (2023) The Epidemiology and Outcomes of Leukopenia in Different Populations and Regions. Answer : Leukopenia Overview Leukopenia is defined as total WBC count < 4000/mm 3 Neutropenia is the most common subset of leukopenia and is defined on absolute neutrophil count: 1 Mild (1.01.5 10^9/L) Moderate (0.50.9

EMS 88
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STREAM-2: Half-Dose Tenecteplase vs Primary PCI in Older Patients with STEMI?

RebelEM

neoplasm, aneurysm, intracranial or spinal surgery) or recent trauma to head or cranium (i.e. Primary PCI: 95.7% Stents Placed: Pharmaco-Invasive Treatment: 97.4% Primary PCI: 95.7% ECG Results: Repeat ECG 90min after tenecteplase indicated 70.3% to 1.0mm Median amount of ST deviations declined from 15.0 Primary PCI: 78.4% Primary PCI: 13.3%

EKG/ECG 137
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Toss Up: A Little Bleeding, or A Lot of Platelets

EM Literature of Note

Platelets, like any blood product, are associated significant risks, not limited to acute lung injury, transfusion-related circulatory overload, allergic reactions, and more. The primary outcome was CVC-related bleeding, graded on a scale of 0 to 4, where Grade 3 and 4 bleeding was associated with significant intervention.

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Cetirizine Vs Diphenhydramine For the Treatment of Acute Urticaria in the ED

RebelEM

Background: Diphenhydramine, a first-generation antihistamine, is the most common pharmacologic agent used to treat acute allergic reactions. Health care professional involved in patient management and outcome assessment was completely blinded. The effectiveness of IV cetirizine was determined to be statistically non-inferior.

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EM Quick Hits 56 – Nitroglycerin in SCAPE, REBOA, Diverticulitis Imaging, CRAO, Penicillin Allergy, Physician Personality

Emergency Medicine Cases

The post EM Quick Hits 56 – Nitroglycerin in SCAPE, REBOA, Diverticulitis Imaging, CRAO, Penicillin Allergy, Physician Personality appeared first on Emergency Medicine Cases.

EMS 117
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Episode 20 - Emergency Department Management of North American Snake Envenomations

EB Medicine

Nachi: Not only are they out, they actually worsen outcomes, so definitely don’t pursue any of them. Instead, since no treatment has been shown to improve outcome, you should prioritize prompt transport. Fasciotomies have not been shown to improve outcomes and are reserved only for those failing anti-venom treatment.