Newsletters

POSTED: April 19th, 2018
POSTED IN: EM Pulse - The Official Newsletter of MOCEP, March/April 2018,

Sandy Schneider, MD, FACEP
ACEP Associate Executive Director, Practice, Policy and Academic Affairs

ACEP would like to provide you with very brief synopses of the latest articles in Annals of Emergency Medicine. Some of these have not appeared in print. These synopses are not meant to be thorough analyses of the articles, simply brief introductions. Before incorporating into your practice, you should read the entire articles and interpret them for your specific patient population. 

Babi FE, Oakley E, Dalziel SR, et al.
Accuracy of Physician Practice Compared to Three Head Injury Decision Rules in Children: A Prospective Cohort Study. 
This study looks at the application of common decision rule regarding head injury in children and compare this to clinical judgement of experienced physicians. The authors did a prospective observational study of children presenting with mild closed head injuries (GCS 13-15). They found their group of clinicians were very accurate at identifying children who had a clinically important traumatic brain injury (sensitivity 98.8%, specificity of 92.4%). This was better than the decision rules also applied to these children which included PECARN, CATCH and CHALICE. 

April MD, Oliver JJ, Davis WT, et al.
Aromatherapy versus Oral Ondansetron for Antiemetic Therapy Among Adult Emergency Department Patients: A Randomized Controlled Trial. 
Inhaled isopropyl alcohol as an aroma therapy has been described as effective is treating post-operative nausea. In this study, the authors compared inhaled isopropyl alcohol to placebo, alone or with oral ondansetron. They found that the aromatherapy with or without ondansetron had greater nausea relief than placebo or ondansetron alone. They recommend a trial of aromatherapy for patients with nausea who do not require immediate IV treatment. 

e Silva LOJ, Scherber K, Cabrera d, et al.
Safety and Efficacy of Intravenous Lidocaine for Pain Management in the Emergency Department: A Systematic Review.  
This is a systematic review of the literature on IV lidocaine for pain. There were only 6 randomized control trials of lidocaine for renal colic. The results were variable. Lidocaine did not appear to be effective for migraine headache but there were only 2 studies of this.  The authors concluded that we do not have enough data at this time to definitively comment on the use of lidocaine for pain in the ED. 

White DAE, Giordano TP, Pasalar S, et al.
Acute HIV Discovered During Routine HIV Screening with HIV Antigen/Antibody Combination Tests in 9 U.S. Emergency Departments
This study looked at HIV screening programs in 9 EDs located in 6 different cites over a 3 year period. There were 214,524 patients screened of which 839 (0.4%) were newly diagnosed.  Of the newly diagnosed 14.5% were acute HIV (detectible virus but negative antibody) and 85.5% were established HIV (positive antibody test). This study reminds us that many patients with acute HIV will have a negative screening test that relies strictly on antibody. Many of these patients present with flu like illness as their initial presentation. 

Axeem S. Seabury SA, Menchine M, et al.
Emergency Department Contribution to the Prescription Opioid Epidemic.
There has been much discussion of the opioid epidemic in both the professional and lay press. Emergency physicians tend to write a lot of prescriptions but for very small amounts. This study examined prescriptions for opioids from 1996-2012. During this period opioid prescription rates rose in private office settings and declined in the ED. For patients receiving high numbers of opioids, only 2.4% received opioids from the ED.