Checklist for Emergency Intubation in Trauma Patient

AEM published “A Preprocedural Checklist Improves the Safety of Emergency Department Intubation of Trauma Patients” in July. This is a prospective, pre-post intubation  study on 141 trauma

patients who intubated in ED. Rate of intubation related complication pre intervention was 9.2% compare with 1.5 % post intervention. This study shows importance of being prepared and following checklist can enhance patient safety during emergent procedures.

Link to article

Link to checklist

EBM, on unprovoked first seizure from Neurology!

Evidence-based guideline: Management of an unprovoked first seizure in adults: Report of the Guideline Development Subcommittee of the American Academy of Neurology and the American Epilepsy Society answers  very critical questions regarding unprovoked first seizure.

1. The recurrence of an unprovoked first seizure is greatest early within the first 2 years (21%-45%)

2. Increased risk may include a prior brain insult (Level A), an EEG with epileptiform abnormalities (Level A), a significant brain-imaging abnormality (Level B), and a nocturnal seizure (Level B).

3. Immediate antiepileptic drug (AED) therapy, as compared with delay of treatment pending a second seizure, is likely to reduce recurrence risk within the first 2 years (Level B) but may not improve quality of life (Level C).

4. Over a longer term (>3 years), immediate AED treatment is unlikely to improve prognosis as measured by sustained seizure remission (Level B).

5. Patients should be advised that risk of AED adverse events (AEs) may range from 7% to 31% (Level B) and that these AEs are likely predominantly mild and reversible.



Link to article

Can we give carbapenems in patients with penicillins allergies?

You have a septic patient with PCN allergies! and now you are in trouble to start appropriate antibiotics due to cross reactivity. This is an Italian based study, that studied the cross-reactivity and

tolerability of aztreonam and imipenem-cilastatin, meropenem, and ertapenem among  patients with documented IgE-mediated hypersensitivity to penicillins.  They enrolled 212 patients with immediate reactions to penicillins and positive results on skin tests to penicillin reagent underwent skin tests with aztreonam and carbapenems. All subjects displayed negative skin test results to both aztreonam and carbapenems. The conclusion is: These data indicate the tolerability of both aztreonam and carbapenems in penicillin-allergic subjects.



Link to article:

Sexually Transmitted Diseases Treatment Guidelines, 2015

New guideline by MMWR in June 2015, reviewing most important topics in STD. This guideline is very comprehensive and answers several critical questions regarding current and future therapy and focuses on STD.

Mycoplasma genitalium, is more common than N. gonorrhoeae but less common than C. trachomatis. in case of Urethritis and Cervicitis, the 7-day doxycycline regimen recommended for treatment  of urethritis is largely ineffective against  M. genitalium  with  a median cure rate of approximately 31% . The  1-g single dose of azithromycin was significantly more effective against  M. genitalium  than doxycycline in two randomized  urethritis treatment trials, and is preferred over  doxycycline. However, resistance to azithromycin appears to  be rapidly emerging.


Link to Guideline

PE and Pregnancy

Having a pregnant patient with suspected PE, you know what I’m talking about. It is usually a disaster, mom is worry about fetus, dad is worry about mom, you are worry about both! how much is the risk of PE in pregnancy?

Meng etal, reviewed 27 articles related to this topic in a meta-analysis. They found 1.1‰ (1.0-1.3‰) for deep vein thrombosis (DVT) and 0.3‰ (0.2-0.4‰) for pulmonary embolism (PE). Risk of VTE after postpartum was significantly higher.


link to article

Appendicitis OR versus IV antibiotics!

There are a lot confusion/controversy regarding appendicitis treatment :ABx vs surgery:

The NOTA Study (Non Operative Treatment for Acute Appendicitis) in Ann surg, 2014 showed that antibiotics for suspected acute appendicitis are safe and effective and may avoid unnecessary appendectomy.

Long-Term Outcomes of Patients with Nonsurgically Managed Uncomplicated Appendicitis in J Am Coll Surg, 2014 with same result.

But there is a JAMA article published today regarding this topic:  Antibiotic Therapy vs Appendectomy for Treatment of Uncomplicated Acute Appendicitis, There were 273 patients in the surgical group and 257 in the antibiotic group. Patients randomized to antibiotic therapy received IV ertapenem (1 g/d) for 3 days followed by 7 days of oral levofloxacin (500 mg once daily) and metronidazole (500 mg 3 times per day). Patients randomized to the surgical treatment group were assigned to undergo standard open appendectomy.
The result showed that 27 % of patients treated with antibiotics instead of surgery have a recurrence within 1 year. Their conclusion is among patients with CT-proven, uncomplicated appendicitis, antibiotic treatment did not meet the pre-specified criterion for non-inferiority compared with appendectomy.

Probably this will come to our practice in near future (next 5-10 years) we will give options to patient to have abx vs surgery.