Surf’s up!! Time to enjoy another literature surf from Associate Professor Michael Ragg.
Check out his take on the studies below, and the abstract summary RSR 003
High versus Low Blood-Pressure Target in Patients with Septic Shock 
My take is that we don’t need to chase a higher MAP on patients in septic shock, as those with a MAP of 65-70 did just as well from a mortality & serious adverse events point of view.
Mortality Related to Severe Sepsis in Australia and NZ, 2000-2012 
Important paper showing mortality from severe sepsis & septic shock in Australia and NZ has reduced from 35% to 18% over the last 12 years. Mortality <5.
Dipstick Screening for Urinary Tract Infection in Febrile Infants 
So in a nutshell, urine dipstick had a NPV of 98.7% for UTIs and PPV of only 66.8%. Clinically, good for ruling out UTIs but not so good for ruling in. So a completely clear dipstick urine may be helpful in excluding the diagnosis
Transradial Coronary Catheterization and Intervention, Allen Test Results 
So in this study of 942 patients undergoing radial artery catheterization, the Allen’s test essentially made no difference and there were no hand ischaemic complications. Has not proved it but certainly is suggesting we need more research to prove whether doing an Allen’s Test is a waste of time
Time to epinephrine after in-hospital arrest with non-shockable rhythms 
So in 25,000 odd patients who had in-hospital cardiac arrest, the longer the delay to the first dose of adrenaline, the worse the outcome. Getting adrenaline earlier improved ROSC, survival in hospital and neurologically intact survival.
Fibrinolysis for Patients with Intermediate-Risk Pulmonary Embolism 
Time to Ambulance-Based Thrombolysis in Acute Ischemic Stroke 
Lorazepam vs Diazepam for Pediatric Status Epilepticus 
Ablation vs Antiarrhythmic Drugs for AF (RAAFT-2) 
RV Dilatation on Bedside Echo Performed by EPs aids Diagnosis of PE 
Systolic BP and outcome in adults with out-of-hospital cardiac arrest 
8.0-cm needle at 4th AAL for tension pneumothorax 
Comparison of new oral anticoagulants with warfarin in patients with AF 
Albumin Replacement in Patients with Severe Sepsis or Septic Shock 
Door-to-Needle Times for TPA, and Outcomes in Acute Ischemic Stroke 
RF Ablation vs Endoscopic Surveillance for Barrett Esophagus 
Sternotomy or Drainage for a Hemopericardium After Penetrating Trauma 
Efficacy of ultrasound-guided radial artery catheterization 
Ultrasonography/MRI Versus CT for Diagnosing Appendicitis 
Major Bleeding in Patients With AF Receiving Apixaban or Warfarin 
The Use of Digoxin in Patients With Worsening Chronic Heart Failure 
- Asfar P. et al, High versus Low Blood-Pressure Target in Patients with Septic Shock.
N Engl J Med 2014; 370:1583-1593 April 24, 2014DOI: 10.1056/NEJMoa1312173
- Kaukonen K-M et al, Mortality Related to Severe Sepsis and Septic Shock Among Critically Ill Patients in Australia and New Zealand. 2000-2012JAMA. 2014;311(13):1308-1316. doi:10.1001/jama.2014.2637.
- Glissmeyer EW et al, Dipstick Screening for Urinary Tract Infection in Febrile Infants Pediatrics.
Vol.133,No.5,May1,2014 pp. e1121 -e1127
- Valmigili M et al, Transradial Coronary Catheterization and Intervention Across the Whole Spectrum of Allen Test Results.
J Am Coll Cardiol. 2014;63(18):1833-1841. doi:10.1016/j.jacc.2013.12.043
- Donnino MW et al, Time to administration of epinephrine and outcome after in-hospital cardiac arrest with non-shockable rhythms: retrospective analysis of large in-hospital data registry.
BMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g3028
- Meyer g et al, Fibrinolysis for Patients with Intermediate-Risk Pulmonary Embolism.
N Engl J Med 2014; 370:1402-1411 April 10, 2014DOI: 10.1056/NEJMoa1302097
- Ebinger M et al, Effect of the Use of Ambulance-Based Thrombolysis on Time to Thrombolysis in Acute Ischemic Stroke: A Randomized Clinical Trial
JAMA. 2014;311(16):1622-1631. doi:10.1001/jama.2014.2850
- Chamberlain JM et al, Lorazepam vs Diazepam for Pediatric Status Epilepticus.
JAMA. 2014;311(16):1652-1660. doi:10.1001/jama.2014.2625.
- Morillo CA et al, Radiofrequency Ablation vs Antiarrhythmic Drugs as First-Line Treatment of Paroxysmal Atrial Fibrillation (RAAFT-2): A Randomized Trial.
JAMA. 2014;311(7):692-700. doi:10.1001/jama.2014.467
- Dresden S et al, Right Ventricular Dilatation on Bedside Echocardiography Performed by Emergency Physicians Aids in the Diagnosis of Pulmonary Embolism.
Ann Emerg Med. 2014 Jan;63(1):16-24. doi: 10.1016/j.annemergmed.2013.08.016. Epub 2013 Sep 27. PubMed PMID: 24075286
- Bray JE et al, The association between systolic blood pressure on arrival at hospital and outcome in adults surviving from out-of-hospital cardiac arrests of presumed cardiac aetiology.
Resuscitation. 2014 Apr;85(4):509-15. doi: 10.1016/j.resuscitation.2013.12.005
- Change SJ et al, Evaluation of 8.0-cm needle at the fourth anterior axillary line for needle chest decompression of tension pneumothorax.
J Trauma Acute Care Surg. 2014 Apr;76(4):1029-34
- Ruff CT et al, Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials.
The Lancet, Volume 383, Issue 9921, Pages 955 – 962, 15 March
- Caironi P et al, Albumin Replacement in Patients with Severe Sepsis or Septic Shock.
N Engl J Med 2014; 370:1412-1421April 10, 2014DOI: 10.1056/NEJMoa1305727
- Door-to-Needle Times for Tissue Plasminogen Activator Administration and Clinical Outcomes in Acute Ischemic Stroke Before and After a Quality Improvement Initiative.
JAMA. 2014;311(16):1632-1640. doi:10.1001/jama.2014.3203
- Nadine Phoa K et al, Radiofrequency Ablation vs Endoscopic Surveillance for Patients With Barrett Esophagus and Low-Grade Dysplasia : A Randomized Clinical Trial.
JAMA. 2014;311(12):1209-1217. doi:10.1001/jama.2014.2511
- Nicol A et al, Sternotomy or Drainage for a Hemopericardium After Penetrating Trauma: A Randomized Controlled Trial.
Annals of Surgery: March 2014 – Volume 259 – Issue 3 – p 438–442
- Wan-Jie Gu et al, Efficacy of ultrasound-guided radial artery catheterization: a systematic review and meta-analysis of randomized controlled trials.
Critical Care 2014, 18:R93 doi:10.1186/cc13862
- Aspelund G et al, Ultrasonography/MRI Versus CT for Diagnosing Appendicitis
Published online March 3, 2014 doi: 10.1542/peds.2013-2128
- Hylek EM et al, Major Bleeding in Patients With Atrial Fibrillation Receiving Apixaban or Warfarin The ARISTOTLE Trial.
J Am Coll Cardiol. 2014;63(20):2141-2147. doi:10.1016/j.jacc.2014.02.549
- Ambrosy AP et al, The Use of Digoxin in Patients With Worsening Chronic Heart Failure. Reconsidering an Old Drug to Reduce Hospital Admissions.
J Am Coll Cardiol. 2014;63(18):1823-1832. doi:10.1016/j.jacc.2014.01.051