Now usually I don’t go and make wild conjectures and hypotheses. But Im going to discuss a pretty interesting (wild conjecture?) one that on paper seems to make sense to me. Let’s look at the COVID-19 risk factors for who gets severe disease and put them in a molecular and biological framework. If you want you […]
Read More COVID-19 RISK FACTORS: Who gets them and why. You are going to ACE this one…
Effect of Piperacillin-Tazobactam vs Meropenem on 30-Day Mortality for Patients With E coli or Klebsiella pneumoniae Bloodstream Infection and Ceftriaxone Resistance
A Randomized Clinical Trial This was a randomized, double-blinded, international multicenter pragmatic (phew! That’s a mouthful!) study to determine if piperacillin/tazobactam (pip-taz) is non-inferior to meropenem. The reason for this study is to see if […]
Read More We’re Back Baby!! The Quick hit article: For ESBL, Just Say NO to PIP/TAZO
We all know hypotension is bad. But should we fill with fluids or rev up the heart with pressors. This begs the question does early norepi help prevent hypotension and mortality? Today’s quick hit article: Permpikul C, et al. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER) : A Randomized Trial. Am J Respir Crit Care Med. 2019 Feb 1. doi: 10.1164/rccm.201806-1034OC. PMID 30704260. […]
Read More Fill the Tank or Rev’ the Engine… WHOA, PUMP the BRAKES: Early fixed dose norepi for septic shock?
Fernando et. al. HELPFUL ONLY WHEN ELEVATED: INITIAL SERUM LACTATE IN STABLE EMERGENCY DEPARTMENT PATIENTS WITH SEPSIS IS SPECIFIC, BUT NOT SENSITIVE FOR FUTURE DETERIORATION Journal of Emergency Medicine, Vol. 54, No. 6, pp. 766–773. https://doi.org/10.1016/j.jemermed.2018.01.040 BOTTOM LINE: A lactate >4 in this prospective observational cohort study of almost 1000 patients with the “CMS” definition […]
Read More Lactate for Safely Screening Sepsis?
Tamma, et al. Rethinking How Antibiotics Are Prescribed: Incorporating the 4 Moments of Antibiotic Decision Making Into Clinical Practice. JAMA. 2018 Dec 27. doi: 10.1001/jama.2018.19509. [Epub ahead of print] BOTTOM LINE: Providers should be asking themselves: “What is the likelihood my patient has an infection and that it requires antibiotic therapy?” Those who know […]
Read More Antibiotic StewardSHIP…Moveover Titanic…there’s a new failure in town.
There hasn’t been an update to the IDSA/ATS guidelines for CAP (community acquired pneumonia) since 2007 (I keep hearing they will be out soon). These guidelines recommend
a macrolide antibiotic as first-line therapy for previously healthy patients who have no risk factors for drug-resistant S. pneumonia (SPN) infection (strong recommendation) and a combination of a […]
Read More Macrolide Resistance: Is Resistance Futile?
Sometimes things aren’t as they seem. As an attending I often hear from a resident “Hey got an easy one for ya, 50 y/o diabetic with bilateral cellulitis vanc given, I’ll get some admit labs” followed by a precipitous mic drop. I was told once that a good attending “makes a difficult case simple and […]
Read More SO YOU THINK YOU KNOW CELLULITIS?
Quick Hit Article: Pyelonephritis treatment in the community emergency department: Cephalosporins vs. first-line agents. Vogler Am J Emerg Med. 2018 Aug 8. pii: S0735-6757(18)30652-1 The Bottom Line: In this retropsective chart review with moderate (not optimal) methods, patients placed on cephalosporins had significantly less treatment failure (0% vs 23%, p< 0.001) than when placed on either […]
Read More Quick Hit Article #8: Say No To Flouro(Quinolone) in Pyelo
Source: J Emerg Med. 2018 Jul 20. pii: S0736-4679(18)30602-4 Today’s (really) quick hit is a neat little article trying to answer the question “Does Lactated Ringers increase your serum lactic acid. Given that sepsis seems to be the only diagnosis of anymore, can our friend lactic acid still help us if we are giving 30 ml/kg […]
Read More (Really) Quick Hit Article #7 – LR does not clinically increase serum lactate. If you believe in lactate…come along with me…
Yes, summer in Arizona is hot but we aren’t talking weather – hot. We are talking fever – hot, as in, is our ED temperature measurements correct? The scientist part of me wants accuracy, the caring part of me wants not to put things in peoples bum! So, is there a happy medium when it […]
Read More QUICK HIT #3: THE ED TEMPERATURE VITAL SIGN – Its HOT! But How Hot????