EM Quick Hits 18 Conservative Management Pneumothorax, Microdosing Buprenorphine, Practical Use of CRITOE, Canadian TIA Score, Pediatric Surviving Sepsis Guidelines, Safety of Peripheral Vasopressors

Emergency Medicine Cases - En podcast af Dr. Anton Helman - Tirsdage

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Topics in this EM Quick Hits podcast Justin Morgenstern on watchful waiting for large spontaneous pneumothoraces (0:44) Michelle Klaiman on mirco-dosing buprenorphine for opiate use disorder (5:17) Arun Sayal on the practical application of CRITOE in pediatric elbow fractures (10:45) Jeff Perry on The Canadian TIA Score (19:37) Sarah Reid on updated pediatric surviving sepsis guidelines (25:59) Salim Rezaie (Best of REBELEM) on safety of vasopressor administration through peripheral IVs (33:40) Podcast production, editing and sound design by Anton Helman Podcast content, written summary & blog post by Michelle Klaiman and Anton Helman Cite this podcast as: Helman, A. Morgenstern, J. Klaiman, M. Sayal, A. Perry, J, Reid, S. Rezaie, S. EM Quick Hits 18 - Conservative Management Pneumothorax, Microdosing Buprenorphine, Practical Use of CRITOE, Canadian TIA Score, Pediatric Surviving Sepsis Guidelines, Safety of Peripheral Vasopressors. Emergency Medicine Cases. May, 2020. https://emergencymedicinecases.com/em-quick-hits-may-2020/. Accessed [date]. Watchful waiting of large spontaneous pneumothorax * This multicenter, open label, non-inferiority trial of 316 patients compared small bore chest tube treatment for primary spontaneous pneumothorax >32% (using Collins method - see below) to conservative management (observation for 4 hours followed by repeat chest x-ray and discharge from the ED if walking comfortably and vital signs were stable) * The primary outcome of complete radiologic resolution of the pneumothorax occurred in 98.5% of the intervention group at 8 weeks and 94.4% of the conservative management group, a "non-inferior" difference and complete resolution of symptoms at 8 weeks was similar ( 93.4% vs 94.6%) * Secondary outcomes show that pneumothoraces took about 2 weeks longer to resolve in the conservative group, however they had shorter hospital stays, less time of work, less CT scans, less recurrence and less serious adverse events * Consider including conservative management of spontaneous pneumothorax in shared decision making NEJM quick video of the trial The Collins method estimates the size of pneumothorax using a calculation based on measuring the interpleural distance at the apex  (A) and the midpoints of the upper (B) and lower (C) halves of the collapsed lung to the hemithorax on a PA chest x-ray. Expand to view reference list * Brown SGA, Ball EL, Perrin K, et al. Conservative versus Interventional Treatment for Spontaneous Pneumothorax. The New England journal of medicine. 2020; 382(5):405-415 * First10EM: Conservative treatment for pneumothorax  * St Emlyn’s JC: Conservative management of pneumothoraces. * REBEL EM: Spontaneous Pneumothorax: Stand There and Do Nothing? ED buprenorphine initiation and microdosing