EM Quick Hits 35 – 10 Best Papers of 2021, Peripartum Cardiomyopathy, Crashing Asthmatic, Febrile Neutropenia, Anaphylaxis update

Topics in this EM Quick Hits podcast Ken Milne on The 10 Best EM Papers of 2021 (00:40) Brit Long on a careful structured approach to Febrile Neutropenia to improve outcomes (11:55) Catherine Varner on how not to miss Peripartum Cardiomyopathy (20:35) Joe Nemeth on Anaphylaxis Update (27:30) Anand Swaminathan on his approach to The Crashing Asthmatic (38:54) Podcast production, editing and sound design by Anton Helman Podcast content, written summary & blog post by Kate Dillon and Joe Nemeth, edited by Anton Helman, January 2022 Cite this podcast as: Helman, A, Milne, K, Varner, C, Long, B, Nemeth, J, Swaminathan, A. EM Quick Hits 35 - 10 Best Papers of 2021, Peripartum Cardiomyopathy, Crashing Asthmatic, Febrile Neutropenia, Anaphylaxis update. January, 2022. https://emergencymedicinecases.com/em-quick-hits-january-2022/. Accessed [date]. 10 Best EM Papers of 2021 from EM Cases Summit 2021 1. TTM2 - Therapeutic Hypothermia after Cardiac Arrest * Population: adult patients with out of hospital cardiac arrest who were comatose * Intervention: cooled to 33°C vs. maintaining normothermia * Primary Outcome: all-cause mortality at 6 months * Results: no statistical difference between groups (~50% in both groups) Bottom line: no benefit to cooling patients after out of hospital cardiac arrest who are comatose Deep dive: https://thesgem.com/2021/07/sgem336-you-cant-always-get-what-you-want-ttm2-trial/ Deep dive into worlds literature on therapeutic hypothermia: Journal Jam on Therapeutic Hypothermia after Cardiac Arrest 2. SALSA Trial - Hypertonic Saline to treat Hyponatremia * Population: adult patients with sodium <126 mmol/L and moderate to severe symptoms * Intervention: rapid intermittent bolus strategy vs. slow continuous infusion strategy * Primary Outcome: incidence of overcorrection of serum sodium up to 48 hours * Results: no statistical difference between groups Bottom line: speed of correction does not matter, but be careful not to overcorrect the sodium Deep Dive: https://thesgem.com/2021/04/sgem326-the-salsa-study-hypertonic-saline-to-treat-hyponatremia/ 3. tPA before endovascular therapy for stroke * Population: adult patients within 4.5 hours of onset of symptoms * Intervention: tPA + EVT within 30 minutes vs. EVT alone * Primary Outcome: modified Rankin Scale (mRS – a scale for neurologic disability) at 90 days * Results: no statistical difference in modified Rankin Scale, or all-cause mortality between groups, however there was more bleeding in the combination group (tPA + EVT) Bottom line: no high-quality evidence to support tPA before EVT, if EVT is readily available Deep dive: https://thesgem.com/2021/06/sgem333-do-you-gotta-be-starting-something-like-tpa-before-evt/ 4. NoPAC Trial - TXA for epistaxis * Population: adult patients with persistent atraumatic epistaxis after local pressure/ice to the bridge of the nose for 10 minutes AND topical vasoconstr...