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Update on Emergency Department Sedation
Procedural sedation is an important and required skill for emergency medicine providers. Performing procedural sedation allows providers to safely perform multiple procedures, such as reductions, suturing, and cardioversion. Multiple agents can be used for procedural sedation and should be chosen based on desired length of sedation and comorbidities, as well as the physician’s level of comfort.
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Atrasentan Tablets (Vanrafia)
The U.S. Food and Drug Administration has approved atrasentan, the first selective endothelin A receptor (ETAR) antagonist to reduce proteinuria in adults with immunoglobulin A nephropathy. It was approved under accelerated approval based on surrogate outcome. Continued approval may be contingent on verification of clinical benefit in a confirmatory clinical trial. Atrasentan is distributed by Novartis Pharmaceuticals Corporation as Vanrafia.
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Vasectomy Follow-Up Rates: How Good Are They?
In this retrospective cohort study of 2,567 patients at a single institution, 42.1% of men did not follow up at all after vasectomy for semen analysis. Of those with spermatozoa on the initial testing post-vasectomy, 43.3% of men failed to return for repeat testing.
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Best Long-Term Antiplatelet Monotherapy Post-PCI
In a multicenter, randomized, open-label trial of clopidogrel vs. aspirin monotherapy in patients post-percutaneous coronary intervention (PCI) who had been on dual antiplatelet therapy for the recommended period, those randomized to clopidogrel showed fewer major cardiovascular or cerebral events over a two-year follow-up period than those on aspirin without an increase in bleeding events.
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Does Thoracentesis Speed Recovery from Heart Failure?
An unblinded, multicentered, randomized trial of patients with acute heart failure hospital admissions and significant pleural effusions showed that early thoracentesis, in addition to recommended medical therapy, did not reduce mortality or length of stay, or increase days alive out of the hospital for 90 days. However, it was relatively safe and could be employed in selected persistently symptomatic patients with very large effusions.
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Stroke Risk in Patients with New AFib During Unrelated Hospitalization
In a Canadian administrative database study of patients who developed atrial fibrillation during a hospitalization for other reasons, researchers followed the patients for one year to ascertain the risk of subsequent stroke. The incidence of stroke in those not anticoagulated generally was below the 2% per year threshold recommended for treatment with anticoagulants. However, in those with a CHA2DS2-VA score ≥ 5 (sex not included based on new data) and in those admitted for cardiac medical problems, the 95% confidence intervals of stroke risk did cross 2%. Thus, selected patients may be candidates for anticoagulation.
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Pediatric Airway Management: The Basics
Pediatric airways present unique challenges to all acute providers. Knowing what to use and when to use it is critical, and being prepared for the most basic and difficult situations is essential. The authors present a comprehensive, escalating review on the approach to a child’s airway to optimize outcomes.
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Epigenetic Changes in Perilesional Brain Tissue After Radiotherapy
Epigenetic and transcriptomic studies of irradiated perilesional brain tissue identified clear changes in deoxyribonucleic acid (DNA) methylation patterns and neuropeptide upregulation that contributed to neuroinflammation, which may underly radiation-related neurotoxicity.
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24-Hour Activity Rhythms and Amyloid-β Deposition in the Brain
This study of dementia-free adults found that greater variability of the 24-hour activity rhythm (greater during the daytime as well as during sleep time) with fragmentation of sleep predicted increased deposition of amyloid-β (Aβ), especially in apolipoprotein E 4 (APOE4) carriers.
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Quantitative Pupillometry in Patients with Large Middle Cerebral Artery Strokes
Secondary neurologic decline after large middle cerebral artery (MCA) stroke is common and is associated with worse outcomes. This study aimed to evaluate the utility of quantitative pupillometry to predict neurologic decline before it occurs. Although no model was found to predict decline, stable Neurological Pupil index (NPi) and dilation velocities may provide some reassurance that an imminent decline is unlikely.