LITFL R&R – Best of 2015

This article is one more piece of the mounting evidence demonstrating a clear call to change what is the usual care in many  institutions in the U.S. Stop the madness! Chest pain is tough — it’s the second most ED common chief complaint, and it scares the heck out of us and our patients – partially because missed MI is one one of the top causes of litigation. But we also see a ton of resources spent on a terribly low yield from chest pain workups. This new study in JAMA-IM including Mike Weinstock (of Bounceback fame), Scott Weingart and David Newman looked at the bad outcomes of patients with normal ECGs and 2 negative troponins admitted for chest pain, and found only 20 bad outcomes in 11k patients (4 in 7000 with appropriate exclusions like abnormal vital signs). Maybe it’s time to change our approach to chest pain? Recommended by Jeremy Fried & Seth Trueger Friedman, B.D, et al. Naproxen With Cyclobenzaprine, Oxycodone/Acetaminophen, or Placebo for Treating Acute Low Back Pain A Randomized Clinical Trial. JAMA 2015; 314(15): 1572-80. PMID 26501533 An outstanding study which examines how we can best care for our patients who present with low back pain. The authors included patients with acute, non traumatic back pain without radicular symptoms; and examined the effect of naproxen with either placebo, cyclobenzaprine, or oxycodone/acetaminophen. At 7 days and 3 months, there was no significant difference in disability or pain control between...
Source: Life in the Fast Lane - Category: Emergency Medicine Authors: Tags: Airway Anaesthetics Cardiology Education Emergency Medicine Intensive Care Pre-hospital / Retrieval R&R in the FASTLANE Respiratory Resuscitation Trauma critical care examination research and reviews Source Type: blogs