Research and Reviews in the Fastlane 171

This study’s methodology doesn’t allow it to put this question to rest but it gives us some insight into the question. The authors performed a retrospective before-and-after study (first 2 years, etomidate was routinely used. second 2 years, department protocol shifted to encourage ketamine over etomidate) and found no statistically significant difference in mortality: OR 1.41 (CI: 0.93 – 2.16). However, the 3% difference in mortality favoring etomidate may be important if it held up in a larger trial powered to look for this difference. Bottom line, we don’t know if one agent is superior to another and for now we’ll continue to act on incomplete information. Recommended by: Anand Swaminathan Emergency Medicine Righini M et al. Anticoagulant Therapy for Symptomatic Calf Deep Vein Thrombosis (CACTUS): A Randomised, Double-Blind, Placebo-Controlled Trial. Lancet Haemotol 2016. PMID: 27836513 This is an underpowered study, that gives us very little guidance on how to treat distal calf DVTs. As there is no clear optimal approach at this time, I would advocate for a shared decision making strategy regarding the use of anticoagulation vs no anticoagulation in isolated low-risk, distal DVTs. With either strategy, close follow up with repeat ultrasound, over the next few days, should be performed to assist with further management and treatment decisions. Recommended by: Salim R. Rezaie Further reading: The CACTUS Trial: Anticoagulation for symptom...
Source: Life in the Fast Lane - Category: Emergency Medicine Authors: Tags: Airway Emergency Medicine R&R in the FASTLANE EBM Education literature recommendations research and reviews Source Type: blogs