Updates

Half strength apple juice for ORT

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The Paediatric gastroenteritis page has been updated with information about the efficacy of half strength apple juice for ORT in children with only mild dehydration. Freedman, SB, Willan, AR, Boutis, K, et al. Effect of dilute apple juice and preferred fluids vs electrolyte maintenance solution on treatment failure among children with mild gastroenteritis: A randomized … Read more

Low dose tPA for stroke

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Some information about low dose (0.6mg/kg) IV tPA for the treatment of stroke has been added to the Thrombolytic therapy in stroke page. Anderson, CS, Robinson, T, Lindley, RI, et al. Low-Dose versus Standard-Dose Intravenous Alteplase in Acute Ischemic Stroke. N Engl J Med 2016.

Below knee DVT complication rates

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The Management of DVT page has been updated with the rates of complications revised downwards from those previously quoted. Horner, D, Hogg, K, Body, R. Should we be looking for and treating isolated calf vein thrombosis? Emergency Medicine Journal 2016;33(6):431-37.

Don’t transfuse platelets to patients with ICH on antiplatelet agents

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The Platelet transfusion and Stroke management pages have been updated with information from the PATCH RCT published in Lancet that demonstrated an increase in disability and mortality from platelet transfusion in patients with supratentorial ICH on mostly aspirin, clopidogrel and/or dipyridamole. The exact mechanism for this is unclear. Baharoglu, MI, Cordonnier, C, Salman, RA-S, et al. … Read more

Single value hsTnI rule out strategy

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The Troponins in ACS page has been updated with some additional information about single value hsTnI to rule out ACS. The bottom line is that hsTnT is probably more sensitive than hsTnI for clinically significantly outcomes, so is currently preferred. Carlton, E, Greenslade, J, Cullen, L, et al. Evaluation of High-Sensitivity Cardiac Troponin I Levels … Read more

hsTnI 1 hour rule out strategy

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The Risk stratification in suspected ACS page has been updated, including information about the use of a hsTnI 1 hour rapid ACS diagnostic pathway. The proposed pathway appears to be not as useful as similar hsTnT pathways. Neumann, JT, Sörensen, NA, Schwemer, T, et al. Diagnosis of Myocardial Infarction Using a High-Sensitivity Troponin I 1-Hour … Read more

NEAT admission performance and mortality

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The Time limited ED care targets page has been revised and additional information about the association between improved NEAT admission performance and hospital mortality has been added. Sullivan, C, Staib, A, Khanna, S, et al. The National Emergency Access Target (NEAT) and the 4-hour rule: time to review the target. Med J Aust 2016;204(9):354.

ICE and PANE – not what you think

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The acronyms relating to ED occupancy have been added to the Emergency Department overcrowding page. Sullivan, C, Staib, A, Eley, R, et al. National Emergency Access Targets metrics of the emergency department–inpatient interface: measures of patient flow and mortality for emergency admissions to hospital. Australian Health Review 2015;39(5):533-38. 

US guided IJV complication rates

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The Central venous catheter insertion technique page has been updated with additional information about the risk of US guided IJV catheter insertion in expert hands. Hourmozdi, JJ, Markin, A, Johnson, B, et al. Routine Chest Radiography Is Not Necessary After Ultrasound-Guided Right Internal Jugular Vein Catheterization. Critical Care Medicine 9000;Publish Ahead of Print.