Time to Treatment and Mortality during Mandated Emergency Care for Sepsis (NEJM, via G Johnson)

Time to Treatment and Mortality during Mandated Emergency Care for Sepsis.

Christopher W. Seymour, M.D., Foster Gesten, M.D., Hallie C. Prescott, M.D., Marcus E. Friedrich, M.D., Theodore J. Iwashyna, M.D., Ph.D., Gary S. Phillips, M.A.S., Stanley Lemeshow, Ph.D., Tiffany Osborn, M.D., M.P.H., Kathleen M. Terry, Ph.D., and Mitchell M. Levy, M.D.

N Engl J Med 2017; 376:2235-2244June 8, 2017DOI: 10.1056/NEJMoa1703058

https://www.ncbi.nlm.nih.gov/pubmed/28528569
https://doi.org/10.1056/NEJMoa1703058

Journal Club Articles for 4/26/2017

Correlation of Venous Blood Gas and Pulse Oximetry With Arterial Blood Gas in the Undifferentiated Critically Ill Patient.
J Intensive Care Med. 2016 Jun 9.
Zeserson E, Goodgame B, Hess JD, Schultz K, Hoon C, Lamb K, Maheshwari V, Johnson S, Papas M, Reed J, Breyer M.
PMID: 27283009
DOI: 10.1177/0885066616652597

Propofol or Ketofol for Procedural Sedation and Analgesia in Emergency Medicine-The POKER Study: A Randomized Double-Blind Clinical Trial.
Ann Emerg Med. 2016 Nov;68(5):574-582.e1.
Ferguson I, Bell A, Treston G, New L, Ding M5, Holdgate A.
PMID: 27460905
DOI: 10.1016/j.annemergmed.2016.05.024
Full text via NYSL: http://www.sciencedirect.com.dbgateway.nysed.gov/science/article/pii/S0196064416302049

 

Recommended NEJM Reading (via G. Johnson)

Recommended reading from the new NEJM, via Dr. Gary Johnson

Acute Spinal Cord Compression
Alexander E. Ropper, M.D., and Allan H. Ropper, M.D.
N Engl J Med. 2017 Apr 6;376(14):1358-1369.
doi: 10.1056/NEJMra1516539.
PMID: 28379788

Two-Year Outcome after Endovascular Treatment for Acute Ischemic Stroke
Lucie A. van den Berg, M.D., Marcel G.W. Dijkgraaf, Ph.D., Olvert A. Berkhemer, M.D., Ph.D., Puck S.S. Fransen, M.D., Debbie Beumer, M.D., Hester F. Lingsma, Ph.D., Charles B.L.M. Majoie, M.D., Ph.D., Diederik W.J. Dippel, M.D., Ph.D., Aad van der Lugt, M.D., Ph.D., Robert J. van Oostenbrugge, M.D., Ph.D., Wim H. van Zwam, M.D., Ph.D., and Yvo B.W.E.M. Roos, M.D., Ph.D., for the MR CLEAN Investigators*
N Engl J Med. 2017 Apr 6;376(14):1341-1349.
doi: 10.1056/NEJMoa1612136.
PMID: 28379802

Initial prescription associated with long term opioid usage (via Paolo)

Characteristics of Initial Prescription Episodes and Likelihood of Long-Term Opioid Use – United States, 2006-2015.
Shah A, Hayes CJ, Martin BC.
MMWR Morb Mortal Wkly Rep.
2017 Mar 17;66(10):265-269.
doi: 10.15585/mmwr.mm6610a1.
PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28301454
Full text PDF: https://www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6610a1.pdf

Rothman adds:

The study has gotten some attention in the popular media as well- here’s what your patients may have read:

Ars Technica’s Beth Mole: With a 10-day supply of opioids, 1 in 5 become long-term users
https://arstechnica.com/science/2017/03/with-a-10-day-supply-of-opioids-1-in-5-become-long-term-users/

Vox: The risk of a single 5-day opioid prescription, in one chart
http://www.vox.com/2017/3/18/14954626/one-simple-way-to-curb-opioid-overuse-prescribe-them-for-3-days-or-less

CNN: Prescriptions may hold clues to who gets hooked on opioids, study says
http://www.cnn.com/2017/03/20/health/opioid-prescriptions-predict-chronic-use-study/

Valium for acute back pain…

“….added nothing above and beyond Naproxen (which we can presume based upon very little distinction within the NSAID class is equivalent to Motrin).
http://www.annemergmed.com/article/S0196-0644(16)31214-8/abstract
[PubMed]

In previous studies this held true for opiates as well.

So take home points—

1) Low back pain (very probably) does not need benzodiazepines
2) Low back pain (very probably) does not need opiates
3) Low back pain (most certainly) never requires an opiate/benzo combo
4) Low back pain (most likely) really only needs NSAIDs and time (probably mostly the time)
5) Don’t give more than 400mg of Motrin.”

-Dr. William Paolo

“And remember…prescribing benzodiezapines for back pain isn’t necessarily ‘safer.’ National statistics show an increase in benzodiezapine related deaths; perhaps partly attributed to their increased prescribing in response to an overall decrease in opioid prescribing.”

-Dr. Ross Sullivan