Rap 70

1) BIG Validation

Review Summary

  • Source: EMA
  • Author: Sanjay Arora, MD
  • Reviewer: McKinzy Butler, MD
5
/ 7
BEEM Rater Scale
6
/ 7
Educational Utility
5
/ 7
Evidence Based Medicine

Takeaway

The BIG is an important tool for identifying risk of neurological deterioration and need for intervention with TBI, and can guide need for admission, repeat HCT, and NSGY consult.

2) Fluids in Sepsis Induced Hypotension

Review Summary

  • Source: The Bottom Line
  • Author: George Walker
  • Reviewer: Autumn Ties, MD
4
/ 7
BEEM Rater Scale
5
/ 7
Educational Utility
5
/ 7
Evidence Based Medicine

Takeaway

In patients with sepsis induced hypotension, restrictive fluids with early vasopressor use doesn’t lead to lower (or higher) mortality at 90 days. 

3) CT for Pyogenic Spinal Infections

Review Summary

  • Source: EMA
  • Author: Mike Menchine, MD
  • Reviewer: Tou Thao, MD
3
/ 7
BEEM Rater Scale
3
/ 7
Educational Utility
6
/ 7
Evidence Based Medicine

Takeaway

CT scan is still inferior to MRI in detecting spinal epidural abscesses. CT scan positive for other pyogenic infections warrants immediate MRI evaluation.

4) Steroid for Severe Pneumonia

Review Summary

  • Source: EMCrit
  • Author: Josh Farkas, MD
  • Reviewer: Zach Affeldt, MD
3
/ 7
BEEM Rater Scale
2
/ 7
Educational Utility
6
/ 7
Evidence Based Medicine

Takeaway

If someone has severe CAP with an elevated CRP the addition of hydrocortisone could be beneficial. 

5) BOX Trial

Review Summary

  • Source: REBEL EM
  • Author: Salim Rezaie
  • Reviewer: Allie Schick, MD
4
/ 7
BEEM Rater Scale
3
/ 7
Educational Utility
6
/ 7
Evidence Based Medicine

Takeaway

Randomizing patients with ROSC after OHCA with likely cardiac cause to restrictive PaO2 goal or higher MAP target did not affect neurologic outcomes or mortality.