LLSA Readings: 2025

Anesthesia

Gottlieb M, Penington A, Schraft E. Digital nerve blocks: a comprehensive review of techniques. J Emerg Med 2022 Oct;63(4):533-40. doi: 10.1016/j.jemermed.2022.07.002. Epub 2022 Oct 11. PMID: 36229322.

This comprehensive review outlines the various techniques for digital nerve blocks, emphasizing anatomical considerations, procedural steps, and comparative efficacy. It highlights that while multiple techniques (e.g., dorsal, transthecal, volar) are effective, individual preferences and specific clinical situations may guide the optimal choice. The review also addresses common pitfalls and complications, aiding in clinical decision-making.

Cardiology

Houseman BS, Martinelli AN, Oliver WD, et al. High-dose nitroglycerin infusion description of safety and efficacy in sympathetic crashing acute pulmonary edema: the HI-DOSE SCAPE study. Am J Emerg Med 2023 Jan;63:74-8. doi: 10.1016/j.ajem.2022.10.018. Epub 2022 Oct 18. PMID: 36327753.

The HI-DOSE SCAPE study evaluates high-dose nitroglycerin infusion in patients with sympathetic crashing acute pulmonary edema (SCAPE). The study found this approach to be both safe and effective, with rapid symptom relief and hemodynamic stabilization. It supports the early aggressive vasodilation strategy in appropriately selected patients.

Endocrine

Glaser N, Fritsch M, Priyambada L, et al. ISPAD clinical practice consensus guidelines 2022: diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes 2022 Nov;23(7):835-56. doi: 10.1111/pedi.13406. PMID: 36250645.

These updated ISPAD guidelines provide detailed recommendations on the diagnosis and management of diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) in children and adolescents. Key updates include fluid management, insulin therapy, and electrolyte correction protocols. Emphasis is placed on early recognition, tailored therapy, and prevention of cerebral edema.

Epidemiology

Garcia RA, Spertus JA, Girotra S, et al. Racial and ethnic differences in bystander CPR for witnessed cardiac arrest. N Engl J Med 2022 Oct 27;387(17):1569-78. doi: 10.1056/NEJMoa2200798. PMID: 36300973; PMCID: PMC9760357.

This study identified significant racial and ethnic disparities in the provision of bystander CPR for witnessed cardiac arrests across the U.S. Black and Hispanic individuals were less likely to receive bystander CPR compared to white individuals, especially in public settings. The findings underscore the urgent need for equitable CPR training and outreach.

Gastroenterology

Bridwell RE, Long B, Ramzy M, et al. Balloon tamponade for the management of gastrointestinal bleeding. J Emerg Med 2022 Apr;62(4):545-8. doi: 10.1016/j.jemermed.2021.11.004. Epub 2022 Jan 20. PMID: 35065859.

This article reviews balloon tamponade devices (e.g., Sengstaken-Blakemore and Minnesota tubes) as temporizing measures for severe gastrointestinal bleeding, particularly variceal hemorrhage. It emphasizes indications, technique, and complication risks. Though rarely used, the procedure can be lifesaving in refractory cases when endoscopy is not immediately available.

Infectious Disease

Niforatos JD, Richard E. Rothman RE. Update on emerging infections from the Centers for Disease Control and Prevention. Ann Emerg Med 2022;80(1):68-70. https://doi.org/10.1016/j.annemergmed.2022.05.017

This brief CDC update highlights several emerging infections, including Candida auris, monkeypox, and resistant Neisseria gonorrhoeae. It calls attention to diagnostic challenges and underscores the importance of vigilance, infection control, and public health coordination in emergency departments.

Ophthalmology

Edlow JA, Hoffmann B. Managing patients with acute visual loss. Ann Emerg Med 2022 May;79(5):474-84. doi: 10.1016/j.annemergmed.2021.10.019. Epub 2021 Dec 16. PMID: 34922777.

This review guides emergency physicians in evaluating acute visual loss, emphasizing a structured approach to distinguish between ocular and neuro-ophthalmic causes. It covers key presentations such as retinal detachment, central retinal artery occlusion, and optic neuritis. Prompt diagnosis can be critical for vision preservation.

Otolaryngology

Hosseinialhashemi M, Jahangiri R, Faramarzi A, et al. Intranasal topical application of tranexamic acid in atraumatic anterior epistaxis: a double-blind randomized clinical trial. Ann Emerg Med 2022 Sep;80(3):182-8. doi: 10.1016/j.annemergmed.2022.04.010. Epub 2022 Jun 23. PMID: 35752521. Paired with companion article: Rech MA, Gottlieb M. Can’t stop, won’t stop: the return of tranexamic acid for epistaxis. Ann Emerg Med 2022 Sep;80(3):189-91. doi: 10.1016/j.annemergmed.2022.04.032. Epub 2022 Jul 13. PMID: 35842341.

Hosseinialhashemi M, et al. (2022) In this RCT, intranasal tranexamic acid (TXA) significantly reduced bleeding duration and improved hemostasis in patients with atraumatic anterior epistaxis compared to placebo. Rech MA, Gottlieb M. (2022) (companion editorial) The authors highlight TXA’s resurgence as a front-line therapy for epistaxis, noting growing evidence supporting its efficacy, ease of use, and safety profile.

Pulmonary

• American Board of Emergency Medicine Key Advances Panel. Outpatient treatment for pulmonary embolism. Key Advances Clinical Policy Alert. June 2023. Accessed September 7, 2023.

This policy update outlines criteria for safely managing select pulmonary embolism patients in the outpatient setting. Key factors include hemodynamic stability, absence of hypoxia, and low-risk scoring per validated tools. The guidance reflects evolving practice patterns toward reducing unnecessary hospitalizations.

• Munshi L, Mancebo J, Brochard LJ. Noninvasive respiratory support for adults with acute respiratory failure. N Engl J Med 2022 Nov;387(18):1688-98. doi: 10.1056/NEJMra2204556. PMID: 36322846.

This review discusses noninvasive respiratory support strategies (e.g., HFNC, CPAP, BiPAP) in acute respiratory failure. It evaluates evidence across conditions like COPD, pneumonia, and COVID-19, emphasizing the need for careful patient selection and monitoring to avoid delayed intubation.

• Papi A, Chipps BE, Beasley R, et al. Albuterol-budesonide fixed-dose combination rescue inhaler for asthma. N Engl J Med 2022 Jun 2;386(22):2071-83. doi: 10.1056/NEJMoa2203163. Epub 2022 May 15. PMID: 35569035 [Disclaimer: This study sponsored by AstraZeneca, which produces the drug mentioned in the article.]

This industry-sponsored trial showed that an albuterol-budesonide fixed-dose combination inhaler used as rescue therapy reduced severe asthma exacerbations compared to albuterol alone. The findings support a new strategy incorporating anti-inflammatory action into rescue treatment. Clinical adoption may be influenced by guideline updates and drug access.

Toxicology

Pistore A, Penney S, Bryce R, et al. A retrospective evaluation of phenobarbital versus benzodiazepines for treatment of alcohol withdrawal in a regional Canadian emergency department. Alcohol 2022 Aug;102:59-65. doi: 10.1016/j.alcohol.2022.05.001. Epub 2022 May 13. PMID: 35569673.

This retrospective study compared phenobarbital to benzodiazepines for alcohol withdrawal management in a Canadian ED. Phenobarbital was found to be safe and effective, with fewer doses required and similar adverse event rates. It supports the growing interest in phenobarbital as an alternative or adjunct in withdrawal protocols.