News: Stop Routinely Ordering Oral Contrast for Abdominal CT Scans

From Emergency Medicine News:

Oral contrast is also sometimes required for diagnosing small bowel obstruction, specifically in locating the transition point. Contrast has been shown to help predict the need for surgery (Am J Surg 2016;211[6]:1114), but diagnosis alone can be made on an unenhanced study. (Eur J Radiol 2009;71[1]:135.) The only times in which oral contrast can be routinely recommended are when patients have undergone bowel-altering surgery (e.g., gastric bypass) or when scans are ordered with a specific indication for bowel obstruction. Otherwise, skipping oral contrast in most instances of abdominal CT scan appears prudent.

Battlefield acupuncture to treat low back pain in the emergency department

From the American Journal of Emergency Medicine:

Introduction

Battlefield acupuncture (BFA) is an ear acupuncture protocol used by the military for immediate pain relief. This is a pilot feasibility study of BFA as a treatment for acute low back pain (LBP) in the emergency department (ED).

Methods

Thirty acute LBP patients that presented to ED were randomized to standard care plus BFA or standard care alone. In the BFA group, outcomes were assessed at the time of randomization, 5 min after intervention, and again within 1 h after intervention. In the standard care group outcomes were assessed at the time of randomization and again an hour later. Primary outcomes included post-intervention LBP on a 10-point numeric pain rating scale (NRS) and the timed get-up-and-go test (GUGT). t-Test and chi squared tests were used to compare differences between groups demographics to evaluate randomization, and Analysis of Covariance (ANCOVA) was used to assess differences in primary/secondary outcomes.

Results

We randomized 15 patients to BFA plus standard care, and 15 patients to standard care alone. Demographics were similar between groups. Post-intervention LBP NRS was significantly lower in the BFA group compared with the standard care group (5.2 vs. 6.9, ANCOVA p = 0.04). GUGT was similar between groups (21.3 s vs. 19.0 s, ANCOVA p = 0.327). No adverse events from acupuncture were reported.

Discussion

This pilot study demonstrates that BFA is feasible as a therapy for LBP in the ED. Furthermore, our data suggest that BFA may be efficacious to improve LBP symptoms, and thus further efficacy studies are warranted. (Clinicaltrials.gov registration number NCT02399969).

Heed the Medical Emergency Call In-Flight?

From MedPage Today:

Most Physicians Don’t Want To Assist In Medical Emergencies In Flight

A majority of physicians indicated that they were not interested in assisting in medical emergencies in flight.

Only 3% would pre-identify (with another 2% agreeing to pre-identify if they were upgraded to first class). Another 19% would not pre-identify but would respond if there was a call for a physician.