A Phase 2 Randomized, Double-Blind, Placebo– Controlled Study of the Safety and Efficacy of Talactoferrin in Patients With Severe Sepsis*,

A Phase 2 Randomized, Double-Blind, Placebo–Controlled Study of the Safety and Efficacy ofTalactoferrin in Patients With Severe Sepsis*

Objectives:
Lactoferrin is a glycoprotein with anti-infective and antiinflammatory
properties found in secretions and immune cells. Talactoferrin
alfa, a recombinant form of human lactoferrin, has similar
properties and plays an important role in maintaining the gastrointestinal
mucosal barrier integrity. In experimental animal models, administration
of talactoferrin reduces translocation of bacteria from the gut
into the systemic circulation and mortality from sepsis. Our objective
was to determine if talactoferrin could reduce 28-day all-cause mortality
in patients with severe sepsis and to assess its safety.

Management of Minor Head Injury in Patients Receiving Oral Anticoagulant Therapy: A Prospective Study of a 24-Hour Observation Protocol

Management of Minor Head Injury in Patients Receiving OralAnticoagulant Therapy: A Prospective Study of a 24-HourObservation Protocol

Background
The indications for computed tomography (CT) scanning in
the setting of minor head injury have been the focus of
substantial research. Long-term oral anticoagulation has been
identified as a significant risk factor for intracranial injury,
and CT scanning is generally recommended for such patients
regardless of clinical presentation. However, it remains
unclear whether such patients should then be hospitalized for
observation or undergo a later second CT scan. Oral
anticoagulant therapy is prescribed to prevent thromboembolic
complications of atrial fibrillation, deep venous thrombosis, and
surgically placed cardiac valves.

Prospective Evaluation of a Clinical Practice Guideline for Diagnosis of Appendicitis in Children

Prospective Evaluation of a Clinical Practice Guideline for Diagnosis of Appendicitis in Children

Objectives:
The objective was to assess the performance of a clinical practice guideline for evaluation of possible appendicitis in children. The guideline incorporated risk stratification, staged imaging, and early surgical involvement in high-risk cases.

Patients With Rib Fractures Do Not Develop Delayed Pneumonia: A Prospective, Multicenter Cohort Study of Minor Thoracic Injury

Patients With Rib Fractures Do Not Develop Delayed Pneumonia: A Prospective, Multicenter Cohort Study of Minor Thoracic Injury

Background
In 2006, there were 119.2 million visits to hospital
emergency departments (EDs) in the United States, and
more than one third of them were injury-related. Thoracic
trauma frequency is estimated at 12 people per million per
day, representing more than 796,000 ED visits annually.
In the case of thoracic trauma, injuries of moderate
severity are most often sustained to the chest wall and thus
rarely require surgical intervention. Ziegler and Agarwal
reported a 10% incidence of rib fractures in trauma patients
treated at their site. In 2003, Liman et al observed that 2 of
3 patients could be safely discharged from EDs. As financial
pressures create more ambulatory care situations, minor
thoracic injury patients are rapidly discharged from EDs
without appropriate follow-up.

Treating primary headaches in the ED: can droperidol regain its role?

Treating primary headaches in the ED: can droperidol regain its role?

OBJECTIVE:
The aim of this study was to describe the use and efficacy of low-dose (≤2 mg) droperidol for the treatment of primary headaches (ie, migraine, cluster, tension-type headache and trigeminal autonomic cephalalgias, and other primary headaches) in the emergency department (ED).

Ketamine With and Without Midazolam for Emergency Department Sedation in Adults: A Randomized Controlled Trial

Ketamine With and Without Midazolam for Emergency Department Sedation in Adults: A Randomized Controlled Trial

Background
Procedural sedation and analgesia is a technique of administering
sedatives (midazolam, propofol, etomidate) or dissociative agents
(ketamine) with or without opioid analgesics (fentanyl, morphine,
meperidine) to induce a state that allows the patient to tolerate
unpleasant procedures while maintaining cardiorespiratory function.
Ketamine, first described in 1965, has been administered extensively for procedural sedation and analgesia in children and is a safe and effective sedative analgesic for painful procedures not only in the emergency department (ED) but also in the out-of-hospital setting.
The widespread acceptance of ketamine as an agent for procedural
sedation and analgesia in adult ED patients may be limited by
physician apprehension about dreaming and hallucinations during
recovery, and unpleasant reactions and nightmares, collectively referred to as recovery agitation.

Vasopression / Epinephrine / Dabigatran / Warfarin and Cardiopulmonary

UF EM Journal Club 06/14/2011

* Vasopressin and Epinephrine vs. Epinephrine Alone in Cardiopulmonary Resuscitation
BACKGROUND: During the administration of advanced cardiac life support for resuscitation from cardiac arrest, a combination of vasopressin and epinephrine may be more effective
than epinephrine or vasopressin alone, but evidence is insufficient to make clinical
recommendations.

* Dabigatran versus Warfarin in Patients with Atrial Fibrillation
BACKGROUND: Warfarin reduces the risk of stroke in patients with atrial fibrillation but increases the risk of hemorrhage and is difficult to use. Dabigatran is a new oral direct thrombin
inhibitor.