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Question In patients who present to the emergency department with septic shock, does early goal-directed therapy (EGDT) reduce mortality more than usual care? Scope Included studies compared EGDT with usual care in patients who presented to the emergency department with septic shock. Outcomes included mortality at 90 days (primary) and 28 days, and hospital discharge. ClinicalTrials.gov NCT02030158. Methods The Protocolized Resuscitation in Sepsis Meta-Analysis (PRISM) study was an individual patient data meta-analysis of 3763 patients (median age 65 y, 58% men) from 3 randomized controlled trials (RCTs): Protocolized Care for Early Septic Shock (ProCESS), Australian Resuscitation in Sepsis Evaluation (ARISE), and Protocolised Management in Sepsis (ProMISe). This meta-analysis was planned before patients were entered into any of the 3 RCTs. Patients from the protocol- based standard therapy group of the ProCESS trial were excluded. Data were analyzed using an intention-to-treat approach. Main results EGDT did not differ from usual care for mortality at 90 or 28 days or at hospital discharge (Table). In prespecified subgroup analyses, the effect of EGDT on 90-day mortality did not differ by age, sex, refractory hypotension and/or hyperlactatemia, baseline lactate level, customized prediction of risk for death, or hospital propensity to use vasopressors or fluids during resuscitation (P ≥0.09). Conclusion In patients with septic shock, early goal-directed therapy does not reduce mortality. Sources of funding: Supported in part by the U.S. National Institute of General Medical Sciences, National Institutes of Health (ProCESS trial); National Health and Medical Research Council of Australia, the Intensive Care Foundation, and the Alfred Foundation (ARISE trial); United Kingdom National Institute for Health Research Health Technology Assessment Programme (ProMISe trial). [ABSTRACT FROM AUTHOR]

In patients in the emergency department with acute pain, 10, 15, and 30 mg of ketorolac did not differ for pain relief ACP Journal Club. 2017 Apr 18;166(8):JC44. Motov S, Yasavolian M, Likourezos A, et al. Comparison of intravenous ketorolac at three single-dose regimens for treating acute pain in the emergency department: a randomized controlled trial. Ann Emerg Med. 2016;Dec 16. [Epub ahead of print.]. 27993418 [ABSTRACT FROM AUTHOR]

A review of the article "Naproxen with Cyclobenzaprine, Oxycodone/Acetaminophen, or Placebo for Treating Acute Low Back Pain: A Randomized Clinical Trial," by B.W. Friedman et. al, which appeared in the periodical the Journal of the American Medical Association on October 20, 2015, is presented.

The article focuses on a study related to the validation of high-sensitivity troponin I in order to assess 30-day outcomes in emergency department patients with possibility of developing acute coronary syndrome as of March 2014. It mentions the results of the Accelerated Diagnostic protocol to Assess Patients with chest pain symptoms using contemporary Troponin as the only biomarker (ADAPT) study. It also mentions the use of high-sensitivity troponin I in diagnosis of acute coronary syndrome.

The article provides an answer to the question on whether ultrasonography (US) lessen failed lumbar puncture (LP) or epidural catheterization procedures compared with standard nonimaging techniques.

The article cites a study to find out whether dexamethasone prevents relapse in patients presenting to the emergency department (ED) with acute migraine headache. Meta-analysis showed that adding dexamethasone to standard therapy for migraine reduced moderate-to-severe headaches at 24-72 hours. The study concluded that in patients presenting to the emergency department with acute migraine headache, adding dexamethasone to standard therapy reduces short-term relapse.