ACEP Now: Vol 39 – No 11 – November 2020 Archives

Surgery or Antibiotics for Appendicitis?

Nov 18, 2020 - By

Surgery has always been assumed to be the standard treatment for appendicitis, but recent research suggests that...

3D illustration of coronavirus COVID-19 under the microscope.

What To Expect When Sending Patients with COVID-19 Home

Nov 13, 2020 - By Austin Kilaru, MD, MSHP; and Kathleen Lee, MD

We have learned much about the novel coronavirus in the months since the start of the pandemic....

Time to Put Negative Perceptions of Metal Detectors to Rest

Dec 02, 2020 - By Diann M. Krywko, MD, FACEP

Violence in the emergency department is not a new phenomenon. Our specialty has been fighting for workplace...

By the Numbers: Firearms in the Emergency Department

Nov 18, 2020 - By

Emergency department shooters: 23% use a security officer’s firearm. 27% of hospital-related shootings are motivated by a...

Are the Benefits of Metal Detectors Worth the Costs?

Dec 02, 2020 - By Tracy G. Sanson, MD, FACEP

When patients enter an emergency department or we begin our shifts, there is the expectation of safety....

ACEP Continues Multi-Front Efforts in Opioid Battle

Nov 18, 2020 - By Jordan Grantham

In early October, St. Joseph’s University Medical Center Emergency Department in Paterson, New Jersey, became the first...

Residency Spotlight: WellSpan York Hospital

Nov 18, 2020 - By Amber Billet, MD, FACEP

Wellspan York Hospital Twitter: @WellSpanYHEMRes Location: York, Pennsylvania Year founded: 1989 Number of residents/program length: 12 per...

Overview of COVID-19 Vaccine Research

Nov 02, 2020 - By Joshua Niforatos, MD, MTS

With thousands of articles published weekly on COVID-19, navigating the literature on this emerging infectious disease can...

Pre-COVID ED Trends Suggest More Challenges Lie Ahead

Nov 18, 2020 - By

The role of emergency department physicians and leaders has been made dramatically more important due to the...

We Must Be at the Forefront in Correcting Racism in Medicine

Nov 18, 2020 - By

Since the spring when coronavirus first came to our shores, and throughout a tumultuous summer focused on...

Racism Is the Ultimate Pre-Existing Condition

Nov 18, 2020 - By Nikkole Turgeon

Editor’s Note: Read Dr. Cedric Dark’s commentary on this EMRA + PolicyRx Health Policy Journal Club article....

Do Antacid Monotherapy or GI Cocktails Work Better for Epigastric Pain?

Nov 18, 2020 - By

The Case A 43-year-old woman arrives at the emergency department complaining of epigastric pain after eating a...

shut by Landon Jones, MD, and Richard M. Cantor, MD, FAAP, FACEP The best questions often stem from the inquisitive learner. As educators, we love, and are always humbled by, those moments when we get to say, “I don’t know.” For some of these questions, you may already know the answers. For others, you may never have thought to ask the question. For all, questions, comments, concerns, and critiques are encouraged. Welcome to the Kids Korner. Antibiotics for Strep Question 1: In children with group A strep pharyngitis, what benefit(s) does antibiotic treatment offer? While a potentially reasonable argument may be made about deferring antibiotic treatment of GAS-positive pharyngitis, is antibiotic treatment beneficial? To begin, an earlier RCT by Nelson evaluated 35 children ages 5–11 years with GAS confirmed by culture and randomized patients to penicillin (PCN) treatment or placebo.1 Follow-up visits occurred at 48 hours. Patients treated with PCN had a significantly shorter duration of fever at follow-up, with 28 percent of placebo patients having persistent fever >48 hours but no treated patients having persistent fever (P=0.031). At 48-hour follow-up, children receiving PCN also had significantly shortened times until improved (P=0.008) and until well (P=0.022). A similar shortened duration of fever at 48 hours was seen in another RCT by Pichichero et al.2 A Cochrane meta-analysis by Spinks et al evaluated 27 trials with 12,835 total cases.3 This included both adults and children and included patients with the diagnosis of sore throat, not specifically GAS. Regarding antibiotics versus placebo, the risk ratio of the incidence of developing the secondary complication of otitis media within 14 days following GAS pharyngitis antibiotic treatment was 0.30 (95 percent CI, 0.15–0.58; 11 studies), suggesting that antibiotic therapy decreased the incidence of the complication of otitis media. Similarly, the risk ratio of the incidence of developing “quinsy”—meaning peritonsillar abscess or retropharyngeal abscess—within two months following GAS antibiotic treatment was 0.15 (95 percent CI, 0.05–0.47; eight studies). Lastly, the risk ratio of the incidence of developing acute rheumatic fever (ARF) within two months was 0.27 (95 percent CI, 0.1–0.50; 14 studies). While ARF is traditionally rare in Western countries (

In Kids with Group A Strep, What Benefit(s) Do Antibiotics Offer?

Nov 18, 2020 - By

The best questions often stem from the inquisitive learner. As educators, we love, and are always humbled...

In Kids with Group A Strep, Do Steroids Shorten Illness Duration, Severity?

Nov 18, 2020 - By

The best questions often stem from the inquisitive learner. As educators, we love, and are always humbled...

Dr. Gillian Schmitz Is Your Next ACEP President

Nov 18, 2020 - By

On Sunday, Oct. 24, 2020, the ACEP Council elected Gillian Schmitz, MD, FACEP, as its President-Elect. She...

The ACEP20 Virtual Package Is Now Available

Nov 18, 2020 - By

If you were unable to attend ACEP20 in late October, you can still access all of the...

Virtual Grand Rounds Continue with Upcoming Neurology, Cardiology Sessions

Nov 18, 2020 - By

ACEP’s Academic Affairs and Education Committee created the monthly Virtual Grand Rounds program in April as a...

ACEP Council Elects New Board Members

Nov 18, 2020 - By

During the ACEP20 Council Meeting, the Council voted for two incumbents and two new Board members. Allison...

A Virtual Version of the ED Directors Academy Kicks Off in December

Nov 18, 2020 - By

A virtual version of the ED Directors Academy (EDDA) Phase I kicks off Nov. 30. This first...

ACEP Now: Vol 39 – No 11 – November 2020

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