EM Quick Hits 10 – TXA CRASH-3, CJEM Cellulitis, Double Defib, Serratus Anterior Block, PARC score, Toxic Shock Syndrome

Topics in this EM Quick Hits podcast Sarah Reid on pediatric appendicitis risk calculator (0:46) Sheldon Cheskes & Mark Ramzy on double defibrillation for refractory ventricular fibrillation (7:52) Hans Rosenberg & Krishan Yadav on cellulitis clinical pearls (14:09)* Anand Swaminathan on serratus anterior block for acute rib fracture pain (19:01) Brit Long on recognition of toxic shock syndrome (25:38) Justin Morgenstern on tranexamic acid in head injury CRASH-3 trial (29:53) *CJEM-EM Cases 'Just the Facts' series collaboration Podcast production, editing and sound design by Anton Helman Blog post by Anton Helman, Anand Swaminathan and Brit Long Cite this podcast as: Helman, A. Swaminathan, Reid, S. Rosenberg, H. Long, B. Morgenstern J. EM Quick Hits 10 - TXA CRASH-3, CJEM Cellulitis, Double Defib, Serratus Anterior Block, PARC score, Toxic Shock Syndrome. Emergency Medicine Cases. November, 2019. https://emergencymedicinecases.com/em-quick-hits-november-2019/. Accessed [date]. PARC Score is the Most Promising Pediatric Appendicitis Risk Stratification Tool * Validation of Pediatric Appendicitis Risk Calculator (PARC) study in children 5-18 years old, <96 hours of abdominal pain with suspected appendicitis in pediatric EDs compared to Pediatric Appendicitis Score (PAS) found PARC to be more accurate at predicting appendicitis * 50% of patients were risk stratified into "low" or "very low" risk (safe for discharge with watchful waiting) or "high" risk (immediate surgical consult with option of no imaging) * Also validated in community ED setting in multicenter prospective observational study of >2000 patients * Items in the PARC score include: sex, age, fever, duration of pain, migration of pain to RLQ, maximum tenderness in RLQ, guarding, pain with cough/hop/walk, WBC, absolute neutrophil count * An online calculator is necessary to calculate this score * Limitations  of the PARC score are that it has yet to be compared to physician gestalt, requires blood work which may not be necessary, still requires an implementation study, and about half the patients will still require further workup in the ED Expand to view reference list * Kharbanda AB, Vazquez-benitez G, Ballard DW, et al. Development and Validation of a Novel Pediatric Appendicitis Risk Calculator (pARC). Pediatrics. 2018;141(4). * Cotton DM, Vinson DR, Vazquez-benitez G, et al. Validation of the Pediatric Appendicitis Risk Calculator (pARC) in a Community Emergency Department Setting. Ann Emerg Med. 2019. Double Defibrillation for Refractory Ventricular Fibrillation: No Robust Evidence, but if Done Early May Benefit * Successful resuscitation with double defibrillation may be time-sensitive, with greater success early in the resuscitation * There are 3 theories: vector theory and