UptoDate

FigureUpToDate® and Emergency Medicine News are collaborating to present select content synopses on “What's New in Emergency Medicine.” UpToDate is an evidence-based, clinical support resource used worldwide by health care practitioners to make decisions at the point of care. For complete, current “What's New” content or to become a subscriber for full content access, go to www.uptodate.com. “What's New” abstract information is free for all medical professionals. Limited Benefit of Nirmatrelvir-Ritonavir in Non-high-risk Individuals with Mild-to-moderate COVID-19 (May 2024) Although nirmatrelvir-ritonavir reduces COVID-19-associated hospitalization and death in patients at high risk for severe disease, the benefit in lower-risk patients is uncertain. The EPIC-SR trial evaluated nirmatrelvir-ritonavir among 1200 outpatients who either had no risk factors for severe disease (and were unvaccinated or vaccinated) or had at least one risk factor but were vaccinated; median age was 42 years, and only five percent were 65 years old or older.1 In the trial, nirmatrelvir-ritonavir did not reduce duration of symptoms, the risk of hospitalization from COVID-19, or all-cause mortality compared with placebo. We continue to suggest against treating patients who are not at high risk for severe disease. Medetomidine Found in United States and Canadian Illicit Fentanyl (May 2024) Medetomidine, an alpha-2 adrenergic receptor agonist used as a veterinary sedative (similar to xylazine), has been found in illicit fentanyl in Philadelphia, Pittsburgh, Chicago, Toronto, and Vancouver.2 Dexmedetomidine is the main active ingredient in medetomidine. Poisoning with alpha-2 adrenergic receptor agonists can cause sedation, bradycardia, and hypotension. However, it is unclear to what extent these adulterants are contributing to toxicity in patients with opioid overdose and whether naloxone reverses their toxicity compared with the co-used opioid. Opioid adulteration with an alpha-2 adrenergic agonist should be on the differential diagnosis of patients with opioid overdose, but management largely remains administration of opioid reversal antidotes and supportive care. New Guidelines for Cannabinoid Hyperemesis Syndrome (May 2024) Cannabinoid hyperemesis syndrome (CHS) causes severe abdominal pain and vomiting that occurs in a cyclical pattern associated with prolonged, regular cannabis use. Standard antiemetics (e.g., ondansetron, metoclopramide) are typically ineffective. The Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE-4) from the Society for Academic Emergency Medicine suggest using dopamine antagonists such as droperidol or haloperidol in addition to usual care to manage symptoms of CHS in adult patients.3 Capsaicin cream may be used as an adjunct but is often less effective. We agree with these guidelines, but typically reserve capsaicin for second-line therapy. 1. Hammond J, Fountaine RJ, Yunis C, et al. Nirmatrelvir for Vaccinated or Unvaccinated Adult Outpatients with Covid-19. N Engl J Med. 2024;390:1186. 2. Krotulski AJ, Shinefeld J, Moraff C, Wood T, Walton SE, DeBord JS, Denn MT, Quinter AD, Logan BK. (2024) Medetomidine Rapidly Proliferating Across USA—Implicated In Recreational Opioid Drug Supply & Causing Overdose Outbreaks, Center for Forensic Science Research and Education, United States. https://www.cfsre.org/images/content/reports/public_alerts/Public_Alert_Medetomidine_052024.pdf. (Accessed on May 21, 2024). 3. Borgundvaag B, Bellolio F, Miles I, et al. Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE-4): Alcohol use disorder and cannabinoid hyperemesis syndrome management in the emergency department. Acad Emerg Med. 202431:425. Disclaimer: This content is provided for reference purposes only and represents a portion of the UpToDate topic. You may not rely on the content or any information cited here as being applicable to specific patient circumstances. All topics are updated as new evidence becomes available and our peer review process is complete. Subscribe to www.uptodate.com for current content and recommendations.

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.