MEDICAL CONFERENCES 2016 LAS VEGAS TRIAL

Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage. Rapid Blood-Pressure Lowering in Patients with acute Intracerebral Hemorrhage. Transfusion of Plasma, Platelets, and Red Blood Cells in a 1:1:1 vs a 1:1:2 Ratio and Mortality in Patients with Severe Trauma: The PROPPR Randomized clinical Trial. Derivation and Validation of Two Decision Instruments for Selective Chest CT in Blunt Trauma: A Multicenter Prospective Observational Study (NEXUS Chest CT). Immediate Total-Body CT Scanning Versus Conventional Imaging and Selective CT Scanning in Patients with Severe Trauma (REACT-2): A Randomized Controlled Trial. Effects of Tranexamic Acid on Death, Vascular Occlusive Events, and Blood Transfusion in Trauma Patients with Significant Hemorrhage (CRASH-2): A Randomized, Placebo-Controlled Trial. Association of Cryoprecipitate and Tranexamic Acid with Improved Survival Following Wartime Injury: Findings from the MATTERs II Study. Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) Study. The biggest impact is seen in patients given TXA 23.4 is quite sensitive and specific for LAD Occlusion

CLINICAL BOTTOM LINE: In Trauma patients who you think are bleeding give 1g TXA IV followed by 1g given as an infusion over the next 8 hours.

All -Cause Mortality: 14.5% TXA vs 16.0% Placebo.

Mortality: 11.6% TXA/Cryoprecipitate vs 18.2% TXA vs 21.4% Cryoprecipitate vs 23.6% no TXA/Cryoprecipitate.

Greatest Benefit in Patients with Massive Transfusion: 14.4% TXA vs 28.1% no TXA.

Unadjusted Mortality: 17.4% TXA vs 23.9% no TXA.

Tranexamic Acid (TXA) to Trauma Patients who we Think are Bleeding.

MEDICAL CONFERENCES 2016 LAS VEGAS TRIAL

PROPPR Trial : In trauma patients requiring massive transfusion protocols, transfusion in a 1:1:1 ratio of platelets, plasma, and red blood cells seems to decrease death from exsanguination at 24 hours and achieves more rapid hemostatsis.

NEXUS Chest CT Rule Trial : Using a clinical decision instrument in patients with blunt trauma can safely reduce unnecessary chest CTs by 25 – 37%.

REACT 2 Trial : Immediate Total-Body CT scanning of trauma patients DOES NOT reduce in-hospital mortality compared with selective radiological work-ups.

What Were Some of the Big Papers Discussed for Trauma?

Tranexamic Acid (TXA) in Trauma Patients with Suspected Bleeding.

Serious Complications or Pain at 24 Hours: NNT = Infinity (No Benefit).

Disease Recurrence: NNT = Infinity (No Benefit).

Conservative Transfusion Threshold in UGIB.

Avoid Intervention During EGD: NNT = 33.

Mortality, Transfusion, Hospital Stay, and Surgery: NNT = Infinity (No Benefit).No Difference in Mortality unless Asian Descent: NNT = 33.Octreotide does decrease blood transfusion by average of 0.7 Units of PRBCs.Improvement in Mortality or Rebleeding: NNT = Infinity (No Benefit).Erythromycin or Reglan Before Endoscopy to Avoid Repeat Endoscopy: NNT = 9.Improvement in Pain Scale Rating: NNT = 6.Global Improvement of Pain at 10 Days: NNT = 3.

Cyclobenzaprine (Flexeril) for Back Pain.Clopidogrel After MI or PCI to Prevent Another MI or Stroke: NNT = 27.The Smaller the NNT the Bigger the Impact.The Number Needed to Treat (NNT) = 1/Absolute Risk Reduction(ARR).Clinical Pearls from ACEP 2016 What are some of the Interventions in EM that Matter (The Number Needed to Treat)? It was impossible to make all of these great lectures, but I was able to take away some very important clinical pearls that I wanted to share with our readers. There was greater than 350 courses, labs, and workshops given throughout the week. This years ACEP 2016 conference took place in Las Vegas, NV from Oct 16th – 19th.

Medical conferences 2016 las vegas