In the Literature – Short Takes

Sepsis Campaign bundles shortened to 1 hour
In response to the 2016 Surviving Sepsis Campaign guidelines, the 3-hour and 6-hour bundles have been combined and shortened into a 1-hour bundle to emphasize the emergent nature of sepsis. Elements of the bundle remain to same: measuring lactate, obtaining blood cultures, administration of broad-spectrume antibiotics, administration of 30mL/kg crystalloid, and vasopressors when necessary.

Citation: Levy MM et al. The Surviving Sepsis Campaign bundle: 2018 update. Crit Care Med. 2018;46(6):997-1000

Early ED discharge for PE
This randomized trial showed that low-risk emergency department patients diagnosed with pulmonary embolism who were discharged from the ED with rivaroxaban within 24 hours of presentation had decreased length of stay and nearly $2,500 in cost savings, compared with patients treated according to standard of care (often including hospitalization) without increased risk of bleeding, recurrent venous thromboembolism, or death.

Citation: Peacock WF et al. Emergency department discharge of pulmonary embolus patients. Acad Emerg Med. 2018. doi: 10.1111/acem.13451.

Outbreak of coagulopathy associated with synthetic cannabinoids
The Centers for Disease Control and Prevention reports a recent outbreak of life-threatening coagulopathy associated with synthetic cannabinoid use, because of contamination with vitmin K antagonist agents. All patients who report synthetic cannabinoid use should be screened with INR testing, especially prior to procedures.

Citation: Outbreak of life-threatening coagulopathy associated with synthetic cannabinoid use. CDC Health Alert Network. June 27, 2018.

Lumbar puncture safe when performed on patients on dual-antiplatelet therapy
In a retrospective review of 100 adult patients who underwent lumbar puncture procedures while taking dual-antiplatelet therapy with aspirin and clopidogrel, Mayo clinic investigators found no epidural hematomas or other serious complications with at least 3 months of follow-up. This study was nto powered to detect the risk of spinal hematoma so caution and open discussion with patients still is recommended.

Citation: Carabenciov ID et al. Safety of lumbar puncture performed on dual anti-platelet therapy. Mayo Clinic Proc. 2018;93(5):627-9.

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