MRI-Guided Alteplase for Wake-Up Stroke

MRI-Guided Alteplase for Wake-Up Stroke

For patients with unknown time of stroke onset, MRI characteristics may be able to discern the timing of the stroke and allow for thrombolytic therapy.  Overall, outcomes were better with thrombolysis but at the possible cost of higher mortality and risk of intracranial bleed.

NPO Status - No Correlation With Sedation Outcomes

NPO Status - No Correlation With Sedation Outcomes

In this cohort of thousands of pediatric ED sedation patients who didn't meet the American Society of Anesthesiologists (ASA) fasting guideline, none had aspiration nor was there any correlation of fasting time with any adverse events or vomiting.  It is time to change hospital NPO policies for the ED.

Syncope/Pre-syncope and Outcome in PE Patients

Syncope/Pre-syncope and Outcome in PE Patients

Syncope or pre-syncope in patients with PE was associated with an increased risk for 30-day mortality (43% vs 6%) and was an independent predictor of 30-day mortality when accompanied by hemodynamic instability on admission.  Don't try to treat them as an outpatient.

Start Strong, Finish Weak - Attending Shift Productivity

Start Strong, Finish Weak - Attending Shift Productivity

Attending physician productivity peaks at the beginning of the shift, starting with about 3 new patients in the first hour and decreases as the shift progresses.  This has important implications for staffing models.  Assuming a simple, uniform average over the shift won't work.

Time to Epi for Non-Shockable Rhythm Matters

Time to Epi for Non-Shockable Rhythm Matters

Earlier epinephrine administration for non-shockable rhythm was associated with better overall survival to discharge and neurologically-intact survival.  Reducing EMS time to the scene, time to IV (or IO) access, and time to drug may improve survival in this group of patients.

More Clarity on IVC POCUS for Fluid Responsiveness

More Clarity on IVC POCUS for Fluid Responsiveness

In intubated patients, respiratory variation of IVC diameter by 16% had fairly high diagnostic accuracy for predicting fluid responsiveness, but only when the tidal volume (TV) was ≥8 mL/kg and positive end-expiratory pressure (PEEP) ≤5 cm H2O.

GlideScope Not Easy to Use in Kids

GlideScope Not Easy to Use in Kids

The GlideScope in pediatric patients was not easy to use.  Experienced intubators had technical difficulty 58% of the time, most often just as the tube passed the cords.  Clockwise rotation helped passage.  You must practice with it before you use it on live patients.

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