Evidence for Hyperbaric Oxygen for CO Poisoning
Hyperbaric oxygen therapy for carbon monoxide (CO) poisoning improved cognitive outcomes at 6 weeks and possibly at 12 months.
September 2017
Does POCUS Degrade CPR Quality?
Point of care ultrasound may be very useful during CPR, but it should not get in the way of chest compressions. If you’re going to use it, get in there quick and get out of the way or choose a view that allows continuous chest compressions (i.e. subxiphoid).
Is PALS Wrong? Rapid Bolus Did Worse
PALS recommends giving a fluid bolus to children in shock over 5-10minutes. This study showed that giving it more slowly, over 15-20 minutes likely decreased the need for mechanical ventilation.
Is Analgesic Rebound Headache a Myth?
Medication overuse headache (MOH), also known as rebound headache or drug-induced headache, may be the stuff of legend. The evidence for it is sketchy. The authors say, “Until the evidence is better, we should avoid dogmatism about the use of symptomatic medication.”
Fluoroquinolones Cause Pseudotumor?
Fluoroquinolone antibiotics were associated with idiopathic intracranial hypertension.
Video on How to Tell Stroke vs. Mimic on Exam
The “upgoing thumb sign” can be used as part of a comprehensive neurological evaluation to help distinguish stroke mimic from actual stroke. It won’t replace MRI, but it can be part of the neurological exam, just like we use the Babinski sign. One editorial from 1993 suggested calling it the Hachinski-Babinski, after the discover. Here’s how to do it.
Wells Score Plus D-dimer for PE Rule-out
Patients in an ED setting with a low pretest probability based on the Wells score, and a negative D-dimer were safely ruled out for pulmonary embolism without further diagnostic imaging.
Does Delaying Appendectomy Cause Complications?
If a pediatric surgeon needs to delay appendectomy, you can reassure families this is a safe practice and will not increase the risk for adverse outcomes, like perforation.
Avoiding Adverse Events in Pediatric Sedation
This large multi-center prospective study of pediatric sedation found adverse events occurred in 12%, most mild desaturation or vomiting. Severe adverse events occurred in 1%. Ketamine given alone was the safest drug. Propofol alone, ketamine + fentanyl, or ketamine + propofol were associated with greater risk for severe adverse events.
Does This Child Have Pneumonia?
No clinical criteria were powerful diagnostic discriminators of the presence or absence of pneumonia in children, though some were fair. When in doubt, a CXR is probably warranted, with the exceptions of obvious bronchiolitis or asthma. Low SpO2 (</= 95 to 96%) or increased work of breathing were the best predictors of radiographic pneumonia in children; auscultatory findings and tachypnea were poor. You don’t need a CXR if no cough, no fever, no tachypnea, and normal SpO2.