November 2017

In this RCT, patients suspected of acute myocardial infarction (AMI) with O2 saturations >/=90% were randomized to receive supplemental oxygen vs ambient air.  There was no statistically significant difference between patients in death from any cause at 1 year.

We’ve all been taught to use the “sniffing position” when intubating patients in a supine position. However, when adding ramped positioning for pre-oxygenation and intubation, fidelity to the “sniffing position” degrades. A couple Australian anesthesiologists have written a letter to clarify the proper technique.

In patients with penetrating trauma, it was better to allow prehospital hypotension and hasten transport for definitive repair prior to beginning volume resuscitation than to try to normalize vital signs in the field by giving IV fluid.

According to this large systematic review, in adults a 30:2 compression to ventilation ratio was better than 15:2.  For kids, either ratio was better than compression only CPR, except under 1 year in which ventilations did not improve outcome beyond compression-only.

Delayed ROSC may occur after cessation of CPR - the so called Lazarus phenomenon.  The incidence is around 6/1000 cases and usually occurred within 3-8 minutes after CPR cessation.  All patients eventually died; 4 of 5 had PEA. It may be wise to allow 10 minutes before pronouncing death (or 4 days if the patient is actually named Lazarus).

This study found it was mechanically impossible to maintain 30-40N of downward force during the laryngoscopy phase of RSI.