After almost twenty years as a doctor, constantly reading, it never ceases to amaze me how much I still don’t know. One of the highlights of my job is working with great residents who also teach me. This week was no exception. Here are two things I learned from our residents this week.
First attempt success was higher in the bougie group vs stylet group (98% vs 87% in all comers, 96% vs 82% in patients with at least one difficult airway characteristic). The median duration of the first-attempt as well as incidence of hypoxemia was similar between bougie and stylet groups.
Internal Medicine interns and residents were either exposed to standard duty-hour policies of the 2011 Accreditation Council for Graduate Medical Education (ACGME) or flexible policies that did not specify limits on shift length or mandatory time off between shifts. Read more to see what they found.
For adults with varied acute illnesses, use of supplemental oxygen in patients with room air SpO2 of 94% or greater was associated with increased short and longterm mortality.
There were no statistically significant differences in pressure-bag flow rates for 1L of NS through all three ports of a standard triple-lumen catheter (TLC) compared to a 16 gauge peripheral venous catheter (PVC) or a 6Fr sheath introducer. On gravity-flow, it was not statistically different from a 16 gauge PVC. But 14ga PVC and 8.5Fr sheath rates were superior in both instances.
Discharging low risk PE patients from the ED on rivaroxaban resulted in overall shorter hospital length of stay and lower costs without any increase in serious adverse events.
If you want to go deeper on stroke, may I suggest this in-depth review by emDocs or a shorter version that Thomas Davis did on JF? Also emDocs has an outstanding post on concussion. From the sideline to the ED to return-to-play, this brief but comprehensive post is stuff we need to know.
Simply presenting patients to another physician reduced serious adverse events (NNT = 24) and near-misses. Now we just need to overcome our hubris and ask our colleagues for advice and input.
We have much room for improvement in educating patients with mild traumatic brain injury (TBI) who are discharged from the ED on the importance of outpatient follow up.
An on-site alcohol sobering facility reduced EMS transports to local EDs by over 50% during a local multi-day mass gathering event.
