September 2021

Spoon Feed There was no clear winner between bag valve mask, supraglottic airway, or endotracheal intubation when patients needed ventilatory support or airway protection in the prehospital setting.

Spoon Feed When intubating COVID-19 confirmed or suspected patients, greater experience, use of RSI, use of a PAPR, and intubation in a high vs low-income country were all associated with higher first pass success.

Spoon Feed In pediatric out-of-hospital cardiac arrest, patients managed by emergency physicians in a mobile ICU who had endotracheal intubation were found to have lower odds of survival at 30 days when compared to bag valve masking or supraglottic airway.

Spoon Feed

Paratracheal pressure was non-inferior to cricoid pressure in degrading direct laryngoscopic view. Many have abandoned cricoid pressure for RSI with no ill effects, and I don’t see this replacing it.

Spoon Feed Use of intramuscular ketamine for patients with severe agitation resulted in significantly shorter time to sedation compared to a combination of intramuscular midazolam and haloperidol (5.8 vs 14.7 minutes).

Spoon Feed There was no difference between IM droperidol and IM olanzapine in time to adequate sedation for the acutely agitated ED patient. Droperidol carried a slightly higher risk of extrapyramidal effects.

Spoon Feed There was no short-term impact of NSAIDs/COX-2 inhibitors on long-bone fracture healing BUT using NSAIDs >3 weeks was associated with higher rates of non-union or delayed union.

Spoon Feed A rising ETCO2 in the setting of out-of-hospital cardiac arrest (OHCA) due to PEA has a higher chance of achieving return of spontaneous circulation (ROSC). If the change in ETCO2 is >20 mmHg during resuscitation, CPR efforts should be continued.

Spoon Feed If current trends stay the same, emergency medicine will likely face an oversupply of physicians in 2030. We as a specialty need to work together to find ways to mitigate this and continue doing what we do best—save lives…and livelihoods.

Spoon Feed A large RCT in Brazilian ICUs found no difference in 90-day mortality between patients who received balanced crystalloids versus normal saline.