March 2022

Transparency in Academic EM Promotion – Closing the Gaps

Ethics

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A Society for Academic Emergency Medicine (SAEM) task force interviewed academic EM leaders to determine areas for improvement in equitable faculty advancement and compensation, and to create systems-based recommendations in each area.

Source
Institutional solutions addressing disparities in compensation and advancement of emergency medicine physicians: A critical appraisal of gaps and associated recommendations. Acad Emerg Med. 2022 Jan 22. doi: 10.1111/acem.14452. Epub ahead of print.

Can’t Intubate, Can’t Oxygenate | Teaching Invasive Airway With Impalpable Neck Anatomy

Airway, Critical Care

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Scalpel-finger-cannula was faster and had higher first-attempt success rate than scalpel-finger-bougie for front-of-neck access in simulated obese, bleeding manikin models.

Source
Success and Time to Oxygen Delivery for Scalpel-Finger-Cannula and Scalpel-Finger-Bougie Front-of-Neck Access: A Randomized Crossover Study With a Simulated “Can’t Intubate, Can’t Oxygenate” Scenario in a Manikin Model With Impalpable Neck Anatomy. Anesth Analg. 2022 Mar 3. doi: 10.1213/ANE.0000000000005969. Online ahead of print.

How to Teach Invasive Airway Access So It Sticks

Airway, Critical Care

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A high-fidelity simulation training program was very effective in teaching anesthesiologists to place invasive subglottic airways; skill retention was outstanding as well.

Source
Emergency Subglottic Airway Training and Assessment of Skills Retention of Attending Anesthesiologists With Simulation Mastery-Based Learning. Anesth Analg. 2022 Feb 10. doi: 10.1213/ANE.0000000000005928. Online ahead of print.

Don’t Stress Over the Stress Test – Does 72-hour Stress Testing Matter?

Cardiology

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More intense follow-up noninvasive cardiac stress testing within 72 hours among patients with chest pain discharged from the ED was associated with greater major adverse coronary outcomes at 60 days, but this was mainly driven by more downstream procedures.

Source
Higher intensity of 72-h noninvasive cardiac test referral does not improve short-term outcomes among emergency department patients with chest pain. Acad Emerg Med. 2022 Jan 22. doi: 10.1111/acem.14448. Online ahead of print.

CHOICE RCT – Post-Thrombectomy tPA for Stroke

Pharmacy/Pharmacology, Stroke

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Among patients with acute ischemic stroke with large vessel occlusion that have been successfully reperfused with thrombectomy, the use of post-thrombectomy adjunctive intra-arterial alteplase results in greater likelihood of excellent neurologic outcome at 90 days – modified-Rankin score 0 or 1 – when compared with placebo.

Source
Effect of Intra-arterial Alteplase vs Placebo Following Successful Thrombectomy on Functional Outcomes in Patients With Large Vessel Occlusion Acute Ischemic Stroke: The CHOICE Randomized Clinical Trial. JAMA. 2022 Feb 10;e221645. doi: 10.1001/jama.2022.1645. Online ahead of print.

Is High-dose Intranasal Fentanyl Safe in Children?

Pain/Sedation/Procedure, Pediatrics, Pharmacy/Pharmacology

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Higher doses of intranasal fentanyl for pain ranging from 2-5 μg/kg (with a maximum of 200 μg) were given in a pediatric emergency department, with no documented episodes of apnea, hypotension, or respiratory failure.

Source
The Safety of High-Dose Intranasal Fentanyl in the Pediatric Emergency Department. Pediatr Emerg Care. 2022 Feb 1;38(2):e447-e450. doi: 10.1097/PEC.0000000000002627.

Early Endovascular Therapy for Basilar Artery Occlusion

Neurology, Stroke

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Time from symptom onset of a basilar artery occlusion (BAO) to endovascular therapy (EVT) of less than 6 hours compared to greater than 6 hours (up to 24 hours) was associated with lower odds of in-hospital mortality, disability, symptomatic intracranial hemorrhage, and higher odds of ambulation at discharge, discharge home and reperfusion.

Source
Association Between Endovascular Therapy Time to Treatment and Outcomes in Patients with Basilar Artery Occlusion. Circulation. 2022 Jan 20. doi: 10.1161/CIRCULATIONAHA.121.056554. Online ahead of print.

Battle of the Catecholamines – Epi vs Norepi for Post-Resuscitation Shock

Critical Care, EMS, Pharmacy/Pharmacology, Resuscitation

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Continuous epinephrine infusion for post-resuscitation shock in out of hospital cardiac arrest (OHCA) was associated with both higher all-cause and cardiovascular specific mortality when compared to norepinephrine.

Source
Epinephrine versus norepinephrine in cardiac arrest patients with post-resuscitation shock. Intensive Care Med. 2022 Mar;48(3):300-310. doi: 10.1007/s00134-021-06608-7. Epub 2022 Feb 7.

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