Should We Add Spiritual Care to Our Critical Care?
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Spirituality is a part of the human experience and can be a mechanism to improve patient-centered care.
August 2022
Should We Stop Using Propofol for RSI? | The INTUBE Study
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Patients who suffer from peri-intubation cardiovascular instability and collapse have an increased risk of mortality. Propofol was significantly associated with increased risk of peri-intubation instability and collapse.
Source
Peri-intubation Cardiovascular Collapse in Patients Who Are Critically Ill: Insights from the INTUBE Study. Am J Respir Crit Care Med. 2022 Aug 15;206(4):449-458. doi: 10.1164/rccm.202111-2575OC.
The TBI SBP Sweet Spot – Is 130-180 mmHg the New Normotension?
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In-hospital mortality of TBI patients decreased linearly as the lowest observed out-of-hospital systolic blood pressure increased, with the lowest mortality between 130 and 180 mmHg.
Source
Optimal Out-of-Hospital Blood Pressure in Major Traumatic Brain Injury: A Challenge to the Current Understanding of Hypotension. Ann Emerg Med. 2022 Jul;80(1):46-59. doi: 10.1016/j.annemergmed.2022.01.045. Epub 2022 Mar 24.
What ECG Findings Predict Crashing in Acute PE?
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In patients with acute pulmonary embolism, only supraventricular tachycardia was an independent predictor of clinical deterioration; however, other ECG findings (below) were associated with abnormal RV function on echo.
Source
Electrocardiographic findings associated with early clinical deterioration in acute pulmonary embolism. Acad Emerg Med. 2022 Jun 24. doi: 10.1111/acem.14554. Online ahead of print.
TXA for Epistaxis Just Can’t Make up its Mind
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This single center, double blinded, randomized control trial of 240 patients demonstrated several positive outcomes with addition of tranexamic acid (TXA) to standard therapy.
Source
Intranasal Topical Application of Tranexamic Acid in Atraumatic Anterior Epistaxis: A Double-Blind Randomized Clinical Trial. Ann Emerg Med. 2022 Jun 22;S0196-0644(22)00247-5. doi: 10.1016/j.annemergmed.2022.04.010. Online ahead of print.
How to Perform Seven Temporomandibular Joint Dislocation Reduction Techniques
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This article covers temporomandibular joint dislocations and 7 high-yield reduction techniques we should all know to best care for these patients in the ED. See reduction photos below.
Is My Patient at Risk for Monkeypox?
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The current monkeypox outbreak is characterized by sexual transmission and presents with a flu-like prodrome followed by characteristic rash.
Source
Monkeypox Virus Infection in Humans across 16 Countries – April-June 2022. N Engl J Med. 2022 Jul 21. doi: 10.1056/NEJMoa2207323. Online ahead of print.
How Good Is the Evidence Base for Joint Commission Mandates? Spoiler Alert…
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A review of actionable standards set forth by the Joint Commission in 2018-2019 showed that the majority of required changes were only partly, or not at all, supported by quality evidence.
Source
The evidence base for US joint commission hospital accreditation standards: cross sectional study. BMJ. 2022 Jun 23;377:e063064. doi: 10.1136/bmj-2020-063064.
Avoiding Laryngospasm During Pediatric Sedation – What Are Risk Factors?
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The prevalence of laryngospasm was 3.3/1000 children. Concurrent URI, airway procedure, and use of combined ketamine + propofol were associated with increased risk.
Source
Predictors of Laryngospasm During 276,832 Episodes of Pediatric Procedural Sedation. Annals of Emergency Medicine. 2022 Jun22;S0196-0644(22)00323-7.
How to Manage Hyponatremia – Spoon-Feed Version
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Regardless of the duration or etiology of hyponatremia, patients that have severe clinical manifestations warrant rapid administration of hypertonic saline as a 100-150 mL bolus of 3% sodium chloride or continuous infusion.
Source
Diagnosis and Management of Hyponatremia: A Review. JAMA. 2022 Jul 19;328(3):280-291. doi: 10.1001/jama.2022.11176.