How and When to Work Up Bleeding Disorder in Suspected Abuse
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Not all pediatric bruising needs workup for a bleeding disorder. This report details not only how but when to do it.
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Not all pediatric bruising needs workup for a bleeding disorder. This report details not only how but when to do it.
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Biphasic or deep precordial T waves on ECG can occur with spontaneous reperfusion of an occluded left anterior descending artery and should not be ignored in the patient with chest pain.
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Wellens’ Syndrome. N Engl J Med. 2022 Sep 22;387(12):e25. doi: 10.1056/NEJMicm2201699.
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Esophageal bougienage is an underutilized bedside technique for managing retained esophageal coins.
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Esophageal Bougienage for Management of Lodged Esophageal Coins: Safe, Effective, Efficient, and Underused. Pediatr Emerg Care. 2022 Sep 30. doi: 10.1097/PEC.0000000000002849. Online ahead of print.
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Previously, first-attempt success rates for pediatric intubations hovered around 50%. Video-assisted laryngoscopy significantly increased first-attempt success rates and also had fewer adverse outcomes.
Source
Video-Assisted Laryngoscopy for Pediatric Tracheal Intubation in the Emergency Department: A Multicenter Study of Clinical Outcomes. Ann Emerg Med. 2022 Oct 15:S0196-0644(22)00604-7. doi: 10.1016/j.annemergmed.2022.08.021. Epub ahead of print.
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In patients presenting with ‘wake-up’ strokes, endovascular therapy improves functional outcomes, while intravenous alteplase may also provide a small beneficial impact.
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What is the Efficacy and Safety of Intravenous Thrombolysis and Thrombectomy Among Patients With a Wake-Up Stroke?. Ann Emerg Med. 2022;80(2):165-167. doi:10.1016/j.annemergmed.2022.02.013
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Relative thoracic distention pattern seen on capnography during cardiac arrest may have a negative impact on blood pressure and cerebral perfusion. Here’s how to recognize and fix it.
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With ventilation rate standardized, chest compression depth explains variations in ETCO2 better than chest compression rate.
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Contribution of chest compressions to end-tidal carbon dioxide levels generated during out-of-hospital cardiopulmonary resuscitation. Resuscitation. 2022 Oct;179:225-232. doi: 10.1016/j.resuscitation.2022.07.009. Epub 2022 Jul 11.
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Drowning is a common cause of death worldwide. The duration of submersion is the best predictor of outcome, with immediate on-scene CPR and ventilation improving outcomes. Prevention is the best medicine, with public health intervention and policy being the most effective way to prevent drowning.
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Prevention of and Emergency Response to Drowning. NEJM 2022 Oct 6. Doi:10.1056/NEJMra2202392
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An increasing propofol dose, combined with a fixed dexmedetomidine infusion, was associated with decreased 90-day mortality in patients ≤ 65 years. An increasing dexmedetomidine dose, combined with a relatively fixed propofol dose, was associated with increased mortality in patients ≤65. Both associations were absent in patients > 65 years old.
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Dexmedetomidine and Propofol Sedation in Critically Ill Patients and Dose Associated 90-day Mortality: A Secondary Cohort Analysis of a Randomized Controlled Trial (SPICE-III). Am J Respir Crit Care Med. 2022 Oct 10. doi: 10.1164/rccm.202206-1208OC. Online ahead of print.
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ACEP released acute heart failure syndrome (AHFS) consensus recommendations that cover: diagnosis with lung ultrasound, risk stratification, high-dose nitroglycerin, and early diuretics.
Source
Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Heart Failure Syndromes: Approved by ACEP Board of Directors, June 23, 2022. Ann Emerg Med. 2022 Oct;80(4):e31-e59. doi: 10.1016/j.annemergmed.2022.05.027.