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.
November 2022
How to Spot Wellens’ Syndrome
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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.
Source
Wellens’ Syndrome. N Engl J Med. 2022 Sep 22;387(12):e25. doi: 10.1056/NEJMicm2201699.
Just Push It Down? Esophageal Bougienage for Coins
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Esophageal bougienage is an underutilized bedside technique for managing retained esophageal coins.
Source
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.
How to Get Pediatric ETT First-Pass Success – VL For the Win!
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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.
Concise Review of Lytics and Endovascular Therapy for ‘Wake Up’ Stroke
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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.
Source
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
Capnogram Master Class – Patterns in Arrest You Need to Know
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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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How to Optimize CPR Quality – Compression Depth or Rate?
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With ventilation rate standardized, chest compression depth explains variations in ETCO2 better than chest compression rate.
Source
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.
Fatal Drownings: A Public Health Problem?
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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.
Source
Prevention of and Emergency Response to Drowning. NEJM 2022 Oct 6. Doi:10.1056/NEJMra2202392
A Dark Side of Dexmedetomidine? Another Look at SPICE-III
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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.
Source
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.
New ACEP Policy on Acute Heart Failure
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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.