December 2022

Cutting the Neck? How About POCUS-Guided Cricothyrotomy?

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Ultrasonography can assist in identification of cricothyroid membrane for scalpel cricothyroidotomy pre-planning but should not be used in completion of the procedure itself.

Source
Role of ultrasonography in an impalpable tissue larynx model during a simulated front-of-neck access scenario: a randomized simulation study. CJEM. 2022 Nov 8. doi: 10.1007/s43678-022-00399-6. Epub ahead of print.

Does Calcium Work for PEA in Suspected Hyperkalemia?

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Empiric calcium administration in PEA arrest not only failed to improve ROSC, but also had no impact when ECG features of hyperkalemia and acute myocardial ischemia were present.

Source
Effect of Calcium in Patients with Pulseless Electrical Activity and Electrocardiographic Characteristics Potentially Associated with Hyperkalemia and Ischemia-Sub-study of the Calcium for Out-of-hospital Cardiac Arrest (COCA) trial. Resuscitation. 2022 Nov 17;S0300-9572(22)00712-2. doi: 10.1016/j.resuscitation.2022.11.006. Online ahead of print.

Refractory Ventricular Fibrillation – What’s the Best Defibrillation Strategy?

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For the treatment of refractory ventricular fibrillation (VF) in out-of-hospital cardiac arrest, survival to hospital discharge was more common among patients who received double sequential external defibrillation (DSED) and vector-change (VC) defibrillation than those who received standard defibrillation. 

Source
Defibrillation Strategies for Refractory Ventricular Fibrillation. N Engl J Med. 2022 Nov 6. doi: 10.1056/NEJMoa2207304. Online ahead of print.

Stop the Bleeding…of Unnecessary Care – Another Strike Against Delayed Head CT

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No significant difference in delayed intracranial hemorrhage (dICH) was seen in patients on antithrombotic (AT) medication vs. no AT among patients with repeat CT.

Source
Findings on Repeat Posttraumatic Brain Computed Tomography Scans in Older Patients With Minimal Head Trauma and the Impact of Existing Antithrombotic Use. Ann Emerg Med. 2022 Oct 31;S0196-0644(22)00580-7. doi: 10.1016/j.annemergmed.2022.08.006. Online ahead of print.

Do We Need Delayed Head CT for Anticoagulated TBI Patients?

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Patients ≥65 years on warfarin with head injury were found to have a significantly higher rate of delayed intracranial hemorrhage (dICH) compared to elderly on direct oral anticoagulants (DOACs) and those not on anticoagulation (AC).

Source
Delayed intracranial hemorrhage after head injury among elderly patients on anticoagulation seen in the emergency department. CJEM. 2022 Oct 15. doi: 10.1007/s43678-022-00392-z. Epub ahead of print.

What’s the Best Treatment for Peripheral Vertigo?

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Vestibular suppressant medications in peripheral vertigo were not associated with symptom resolution, decrease in repeat ED visits, patient satisfaction, or increased quality of life. The authors suggest that positional maneuvers, such as the Epley maneuver, should be the primary treatment for BPPV.

Source
Vestibular suppressants for benign paroxysmal positional vertigo: A systematic review and meta-analysis of randomized controlled trials. Acad Emerg Med. 2022 Oct 21. doi: 10.1111/acem.14608. Online ahead of print.

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