February 2024

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This prospective study identified a handful of clinical features associated with radiographic pneumonia in young febrile infants, including elevated procalcitonin and/or absolute neutrophil count, respiratory distress, and positive viral testing.

Source
Radiographic pneumonia in young febrile infants presenting to the emergency department: secondary analysis of a prospective cohort study. Emerg Med J. 2023;41(1):13-19. Published 2023 Dec 22. doi:10.1136/emermed-2023-213089.

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In trauma patients, 24-hour mortality rate increased with increasing ratio of packed red blood cells (pRBC) to whole blood (WB) transfusion, even when pRBC transfusion was balanced with platelets and fresh frozen plasma (FFP). Mortality rate was lowest in patients transfused with whole blood alone.

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Trauma patients who were resuscitated with whole blood compared to component therapy had improved 24-hour mortality and a decrease in the total amount of blood products needed for resuscitation.

Source
Doing more with less: low-titer group O whole blood resulted in less total transfusions and an independent association with survival in adults with severe traumatic hemorrhage. J Thromb Haemost. 2024 Jan;22(1):140-151. doi: 10.1016/j.jtha.2023.09.025. Epub 2023 Oct 4.

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In out-of-hospital cardiac arrest (OHCA) patients with refractory ventricular fibrillation (RVF), there was an association with short-interval (<75ms) dual sequential external defibrillation (DSED) and higher probability of termination of ventricular fibrillation (VF) and return of spontaneous circulation (ROSC) compared with longer DSED intervals.

Source
The impact of double sequential shock timing on outcomes during refractory out-of-hospital cardiac arrest. Resuscitation. 2024 Jan;194:110082. doi: 10.1016/j.resuscitation.2023.110082. Epub 2023 Dec 11.

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Patients with TBI who were intubated in the prehospital setting had no difference in 30-day mortality when comparing induction with ketamine versus etomidate.

Source
Etomidate versus Ketamine as prehospital induction agent in patients with suspected severe traumatic brain injury. Anesthesiology. 2024. Jan 8. Doi: 10.1097/ALN.0000000000004894. Online ahead of print.

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A panel of experts appraising a systematic review on prehospital airway management created 22 recommendations relating to ventilation (BVM vs SGA vs ETI), video laryngoscopy (VL), and drug-assisted airway management.

Source
Evidence-Based Guideline for Prehospital Airway Management. Prehosp Emerg Care. 2023. Dec 22. Doi: 10.1080/10903127.2023.2281363. Online ahead of print.

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Mortality in patients with high-risk pulmonary embolism (PE) in the United States increased over the last decade. Surprised? Here’s why this might be true, and what we should do about it.

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A prospective study by the PERT Consortium found an in-hospital mortality rate of 20% in patients with high-risk PE. 41.9% of patients with high-risk PE were treated with advanced therapies (systemic thrombolytics, catheter-directed thrombolysis or embolectomy, surgical embolectomy, ECMO).

Source
Contemporary Management and Outcomes of Patients With High-Risk Pulmonary Embolism. J Am Coll Cardiol. 2024;83(1):35-43. doi:10.1016/j.jacc.2023.10.026

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When providing respiratory support to preterm infants with a facemask, avoid excessive force on the face that is associated with apnea and bradycardia.

Source
Exerted force on the face mask in preterm infants at birth is associated with apnoea and bradycardia. Resuscitation. 2024;194:110086.

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Tidal volume (TV) delivered is hard to control during cardiac arrest, and evidence has shown that over-ventilation can be detrimental in physiological parameters integral to cardiac arrest survival. Small bags were thus integrated into a single EMS system to help combat over-ventilation. Paradoxically, large bags had a greater likelihood of return of spontaneous circulation (ROSC) in out of hospital cardiac arrests (OHCA).

Source
Association of small adult ventilation bags with return of spontaneous circulation in out of hospital cardiac arrest. Resuscitation. 2023 Dec:193:109991. doi: 10.1016/j.resuscitation.2023.109991. Epub 2023 Oct 5.