Midazolam Beat Haloperidol for Agitation

Midazolam Beat Haloperidol for Agitation

Midazolam 5mg IM beat haloperidol 5 mg, ziprasidone 20 mg, olanzapine 10 mg, and haloperidol 10 mg (all also given IM), with 71% sedated at 15 minutes.  Olazapine came in second.

Bougie vs Stylet - The BEAM Trial

Bougie vs Stylet - The BEAM Trial

First attempt success was higher in the bougie group vs stylet group (98% vs 87% in all comers, 96% vs 82% in patients with at least one difficult airway characteristic). The median duration of the first-attempt as well as incidence of hypoxemia was similar between bougie and stylet groups.

IOTA - Oxygen, Less Is More

IOTA - Oxygen, Less Is More

For adults with varied acute illnesses, use of supplemental oxygen in patients with room air SpO2 of 94% or greater was associated with increased short and longterm mortality.

Are 3 Ports Better Than One? Triple Lumen Flow Rates

Are 3 Ports Better Than One? Triple Lumen Flow Rates

There were no statistically significant differences in pressure-bag flow rates for 1L of NS through all three ports of a standard triple-lumen catheter (TLC) compared to a 16 gauge peripheral venous catheter (PVC) or a 6Fr sheath introducer.  On gravity-flow, it was not statistically different from a 16 gauge PVC.  But 14ga PVC and 8.5Fr sheath rates were superior in both instances.

NPO Status - No Correlation With Sedation Outcomes

NPO Status - No Correlation With Sedation Outcomes

In this cohort of thousands of pediatric ED sedation patients who didn't meet the American Society of Anesthesiologists (ASA) fasting guideline, none had aspiration nor was there any correlation of fasting time with any adverse events or vomiting.  It is time to change hospital NPO policies for the ED.

Syncope/Pre-syncope and Outcome in PE Patients

Syncope/Pre-syncope and Outcome in PE Patients

Syncope or pre-syncope in patients with PE was associated with an increased risk for 30-day mortality (43% vs 6%) and was an independent predictor of 30-day mortality when accompanied by hemodynamic instability on admission.  Don't try to treat them as an outpatient.

Time to Epi for Non-Shockable Rhythm Matters

Time to Epi for Non-Shockable Rhythm Matters

Earlier epinephrine administration for non-shockable rhythm was associated with better overall survival to discharge and neurologically-intact survival.  Reducing EMS time to the scene, time to IV (or IO) access, and time to drug may improve survival in this group of patients.

More Clarity on IVC POCUS for Fluid Responsiveness

More Clarity on IVC POCUS for Fluid Responsiveness

In intubated patients, respiratory variation of IVC diameter by 16% had fairly high diagnostic accuracy for predicting fluid responsiveness, but only when the tidal volume (TV) was ≥8 mL/kg and positive end-expiratory pressure (PEEP) ≤5 cm H2O.

GlideScope Not Easy to Use in Kids

GlideScope Not Easy to Use in Kids

The GlideScope in pediatric patients was not easy to use.  Experienced intubators had technical difficulty 58% of the time, most often just as the tube passed the cords.  Clockwise rotation helped passage.  You must practice with it before you use it on live patients.

Coagulopathy From Contaminated Synthetic Cannabinoids

Coagulopathy From Contaminated Synthetic Cannabinoids

Think of synthetic cannabinoid use in patients with unexplained serious coagulopathy due to possible contamination with long acting vitamin K antagonists. They will need prolonged oral vitamin K treatment, which can challenging due to the cost.

Mallampati Score and Pediatric Sedation Risk

Mallampati Score and Pediatric Sedation Risk

Children needing deep sedation in the ED were not at greater risk for adverse events if they had Mallampati III/IV scores.  But they did need to be repositioned more often than children with Mallampati I/II scores.

LR - When NOT to Use It

LR - When NOT to Use It

With all the talk of using balanced, lower chloride solutions for volume in the ED and ICU, we thought it might be a good idea to discuss the potential downsides of LR.

SMART Trial - Balanced Crystalloids vs NS in Critically Ill Adults

SMART Trial - Balanced Crystalloids vs NS in Critically Ill Adults

In patients admitted to the ICU, use of balanced fluids resulted in a lower rate of major acute kidney events (MAKE) at 30 days compared to normal saline (14.3% vs 15.4%). This is a NNT of 94 to avoid one MAKE.

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