New Risk After TBI - Suicide

New Risk After TBI - Suicide

The incidence of suicide nearly doubled in patients who had traumatic brain injury (TBI) compared to baseline.  Risk increased with severity of injury, number of visits, and was highest in the first 6 months post-injury.

Do Steroids Benefit Influenza Pneumonia?

Do Steroids Benefit Influenza Pneumonia?

Unless there is compelling alternative reason to do so (i.e. asthma), giving a glucocorticoid to treat influenza pneumonia was associated with increased risk of mortality.

Why SEP-1 CMS "Quality" Metrics Are Dumb

Why SEP-1 CMS "Quality" Metrics Are Dumb

Sepsis bundles like the CMS SEP-1 guidelines are too restrictive, requiring an all-or-nothing approach to achieve compliance. These bundles fail to prioritize the most important bundle components while penalizing providers for meaningless omissions that have no impact on mortality.

LR vs NS for Pediatric DKA

LR vs NS for Pediatric DKA

Use of any LR in pediatric patients with DKA, as opposed to only NS, was associated with lower overall costs, similar length of stay, and markedly reduced incidence of cerebral edema in this retrospective study.

Where Will You Cut the Neck? POCUS Makes Perfect

Where Will You Cut the Neck? POCUS Makes Perfect

Practicing to find the midpoint of the cricothyroid membrane with ultrasound is a much better way to learn than by using only external landmarks and no ultrasound.

Does Negative CTPA Rule Out High Pretest Probability PE?

Does Negative CTPA Rule Out High Pretest Probability PE?

For patients with high pretest probability for pulmonary embolism, a negative CT pulmonary angiography alone does not appear to adequately rule out venous thromboembolism.

PAMPer - Prehospital Plasma for Hemorrhagic Shock Saves Lives

PAMPer - Prehospital Plasma for Hemorrhagic Shock Saves Lives

Prehospital administration of 2 units of thawed plasma in adult trauma patients at risk for hemorrhagic shock reduced mortality compared to standard care, NNT = 10.

PARAMEDIC2 - Epinephrine in Arrest RCT

PARAMEDIC2 - Epinephrine in Arrest RCT

Epinephrine for out-of-hospital cardiac arrest improved overall 30-day survival (3.2%, epi vs 2.4%, placebo) but did not improve survival to discharge with a good neurological outcome.  In fact, more patients who received epinephrine and survived had severe neurological impairment than in the placebo group.

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.

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