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.

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.

Fast PEA | Slow PEA - Survival Difference

Fast PEA | Slow PEA - Survival Difference

There is a difference between PEA rhythms.  Slow rates of electrical activity had the usual dismal prognosis.  But those with electrical rates >60 had survival and favorable neurological outcome comparable to VF/VT, 22% and 15% respectively.

Reducing Elderly Transports to the ED for Falls

Reducing Elderly Transports to the ED for Falls

Paramedics responding to elderly patients who had fallen in an assisted living facility followed a protocol that included discussing the case with the patient's primary care physician (PCP).  This drastically reduced the number actually getting transported to the ED by 63% and was safe.

Why We Delay Volume Administration in Penetrating Trauma

Why We Delay Volume Administration in Penetrating Trauma

In patients with penetrating trauma, it was better to allow prehospital hypotension and hasten transport for definitive repair prior to beginning volume resuscitation than to try to normalize vital signs in the field by giving IV fluid.

Which Compression to Ventilation Ratio Should You Use?

Which Compression to Ventilation Ratio Should You Use?

According to this large systematic review, in adults a 30:2 compression to ventilation ratio was better than 15:2.  For kids, either ratio was better than compression only CPR, except under 1 year in which ventilations did not improve outcome beyond compression-only.

Lazarus Phenomenon - Delayed ROSC After CPR Termination

Lazarus Phenomenon - Delayed ROSC After CPR Termination

Delayed ROSC may occur after cessation of CPR - the so called Lazarus phenomenon.  The incidence is around 6/1000 cases and usually occurred within 3-8 minutes after CPR cessation.  All patients eventually died; 4 of 5 had PEA. It may be wise to allow 10 minutes before pronouncing death (or 4 days if the patient is actually named Lazarus).

Significance of Gasping During Arrest

Significance of Gasping During Arrest

Gasping during cardiac arrest was associated with improved neurologically intact survival.  The practical take-home is to avoid premature cessation of CPR if any signs of gasping or agonal respirations are present and to avoid suppression of spontaneous gasping during CPR.

Increased Mortality With Prehospital Intubation

Increased Mortality With Prehospital Intubation

Numerous observational studies have suggested that prehospital intubation (PHI) (in this case of trauma patients) was associated with greater mortality than when it was done in the ED, and this systematic review indicated the same thing.

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