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.

POCUS for Retinal Detachment - Be Careful

POCUS for Retinal Detachment - Be Careful

In less experienced sonographers, ocular ultrasound for retinal detachment was specific but not sensitive.  It's useful to rule it in, but don't use it as the sole means to rule it out.

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.

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.

Atraumatic Needles Drastically Reduce Post-LP Headache

Atraumatic Needles Drastically Reduce Post-LP Headache

In this large meta-analysis of 110 RCTs, the incidence of post-dural puncture headache (PDPH) was only 4.2% compared to conventional LP needles at 11%; NNT = 14.  This is a game-changer.

Opioids Not Better Than Non-Opioids for Back, Hip, Knee Pain

Opioids Not Better Than Non-Opioids for Back, Hip, Knee Pain

Opioids were no better than non-opioid medicines for chronic back, hip, or knee pain. However, undesirable medication-related symptoms occurred more commonly among those taking opioids. 

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.

Self-Reduction of Shoulder Dislocation - Like a Boss

Self-Reduction of Shoulder Dislocation - Like a Boss

The Boss-Holzach-Matter (aka Davos, self-reduction) technique was less painful than the physician-driven Spaso technique and just as successful and efficient.

How to Change Opiate Prescribing Habits

How to Change Opiate Prescribing Habits

Emergency clinicians who underestimated their own opiate prescribing were impacted more profoundly to reduce prescriptions by being shown their opiate prescribing data compared to their peers.

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