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.

Start Strong, Finish Weak - Attending Shift Productivity

Start Strong, Finish Weak - Attending Shift Productivity

Attending physician productivity peaks at the beginning of the shift, starting with about 3 new patients in the first hour and decreases as the shift progresses.  This has important implications for staffing models.  Assuming a simple, uniform average over the shift won't work.

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.

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.

Influenza Kills - A Sobering Reminder

Influenza Kills - A Sobering Reminder

Influenza killed 675 children from the 2010-11 flu season to the 2015-16 season.  Infants under 6 months had the highest incidence of mortality.  Encourage everyone to get vaccinated.  Antiviral treatment is encouraged in all children under 2, all patients with severe illness, and all hospitalized patients regardless of whether or not the duration of illness exceeds 48 hours.

Does Pan-Scan Benefit Pediatric Trauma Patients?

Does Pan-Scan Benefit Pediatric Trauma Patients?

Whole body CT vs selective CT in children with trauma did not result in mortality benefit.  This large, retrospective study with propensity matching suggested that any additional injuries found on pan-CT may have been either not life-threatening or did not change management to produce mortality benefit.

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.

Pediatric Head CT - Does Vomiting Matter?

Pediatric Head CT - Does Vomiting Matter?

In pediatric patients with blunt traumatic head injury, none had clinically important traumatic brain injury or significant injury on CT if the only symptom was vomiting <3 times.  It was still extremely low if isolated vomiting 3 or more times: 3/1000 for ciTBI and 6/1000 for TBI-CT.

The Next PECARN Rule? - NEXUS II CT Rule for Kids

The Next PECARN Rule? - NEXUS II CT Rule for Kids

The NEXUS II Pediatric Head CT Decision Instrument was 100% sensitive for ruling out children with a neurosurgical outcome, but it was relatively small and had wide confidence intervals.  I don't think this will supplant PECARN.

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.

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.

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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