ANDROMEDA-SHOCK - Capillary Refill vs. Lactate

ANDROMEDA-SHOCK - Capillary Refill vs. Lactate

Peripheral perfusion guided resuscitation was better than lactate clearance in patients with septic shock in regard to improving organ dysfunction at 72 hours (SOFA score) and barely missed statistical significance in reducing 28-day mortality.

Pediatric Needle Decompression - What Size Needle?

Pediatric Needle Decompression - What Size Needle?

A standard 5cm 14-16 gauge needle for chest decompression was more than twice as long as needed for children < 13 years old based on CT chest wall thickness (CWT).

Shockingly Ineffective - Double Sequential Defibrillation for Refractory Vfib and Vtach

Shockingly Ineffective - Double Sequential Defibrillation for Refractory Vfib and Vtach

Prehospital double sequential defibrillation was not associated with improved survival for out-of-hospital cardiac arrest patients with refractory ventricular fibrillation or pulseless ventricular tachycardia.

Antiarrhythmics In Arrest - New ILCOR Update

Antiarrhythmics In Arrest - New ILCOR Update

The European Resuscitation Council International Liaison Committee on Resuscitation 2018 guideline has made one minor change regarding antiarrhythmic drugs in arrest: lidocaine, in place of amiodarone, is now a viable, equally effective option in patients with VF/pVT refractory to defibrillation.

ETT vs. SGA for OHCA - Metaanalysis Includes AIRWAYS-2 and PART

ETT vs. SGA for OHCA - Metaanalysis Includes AIRWAYS-2 and PART

There was no difference in an endotracheal tube vs supraglottic airway for patients with out-of-hospital cardiac arrest in the outcomes of return of spontaneous circulation, survival to admission, survival to discharge, or survival with good neurological outcome in studies with low risk of bias in this large metaanalysis.

Do Antiarrhythmic Drugs Help In Cardiac Arrest?

Do Antiarrhythmic Drugs Help In Cardiac Arrest?

When considering 14 RCTs on use of antiarrhythmic drugs for shockable cardiac arrest, there was no benefit for survival to discharge or survival with good neurological outcome. Lidocaine improved ROSC vs placebo.

Prehospital Airway Management

Prehospital Airway Management

In light of the important prehospital airway management articles that came out this week, I thought it might be helpful to go into more depth on the topic of prehospital airway management.

How Many Intubations Does It Take For Proficiency?

How Many Intubations Does It Take For Proficiency?

It is estimated that to place an endotracheal tube (ETT) successfully in 30-60 seconds, using direct laryngoscopy, would take 3-5 years of experience and 137-243 endotracheal intubations (ETI). Increased experience did not reduce the time chest compressions were paused. The key take home is that ETI during CPR is really hard. Be prepared.

EMS ETT or LT for OHCA? Answers in PART

EMS ETT or LT for OHCA? Answers in PART

For adults with out-of-hospital cardiac arrest, initial laryngeal tube insertion by emergency medical service providers was associated with improved 72-hour survival, return of spontaneous circulation, hospital survival, favorable neurologic outcome, and airway success compared to initial endotracheal tube insertion.

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.

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