ADviSED – Aortic Dissection Detection Risk Score Plus D-Dimer for Aortic Syndromes
The combination of a negative D-Dimer (<500 ng/ml) and an Aortic Dissection Detection (ADD) risk score of ≤1 missed 0.3% of patients with acute aortic syndrome.
No Teeth? No Problem. Use a Smaller Blade
When intubating edentulous patients, using a smaller Macintosh curved blade (Mac 3 for men and Mac 2 for women) led to an improved glottic view.
Is There Such Thing as a Black Cloud?
There is no such thing as a "black cloud." Those who self-identified as a black-cloud were also identified as such by their peers, but a look at the actual PED metrics showed no statistical difference except higher admission rate. I'm not sure I believe this, but there you go...
Ketamine and Long-term Behavioral Change in Children
After using ketamine for pediatric procedural sedation, 22% of children experienced negative behavioral symptoms measured 1-2 weeks after ED discharge. The most common symptoms were apathy/withdrawal and separation anxiety. Pre-procedural anxiety was the greatest predictor of negative behavioral changes.
Treatment of Massive PE in Pregnancy
Treatment with lytics for acute PE (mostly massive or with arrest) in pregnancy out to 6 weeks postpartum was associated with 94% overall maternal survival and 88% fetal survival. Major bleeding occurred in 17% of pregnant women and 58% of those in the postpartum period.
How Aortic Dissection Presents
Sudden-onset, severe ("worst-ever"), sharp chest pain was the hallmark type A and B aortic dissection. Ripping or tearing pain was present in only half of patients. Classic features of aortic regurgitation murmur and pulse deficit were frequently lacking.
Better Sepsis Care in Resource-Limited Settings
Early sepsis treatment with protocolized IV fluid, pressors, and transfusions vs usual care was undertaken in Zambia, and resulted in much higher mortality. Most patients had HIV. This is yet another strike against a form of early goal-directed therapy (EGDT) vs. usual sepsis care.
Capnography Flatline Beats Gestalt for Paralysis in RSI
Using loss of wave capnography rather than gestalt assessment of relaxation after paralytic administration for RSI in the ED led to shorter time to intubation and increased first-pass success.
Morphine Harmful in CHF
Morphine was associated with worse short-term mortality all other known variables being equal: 20% vs. 12.7%.
Ibutilide for A-fib in Real World Practice
Ibutilide worked to chemically cardiovert rapid atrial fibrillation in just over half of cases but was associated with the feared complication, ventricular tachycardia, in 2 patients (0.6%).