Should Supraglottic Airways Be Used in Arrest?
Use of a supraglottic airway (SGA) was associated with improved survival with a good neurological outcome.
A Simple Trick For Easier Subclavian Access
For better success at subclavian central venous catheter placement, have the patient turn their head 30 degrees toward the side of insertion to increase the cross sectional area of the vein.
Why Norepinephrine is Better than Dopamine for Shock
Norepinephrine and dopamine were equal with regard to mortality in shock, except for the subgroup with cardiogenic shock, in which the dopamine group fared worse. There were twice as many dysrhythmias in the dopamine group, largely atrial fibrillation.
AHA Cardiogenic Shock Spoon Feed
This 50 page AHA guideline is very concisely but completely summarized right here. Save some time and get the pearls. Table 5 is fantastic, and this article is available in free full text (see Source below), so take advantage and look at this.
Are We Giving Epinephrine Too Frequently?
Current PALS (and ACLS) algorithms recommend repeat epinephrine doses q3-5 minutes. This study suggested that this is too frequent. If doses were spaced 8-10 minutes, pediatric patients had significantly better survival.
Does POCUS Degrade CPR Quality?
Point of care ultrasound may be very useful during CPR, but it should not get in the way of chest compressions. If you're going to use it, get in there quick and get out of the way or choose a view that allows continuous chest compressions (i.e. subxiphoid).
Is PALS Wrong? Rapid Bolus Did Worse
PALS recommends giving a fluid bolus to children in shock over 5-10minutes. This study showed that giving it more slowly, over 15-20 minutes likely decreased the need for mechanical ventilation.
Avoiding Adverse Events in Pediatric Sedation
This large multi-center prospective study of pediatric sedation found adverse events occurred in 12%, most mild desaturation or vomiting. Severe adverse events occurred in 1%. Ketamine given alone was the safest drug. Propofol alone, ketamine + fentanyl, or ketamine + propofol were associated with greater risk for severe adverse events.
Does Peds Damage Control Transfusion Help?
A high plasma to PRBC transfusion ratio (>/= 1:2) was not beneficial in pediatric massive trauma transfusion. But this study was different than adult studies of damage control resuscitation in that these children did not receive platelets
The ProCESS of Dismantling Early Goal-Directed Therapy
There was no mortality advantage to early goal-directed therapy (EGDT) over protocol-based care (using lactate clearance), or usual sepsis care.