EMS

The TBI SBP Sweet Spot – Is 130-180 mmHg the New Normotension?

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In-hospital mortality of TBI patients decreased linearly as the lowest observed out-of-hospital systolic blood pressure increased, with the lowest mortality between 130 and 180 mmHg.

Source
Optimal Out-of-Hospital Blood Pressure in Major Traumatic Brain Injury: A Challenge to the Current Understanding of Hypotension. Ann Emerg Med. 2022 Jul;80(1):46-59. doi: 10.1016/j.annemergmed.2022.01.045. Epub 2022 Mar 24.

Does Prehospital Intranasal Glucagon for Hypoglycemia Work?

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In this small study of hypoglycemic patients who received prehospital intranasal glucagon, 32% had substantial improvement, 30% had slight improvement, and 38% had no improvement. There was no clear patient characteristic that predicted response.

Source
Prehospital Intranasal Glucagon for Hypoglycemia. Prehosp Emerg Care. 2022 Mar 2;1-4. doi: 10.1080/10903127.2022.2045406. Online ahead of print.

How Often Does EMS Perform Pediatric Airway Management?

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One in 180 out-of-hospital pediatric encounters require bag-mask ventilation (BMV) or advanced airway management (AAM). Of these, 49% involve tracheal intubation (TI) despite a lack of evidence showing superiority to BMV.

Source
Epidemiology of out-of-hospital pediatric airway management in the 2019 national emergency medical services information system data set. Resuscitation. 2022 Apr;173:124-133. doi: 10.1016/j.resuscitation.2022.01.008. Epub 2022 Jan 19.

Decompression Sickness | Arterial Gas Embolism – Spoon-Feed Version

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Decompression sickness and arterial gas embolism can present similarly and have similar treatment protocols. Decompression illness is a term that can encompass both disease processes. Recompression and hyperbaric oxygen are definitive treatments for both conditions. If you need additional help, you should contact a 24-hour expert on the topic.

Source
Decompression Sickness and Arterial Gas Embolism. NEJM. 2022;386:1254-1264. DOI: 10.1046/NEJMra2116554

Is Early ECPR Better than ACLS for OHCA?

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Early extracorporeal cardiopulmonary resuscitation was not superior to standard advanced cardiac life support for 180-day survival with good neurological outcome, but there may be a silver lining.

Source
Effect of Intra-arrest Transport, Extracorporeal Cardiopulmonary Resuscitation, and Immediate Invasive Assessment and Treatment on Functional Neurologic Outcome in Refractory Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA. 2022 Feb 22;327(8):737-747. doi: 10.1001/jama.2022.1025.

Battle of the Catecholamines – Epi vs Norepi for Post-Resuscitation Shock

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Continuous epinephrine infusion for post-resuscitation shock in out of hospital cardiac arrest (OHCA) was associated with both higher all-cause and cardiovascular specific mortality when compared to norepinephrine.

Source
Epinephrine versus norepinephrine in cardiac arrest patients with post-resuscitation shock. Intensive Care Med. 2022 Mar;48(3):300-310. doi: 10.1007/s00134-021-06608-7. Epub 2022 Feb 7.

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