Refractory Ventricular Fibrillation – What’s the Best Defibrillation Strategy?
Spoon Feed
For the treatment of refractory ventricular fibrillation (VF) in out-of-hospital cardiac arrest, survival to hospital discharge was more common among patients who received double sequential external defibrillation (DSED) and vector-change (VC) defibrillation than those who received standard defibrillation.
Source
Defibrillation Strategies for Refractory Ventricular Fibrillation. N Engl J Med. 2022 Nov 6. doi: 10.1056/NEJMoa2207304. Online ahead of print.
Should Medics Clear C-Spine in the Field?
Spoon Feed
In this large, single-center prospective cohort implementation study, paramedics were able to apply a modified Canadian C-spine rule to assess low risk trauma patients and transport a large proportion of them to a higher level of care without spinal precautions.
The TBI SBP Sweet Spot – Is 130-180 mmHg the New Normotension?
Spoon Feed
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?
Spoon Feed
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?
Spoon Feed
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
Spoon Feed
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
Does Mechanism of Injury Matter for Trauma Triage by EMS?
Spoon Feed
Mechanism of injury and special consideration criteria are important in predicting trauma severity, but some criteria need to be dropped and others added to current field triage guidelines.
Source
Mechanism of Injury and Special Considerations as Predictive of Serious Injury: A Systematic Review. Acad Emerg Med. 2022 Mar 23. doi: 10.1111/acem.14489. Online ahead of print.
Is Early ECPR Better than ACLS for OHCA?
Spoon Feed
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.
Should EMS “Scoop and Run” or “Stay and Play” for Trauma?
Spoon Feed
In the prehospital setting, prolonged on-scene times were associated with increased 24-hour and 30-day mortality for moderately or severely injured, undifferentiated trauma patients.
Source
The impact of prehospital time intervals on mortality in moderately and severely injured patients. J Trauma Acute Care Surg. 2022;92(3):520-527. doi:10.1097/TA.0000000000003380
Battle of the Catecholamines – Epi vs Norepi for Post-Resuscitation Shock
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.