Pain/Sedation/Procedure

Mounting Evidence that Paralysis Awareness is a Big Problem

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In this single center cohort of 886 patients, 5 patients had definite awareness during paralysis. However, there were 61 patients determined to have possible awareness, meaning upwards of 7.4% of patients could have been aware.

Source
Recall of awareness during paralysis among emergency department patients undergoing tracheal intubation. Chest. 2022 Sep 08. Doi: https://doi.org/10.1016/j.chest.2022.08.2232

Do We Need Sterile Gloves for Laceration Repair?

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This trial suggests that there is unlikely to be a large difference in wound infection rates between non-sterile gloves and dressings and sterile gloves, dressings, and drapes for suturing of traumatic wounds in the ED.

Source
Non-sterile gloves and dressing versus sterile gloves, dressings and drapes for suturing of traumatic wounds in the emergency department: a non-inferiority multicentre randomised controlled trial. Emerg Med J. 2022 Jul 26;emermed-2021-211540. doi: 10.1136/emermed-2021-211540. Online ahead of print.

Virtual Reality – Are Adults as Distractible as Kids?

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Distraction as a method of analgesia and anxiolysis for minor ED procedures using a 3D virtual reality display was not better than using a 2D screen.

Source
Analgesic and Anxiolytic Effects of Virtual Reality During Minor Procedures in an Emergency Department: A Randomized Controlled Study. Ann Emerg Med. 2022 May 28:S0196-0644(22)00264-5. doi: 10.1016/j.annemergmed.2022.04.015. Epub ahead of print.

Don’t Forget the Sedation – A Paralytic Nightmare

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The proportion of patients that experience awareness with paralysis is alarmingly high; 3.4% were aware of their surroundings but paralyzed, which 3.4% more than what should occur.

Source
Awareness With Paralysis Among Critically Ill Emergency Department Patients: A Prospective Cohort Study. Crit Care Med. 2022 Jul 22. doi: 10.1097/CCM.0000000000005626. Online ahead of print.

Infant LP – Is Sitting or Lateral Recumbent Position Better?

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There was no statistically significant difference in adequate cerebrospinal fluid collection or rate of traumatic taps for lumbar punctures performed on infants <92 days of age when comparing sitting versus lateral recumbent positioning for the procedure.

Source
Retrospective study comparing success rates of lumbar puncture positions in infants. Am J Emerg Med. 2022 Jun;56:228-231. doi: 10.1016/j.ajem.2022.04.013. Epub 2022 Apr 12.

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