Spoon Feed
This randomized controlled trial demonstrated that lateral decubitus position was statistically the same as the upright position for lumbar puncture success.
Source
Is Lateral Decubitus or Upright Positioning Optimal for Lumbar Puncture Success in a Teaching Hospital? J Emerg Med. 2023 Jan 11;S0736-4679(22)00527-3. doi: 10.1016/j.jemermed.2022.09.002. Online ahead of print.
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This randomized, non-inferiority trial found that remifentanil plus hypnotics were inferior to neuromuscular blocking agents plus hypnotics for rapid sequence intubation of patients at risk of aspiration in the operating room setting.
Source
Effect of Remifentanil vs Neuromuscular Blockers During Rapid Sequence Intubation on Successful Intubation Without Major Complications Among Patients at Risk of Aspiration: A Randomized Clinical Trial. JAMA. 2023 Jan 3;329(1):28-38. doi: 10.1001/jama.2022.23550.
Spoon Feed
Here are the counterpoints for why these authors think intravenous (IV) haloperidol (Haldol) should be avoided in the emergency department setting.
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The next couple of reviews will look at different authors making their case for why intravenous (IV) haloperidol (Haldol) should or should not be used in the emergency department setting.
Source
Haloperidol May Be Safely Administered Intravenously in the Emergency Department. Annals of Emergency Medicine. 2023;81:95-96. doi: 10.1016/j.annemergmed.2022.07.004
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Intra-articular lidocaine (IAL) is a safe alternative for the reduction of anterior shoulder dislocations and may have similar efficacy to intravenous (IV) sedation, with fewer adverse events and shorter ED length of stay.
Source
Intra-articular lidocaine versus intravenous sedation for closed reduction of acute anterior shoulder dislocation in the emergency department: a systematic review and meta-analysis. CJEM. 2022 Dec;24(8):809-819. doi: 10.1007/s43678-022-00368-z. Epub 2022 Oct 1.
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Placing transcutaneous cardiac pacer pads in the anteroposterior position required less energy to successfully capture.
Source
Anteroposterior Pacer Pad Position Is More Likely to Capture Than Anterolateral for Transcutaneous Cardiac Pacing. Circulation. 2022;146(14):1103-1104. doi:10.1161/CIRCULATIONAHA.122.060735
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Having an array of techniques for digital nerve blocks in your back pocket can only serve to improve your patient care. Let’s review some approaches.
Source
Digital Nerve Blocks: A Comprehensive Review of Techniques. J Emerg Med. 2022 Oct 10;S0736-4679(22)00428-0. doi: 10.1016/j.jemermed.2022.07.002. Online ahead of print.
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This study showed no difference in post-intubation hypotension for endotracheal intubations in the ED between ketamine and etomidate.
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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
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This pilot trial showed that an educational initiative focused on reducing deep post-intubation sedation in the Emergency Department was feasible and associated with lower mortality, more ventilator-free and ICU-free days, and no increase in adverse events.
