Pain/Sedation/Procedure

What is the Optimal Position for Successful Lumbar Puncture?

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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.

New RCT – Remifentanil vs. Neuromuscular Blockers for RSI First-Pass Success

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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.

Point-Counterpoint | IV Haloperidol is Safe for Emergency Department Use

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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

Does Intra-Articular Lidocaine Work for Shoulder Reduction?

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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.

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

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