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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.
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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.
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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.
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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.
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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.
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The prevalence of laryngospasm was 3.3/1000 children. Concurrent URI, airway procedure, and use of combined ketamine + propofol were associated with increased risk.
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Predictors of Laryngospasm During 276,832 Episodes of Pediatric Procedural Sedation. Annals of Emergency Medicine. 2022 Jun22;S0196-0644(22)00323-7.
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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.
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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.
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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.
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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.
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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.
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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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Ultrasound guided peripheral intravenous cannulation (PIVC) has been shown to be effective in some pediatric populations.
Source
Ultrasound for Pediatric Peripheral Intravenous Catheter Insertion: A Systematic Review. Pediatrics. 2022 May 1;149(5):e2021055523. doi: 10.1542/peds.2021-055523.
