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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.

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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.

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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.

Source
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.

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.

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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.