There was no difference in first pass success with a non-supine (ramped) vs supine intubating position in this retrospective study, and composite adverse events were more common when ramped. But patients most likely to be ramped were also obese or had predicted difficult airway.
Polyethylene drapes used as a physical barrier to cover patients during defibrillation reduced electrical current to acceptable levels for medical personnel to continue compressions throughout defibrillation during cardiac arrest.
Hyperlactatemia appears to arise from impaired oxygen utilization more often than decreased O2 delivery but doesn’t cause acidemia unless there is impaired renal function. The novel “alactic base excess” may give us an early way to tell when the kidneys are failing to compensate.
Evidence for the 1-hour bundle release by the Surviving Sepsis Campaign is weak. Yet, this is the new standard we are held to, despite ACEP, AAEM, and thousands of physicians, EM and non-EM alike, voicing concern that this is a very bad idea.
The Pediatric Advanced Life Support (PALS)/Advanced Trauma Life Support (ATLS) formula to define hypotension in children (i.e. 5th percentile SBP) seems to be a good compromise between German and U.S. population norms for children. The formula is: Low SBP = <70 + 2(age in years).
In patients with predicted difficult airway, use of a Glidescope plus fiberoptic scope (aScope, Ambu) as a dynamic, controllable stylet vs Glidescope with usual stylet resulted in much higher first-pass success, 91% vs 67%, NNT = 4.
Peripheral perfusion guided resuscitation was better than lactate clearance in patients with septic shock in regard to improving organ dysfunction at 72 hours (SOFA score) and barely missed statistical significance in reducing 28-day mortality.
Presence of any virus on multiplex PCR (particularly influenza, parainfluenza, and RSV) in critically ill hematology patients was associated with an increased risk for respiratory failure and ICU mortality.