Reference: Villar. Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomised controlled trial. Lancet Respir Med 2020; 8: 267–76. I know what you are thinking, “What gives? No COVID!” Well the two of you who read this are probably inundated with COVID info. So to give our brains a change I thought I would …
ICU
Quick Hit Article: Difficult vascular access: You know the drill… but do you really know the drill?
Kawano et al. Intraosseous Vascular Access Is Associated With Lower Survival and Neurologic Recovery Among Patients With Out-of-Hospital Cardiac Arrest. Ann Emerg Med. 2018;71:588-596. THE BOTTOM LINE This study was a secondary analysis of a large EMS trial conducted in 7 sites in the US and Canada. This is a really interesting study that looks …
LVAD Complications: A review
This is a nice little review by Dr. Long in Dallas entitled: B. Long, J. Robertson, A. Koyfman, et al., Left ventricular assist devices and their complications: A review for emergency clinicians, American Journal of Emergency Medicine, https://doi.org/10.1016/j.ajem.2019.04.050 INTRODUCTION: A ventricular assist device (VAD) can be placed into the right, left, or both ventricles thus …
Recent Recommendations in Neonatal Resuscitation 2019 UPDATE
Sometimes we need a reminder and update on the basics… Your Welcome.. Recent Recommendations and Emerging Science in Neonatal Resuscitation. Pediatr Clin N Am 66 (2019) 309–320. https://doi.org/10.1016/j.pcl.2018.12.002 TIMING OF UMBILICAL CORD CLAMPING – The 2017 NRP guidelines recommend a 30- to 60-second delay in clamping in all term and preterm infants not requiring resuscitation. – …
Cardiac Arrest in Pregnancy: An 2019 UPDATE
Sometimes we need a reminder and update on the basics… Your Welcome.. Cardiac arrest in pregnancy. SEMINARS IN PERINATOLOGY 42(2018)33–38. https://doi.org/10.1053/j.semperi.2017.11.007 MATERNAL PHYSIOLOGY – The maternal heart rate increases by 20–30% or 15–20 beats per minute – Cardiac output increases by 30–50% or 1.8 L per minute with the uterus receiving approximately 17% of maternal cardiac …
Fill the Tank or Rev’ the Engine… WHOA, PUMP the BRAKES: Early fixed dose norepi for septic shock?
We all know hypotension is bad. But should we fill with fluids or rev up the heart with pressors. This begs the question does early norepi help prevent hypotension and mortality? Today’s quick hit article: Permpikul C, et al. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER) : A Randomized Trial. Am J Respir Crit Care Med. 2019 Feb 1. doi: 10.1164/rccm.201806-1034OC. PMID 30704260. …
Lactate for Safely Screening Sepsis?
Fernando et. al. HELPFUL ONLY WHEN ELEVATED: INITIAL SERUM LACTATE IN STABLE EMERGENCY DEPARTMENT PATIENTS WITH SEPSIS IS SPECIFIC, BUT NOT SENSITIVE FOR FUTURE DETERIORATION Journal of Emergency Medicine, Vol. 54, No. 6, pp. 766–773. https://doi.org/10.1016/j.jemermed.2018.01.040 BOTTOM LINE: A lactate >4 in this prospective observational cohort study of almost 1000 patients with the “CMS” definition …
To B (VM) or Not to B (VM) THAT is the question!
Source: Casey et. al. Bag-Mask Ventilation during Tracheal Intubation of Critically Ill Adults. NEJM. February 18, 2019DOI: 10.1056/NEJMoa1812405 Whether ‘tis noble in the mind to suffer the slings and arrows of aspiration or by bagging end them? This is a great methodological (and probably landmark) trial by the impressive authors at Vanderbuilt et al. They have been …
SUP-ICU Trial: Pantoprazole in patients at risk for Gastrointestinal Bleeding
SUP-ICU Trial Kart, M. Pantoprazole in patients at risk for Gastrointestinal Bleeding in the ICU. N Engl J Med 2018;379:2199-208. Trial done in the UK. It was a multicenter, stratified, parallel group, placebo controlled blinded randomized trial. Included pts admitted to the ICU who were 18 yo or older and had at least one risk …
HYPONATREMIA 2.0
HYPONATREMIA PART I – TREATMENT RECOMMENDATIONS IN CASE OF HEMODYNAMIC INSTABILITY, THE NEED FOR RAPID FLUID RESUSCITATION OVERRIDES THE RISK OF AN OVERLY RAPID INCREASE IN SERUM SODIUM CONCENTRATION. TREATMENT GOALS: An increase by 4-6-mmol/L [Na] is sufficient to reverse most serious manifestations of acute hyponatremia. Increase [Na] no more than 10 mEq/L in 24 hour …