Fri.Apr 19, 2024

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The Evolution Of Penetrating Neck Trauma Management – Part 2: Initial Steps

The Trauma Pro

In my previous post, I described the early days of penetrating neck injury management and introduced a paper suggesting that this concept should be revised. Today, I will summarize a paper by Siletz and Inaba that is currently in press and outlines what the contemporary way of treating these injuries should be. Step 1. If present, rapidly control external hemorrhage and airway compromise.

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R-A-C-E session at RCEM CPD conference. St Emlyn’s

St. Emlyn

St.Emlyn's - Emergency Medicine #FOAMed This was a really powerful session that took us on a journey from the past, to the present and left us with a feeling of hope for the future. I’ll […] The post R-A-C-E session at RCEM CPD conference. St Emlyn’s appeared first on St.Emlyn's.

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Dr. John Ioannidis: “The Biggest Mistakes I am Sure Are Mine.”

Science Based Medicine

Part 3: Dr. John Ioannidis said his biggest mistake was the he "underestimated how much power politics and media and powers outside of science, could have on science." Really? The post Dr. John Ioannidis: “The Biggest Mistakes I am Sure Are Mine.” first appeared on Science-Based Medicine.

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NICO – Noninvasive Airway Management of Comatose Patients with Acute Poisoning

The Bottom Line

Effect of Noninvasive Airway Management of Comatose Patients with Acute Poisoning: A Randomized Clinical Trial Freund Y. JAMA. 2023. DOI: 10.1001/jama.2023.24391 Clinical Question In adults with a decreased conscious level from suspected acute poisoning, does withholding intubation versus routine practice reduce in-hospital death, and length of ICU stay and hospital stays?

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Extracorporeal membrane oxygenation (ECMO) for cardiogenic shock after MI (ECLS-SHOCK trial)

PulmCCM

When patients with massive myocardial infarctions develop cardiogenic shock, it’s a terrible sign. Even if they undergo rapid revascularization of the culprit lesion(s) with percutaneous coronary intervention (PCI) with stent placement, as many as half die within a month. Many of the rest are left with significant disability.

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Rebaked Morsel: Pediatric Buckle and Greenstick Forearm Fractures

Pediatric EM Morsels

Trauma season is at hand and like all other pediatric emergency departments in the country, we find our ED breaking ( pun intended ) at the seams with orthopedic injuries. We see all different flavors of upper extremity injuries. Yes, we’re talking about your clavicular , proximal humeral, supracondylar, lateral condylar , scaphoid and metacarpal fractures.

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Immediate extubation vs. gradual ventilator weaning in comfort care

PulmCCM

No good data exist to guide the process of withdrawal of invasive mechanical ventilation just prior to the end of life–variously known as “terminal extubation,” “compassionate withdrawal,” “extubation to comfort care,” et al.

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Systematic decolonization of nursing home patients reduced hospitalizations and infections (SHIELD-OC)

PulmCCM

About half of nursing home residents and 80% of patients in long term acute care hospital (LTACH) patients are colonized with multidrug resistant organisms (MDROs). The rate is 10-15% in most acute care hospitals.

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How safe is early mobilization in the ICU?

PulmCCM

Providing physical therapy early in the ICU is a recommended practice that appears to prevent ICU-related weakness at the time of discharge, based on limited evidence. Any longer-term benefits remain unknown, due to a paucity of research. “Early mobilization” has no standard definition, but can include ambulating patients on ventilators or even ECMO.

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Higher vs. lower oxygenation targets in Covid-19 (HOT-COVID trial)

PulmCCM

Published in January 2021, the HOT-ICU trial found no difference in mortality (42.9% vs 42.4%) among 2928 hypoxemic patients in European ICUs receiving at least 10L/min oxygen, regardless of whether they were randomized to a high (PaO2 90 mmHg) or low (PaO2 60 mmHg) oxygenation target.

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One in 33 central-line placements results in major complications?

PulmCCM

A new paper in JAMA Internal Medicine overstates the risks of central venous catheter placements, asserting that 3% of CVC placements result in either arterial puncture, pneumothorax, bloodstream infection, or deep venous thrombosis, within 3 days. Let’s take a look at the methods they used to arrive at this surprising finding.

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Extracorporeal CO2 removal for COPD exacerbations (VENT-AVOID trial)

PulmCCM

Extracorporeal membrane oxygenation (ECMO) is a sometimes life-saving technology for acute respiratory or cardiac failure. ECMO remains primarily a rescue or bridging therapy, but as the technology has evolved, potential new applications continue to be tested.

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Ceftriaxone for all vented brain injured patients? (PROPHY-VAP)

PulmCCM

Patients with strokes and traumatic brain injuries who require mechanical ventilation due to coma are at very high risk for developing ventilator associated pneumonia. Prophylactic antibiotics, given enterally or intravenously, have been shown to reduce the rate of VAP, but with unproven clinically meaningful benefits like survival.

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Are midline catheters or PICCs safer? A randomized trial

PulmCCM

Midline catheters are long (8 to 20 cm) peripherally inserted lines that terminate in or just distal to the axillary vein. They’re shorter than peripherally inserted central catheters (PICCs), which usually terminate in the superior vena cava. Midlines have become widely adopted, but there's been very little quality data to guide their use.

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Machine learning to individualize oxygenation targets during mechanical ventilation

PulmCCM

Multiple randomized trials in heterogeneous patients requiring mechanical ventilation have not shown any benefit from any particular oxygenation target (higher vs. lower).

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Adding anticoagulation to thrombolytics for acute ischemic stroke (MOST trial)

PulmCCM

There were lingering hopes that for patients with ischemic stroke, adding parenteral anticoagulation after thrombolytic therapy might improve outcomes.

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Intensive blood glucose control in the ICU is not helpful (TGC-FAST trial)

PulmCCM

Hyperglycemia is associated with worse outcomes in the ICU (and in medical patients generally), so correcting it must improve outcomes … right?