Exploration of bag size in Resus, GTN dose for SCAPE, button battery honey fixes, and pondering if pregnancy is a disease. Also, discussions on nitroglycerin dosing, contact precautions, button battery injuries, nebulized ketamine, ventilation bags, redefining diseases, and chair placement impact on patient satisfaction.
Bag size affects ROSC rates in out-of-hospital cardiac arrests.
Nebulized ketamine is non-inferior to IV morphine for acute musculoskeletal pain.
Evidence-based practices improve treatment of acute hyperkalemia in the ED.
High-dose nitroglycerin shows potential benefits in managing hypertensive pulmonary edema.
Deep dives
Smaller Ventilation Bags and Return of Spontaneous Circulation
The Seattle paramedic EMS fire department shifted from a standard 1500 ml Ambu bag to a smaller 1000 ml bag in 2017 for out-of-hospital cardiac arrests. Contrary to expectations, using smaller bags resulted in lower rates of return of spontaneous circulation (ROSC) at 33% compared to 40% with standard bags, a statistically significant difference. This outcome was unexpected as smaller bags are typically associated with better outcomes in resuscitation scenarios.
Nebulized Ketamine for MSK Pain in Older Adults
A non-inferiority randomized control trial compared nebulized ketamine to intravenous morphine for elderly patients with acute musculoskeletal pain in the emergency department. The trial, aiming to avoid opioids, found that nebulized ketamine was non-inferior to IV morphine for pain relief. However, the clinical importance of this finding is questioned as the endpoints focused on pain scores reduction rather than long-term pain management strategies, emphasizing the potential limitations of nebulized ketamine in this patient population.
Dispelling Myths and Misconceptions about Hyperkalemia Treatment
A comprehensive review dispels common myths regarding the treatment of acute hyperkalemia in the emergency department. The paper highlights the ineffectiveness of K-exolate or Rosonium, the lack of necessity for giving lactated ringers in hypokalemia cases, the limited predictive utility of ECG changes in hypokalemia, and the selective use of calcium in hyperkalemia management. The emphasis is on evidence-based practices to improve hyperkalemia treatment strategies.
Comparing High-Dose Nitroglycerin in Hypertensive Pulmonary Edema
A single-center unblinded trial compared high-dose intravenous nitroglycerin to low-dose nitroglycerin in the treatment of hypertensive flash pulmonary edema. The trial showed dramatic differences in outcomes, with high-dose nitroglycerin significantly improving patient conditions compared to low-dose. Despite some trial limitations, the results suggest the potential benefits of high-dose nitroglycerin in managing hypertensive pulmonary edema episodes.
Impact of Bag Size on Ventilation in Advanced Airway Patients
Using smaller bags for bag valve mask ventilation in advanced airway patients may not support optimal ventilation outcomes. The decision to exclude all patients in the research except those with advanced airways may limit the generalizability of the findings. The study raises questions about the effectiveness of smaller bags in resuscitation scenarios and highlights the importance of considering outcomes for all patients.
Periphery of Norepinephrine and Disease Definition
A study on peripheral norepinephrine administration challenges conventional practices, indicating safety and effectiveness outside central lines. The debate on whether pregnancy should be considered a disease prompts reflection on complex definitions of health and illness. The discussion delves into the subjectivity and implications of defining disease, emphasizing the need for nuanced perspectives in medical ethics and practice.
Hospital Chair Placement and Patient Satisfaction
A randomized deception trial on chair placement in patient rooms reveals a significant impact on physician-patient interactions. Study findings suggest that visible chairs in rooms enhance doctor-patient communication and overall patient satisfaction. The study underscores the importance of hospital room design in facilitating effective patient care and highlights the need for optimizing spaces to promote quality interactions between healthcare providers and patients.
In this episode we look at bag size in Resus, GTN dose for SCAPE (O), button battery honey fixes and ask the question: is pregnancy a disease? There is a ton of other topics to make you tink about what we do in the ED..
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