This podcast delves into the significance of three key papers from June 2024. They discuss the prevalence of radiological abnormalities in first episode psychosis and the need for MRI in initial assessment. Additionally, they compare the effectiveness of physician gestalt vs. screening tools for predicting sepsis in critically ill patients. Lastly, they explore the impact of gastric distension on resuscitation outcomes post-cardiac arrest.
Neuroimaging is crucial in initial assessments of psychosis patients to detect intracranial abnormalities, supporting its significance in patient care.
Physician gestalt outperformed sepsis screening tools in quickly identifying sepsis, emphasizing the importance of early clinician assessment in emergency scenarios.
Deep dives
Prevalence of Neuro-Radiological Abnormalities in First Episode Psychosis
Investigations in psychiatric presentations like psychosis can be complicated. A systematic review found that 26.4% of patients with first episode psychosis had intracranial abnormalities, with 5.9% having clinically relevant ones. Neuroimaging is crucial, supporting its use in initial patient assessments.
Physician Gestalt vs. Screening Tools for Sepsis Prediction
In a study comparing physician gestalt and screening tools for sepsis prediction, physician gestalt outperformed the tools in identifying sepsis within 15 minutes of assessment. Gestalt had an area under the curve of 0.9, while screening tools ranged from 0.66 to 0.84, with no significant differences between them. This highlights the importance of early clinician assessment in emergency settings.
Effect of Gastric Insufflation on Return of Spontaneous Circulation in Cardiac Arrest
Gastric insufflation during CPR may not prevent ROSC according to a retrospective observational study. Median gastric volume post-resuscitation was 400 ml, with 1 liter for distended and 287 ml for non-distended cases. Although gastric distension didn't impact ROSC rates significantly, vigilance in ventilation technique is essential.
Conclusion
Three insightful papers discussed prevalence of neuro-radiological abnormalities in psychosis, superior performance of physician gestalt in sepsis prediction, and the impact of gastric insufflation on ROSC. These findings underscore the importance of thorough assessments and appropriate medical interventions for optimal patient outcomes in emergency situations.
We kick off this month looking at the work up of patients with a first episode of psychosis. With these patients there is a chance of a psychosis secondary to an underlying structural cause. Getting neuro-imaging to look for this prior to psychiatric assessment is tricky though, often with a need for sedation and then the subsequent delay for psychiatric assessment. Our first paper looks at the yield of positive scans for these patients and helps us to understand a bit more about the need for this.
Secondly; sepsis screening tools are commonplace in most emergency services and departments, but how do they compare against senior clinician gestalt?
Finally we look at the association of gastric distension in cardiac arrest and the rates of ROSC, should we be concentrating more on decompression of gastric volume intra-arrest?
Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!
Simon & Rob
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