Intraosseous Access is associated with lower survival in out of hospital cardiac arrest

Takahisa Kawano,  Brian Grunau,  Frank X. Scheuermeyer  et el published a study comparing  intraosseous versus intravenous vascular access on survival as well as neurological outcome in out of hospital cardiac arrest in Annals of emergency medicine. BACKGROUND Intraosseous access (IO) was first pioneered by Drinkler and colleagues in 1922 but it became popular as a substitute to …

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It is okay to abruptly stop steroids in resolving septic shock

Kristine A. Sobolewski , Alison Brophy , Yekaterina Opsha et el published a retrospective cohort study comparing abrupt withdrawal versus taper of hydrocortisone in resolving septic shock patients. BACKGROUND Severe sepsis and septic shock remains one of the most common diagnosis as well as cause of death in intensive care units around the world. Hydrocortisone has been shown to quicker …

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Laryngeal tube insertion in out of hospital cardiac arrest may save lives

Henry E.Wang, Robert H. Schmicker,  Mohamud R. Daya et el  published PART trial (Pragmatic Airway Resuscitation Trial) in which they compared laryngeal tube insertion with endotracheal intubation in out of hospital cardiac arrest.  BACKGROUND About 350000 adults in the United States suffer out of hospital cardiac arrest each year, with less than 10%surviving to hospital discharge.  More …

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No effect of early cycling exercise in ICU

Guillaume Fossat,  Florian Baudin,  Léa Courtes et el  published a trial of in-bed cycling exercises and electrical stimulation versus standard rehabilitation in critically ill patients.  BACKGROUND About half of patients admitted to Intensive care units experience muscle weakness and wasting which may persist for up to 5 years.  Factors contributing are inflammation, metabolic disorders, sedation and prolonged …

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Plasma as pre hospital resuscitation in trauma patients

J.L. Sperry, F.X. Guyette, J.B. Brown, M.H. Yazer et el published a trial of plasma vs standard fluid resuscitation in trauma patients who were at risk of hemorrhagic shock while being transported by air medical services. BACKGROUND In hospital treatment of trauma involves “damage control resuscitation” which aims to prevent coagulopathy by minimization of the use of crystalloid-based …

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Epinephrine in Cardiac arrest : Saves lives but not brain

G.D. Perkins, C. Ji, C.D. Deakin, T. Quinn et el  published a trial of epinephrine in out of hospital cardiac arrest in NEJM ( PARAMEDIC2 Collaborators ). BACKGROUND Epinephrine  causes constriction of arterioles mediated by α-adrenergic receptors. Such constriction increases aortic diastolic pressure during CPR, thereby augmenting coronary blood flow and increasing the chance of a return of spontaneous circulation.  It …

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FDA approves Sodium Zirconium Cyclosilicate for Hyperkalemia

In May, 2018, FDA approved Sodium Zirconium Cyclosilicate (ZS-9) for treatment of hyperkalemia. This is available as Lokelma in USA, manufactured by AstraZeneca. This is the third drug in the category of Gastrointestinal cation exchangers for treatment of hyperkalemia. Earlier two drugs are sodium polystyrene sulfonate(Kayexalate, approved in 1958) and patiromer(Approved in 2015). Its efficacy …

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Flexible Versus Restrictive Visiting Policies in ICUs

Antonio Paulo Nassar Junior, Bruno Adler Maccagnan Pinheiro Besen et el published a meta analysis and systematic review in critical care medicine about restrictive and flexible visiting policies in ICUs.  BACKGROUND Most ICUs worldwide place restrictions on visiting patients due to fear of infection, disorganization of care and increased workload on staff. Liberal visiting hours have …

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Norepinephrine better than Terlipressin in Septic Shock

Liu ZM, Chen J, Kou Q et el published results of a randomized trial in intensive care medicine comparing Terlipressin with Norepinephrine in septic shock. BACKGROUND Norepinephrine (NE) is first line recommended agent for correcting hypotension in septic shock. Terlipressin is a synthetic long acting analogue of Vasopressin which has higher affinity for V1 receptor. …

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