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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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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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Relief Trial : Liberal fluids (?) in abdominal surgical patients

P.S. Myles, R. Bellomo, T. Corcoran et el published results of Relief trial (Restrictive versus Liberal Fluid Therapy in Major Abdominal Surgery) in New England Journal of Medicine. BACKGROUND Each year, 310 million surgeries happen world wide. These patients end up getting large amounts of intravenous fluids leading to fluid overload.  A study published in 2003, showed that fluid …

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Elusive answer : Balanced fluids vs saline in critical care

In a late breaking abstract in the CHEST meeting in Toronto, Matthew Semler, Wesley Self, Todd Rice et el presented finding of their SMART(The Isotonic Solutions and Major Adverse Renal Events Trial) trial. They reported that  total of 1,139 patients (14.3%) in the balanced crystalloid group experienced the primary outcome of MAKE30(Major Adverse Kidney Events within 30 …

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Timing of intubation for in hospital cardiac arrest ?

Traditional wisdom taught us to secure airway as soon as possible in case of cardiac arrest(at least in hospital arrest), though over the course of years, American hearth association have moved their focus from “ABC” (airway-breathing-circulation) to “CAB” (circulation-airway-breathing). AHA also suggested that if a trained individual is not present to secure airway, bag mask ventilation …

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Give that EPI early in non-shockable arrest in hospital cardiac arrest

Rohan Khera, Paul S. Chan published in circulation about timing of epinephrine in non-shockable cardiac arrest (in hospital) across 548 hospitals who participate in “get on with the guidelines” database. What they did They looked at 103,932 adult patients with non-shockable cardiac arrests from 2001 to 2014. 13,213 (12.7%) patients had delays to epinephrine (more than 5 …

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