Brown RM, Wang L, Coston TD , Krishnan NI et el published a secondary analysis of patients from SMART (Isotonic Solutions and Major Adverse Renal Events Trial) admitted with sepsis to ICU. Original smart trial was published in 2017, which is discussed here . A total of 15,802 patients were enrolled in the trial. It was a pragmatic, cluster-level … Read more Balanced crystalloids are gaining ground in sepsis?
American Heart Association published focused update on Advanced Cardiac Life Support in conjunction with 2019 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendation from International liaison committee on resuscitation(ILCOR). This focus update provide new recommendations for use of advanced airways, vasopressors and extracorporeal CPR( ECPR). Rest of the guidelines remain … Read more 2019 Focused update on Advanced cardiac life support
J.B. Lascarrou, H. Merdji, A. Le Gouge et el published the results of HYPERION (Hypothermia after Cardiac Arrest in Nonshockable Rhythm) trial in NEJM. WHAT Open-label, randomized, controlled trial comparing moderate therapeutic hypothermia (33°C during the first 24 hours) with targeted normothermia (37°C) in adult patients with coma(GCS <8) after resuscitation from cardiac arrest with … Read more Targeted Temperature Management in Cardiac Arrest with Nonshockable Rhythm
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 … Read more Intraosseous Access is associated with lower survival in out of hospital cardiac arrest
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 … Read more Plasma as pre hospital resuscitation in trauma 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 … Read more Relief Trial : Liberal fluids (?) in abdominal surgical patients
Securing airway in setting of massive vomiting or bleeding can be challanging and following a proper algorithm can save life. Dr. James DuCanto has been a pioneer in developing SALAD algorithm( Suction-Assisted Laryngoscopy Assisted Decontamination System). This video by him shows how to do it perfectly….
Patel KK, Spertus JA , Khariton Y et el published in Circulation a retrospective study of patients of in hospital cardiac arrest looking at timing of Epinephrine in PEA arrest and defibrillation in shockable rhythm. They looked at the data for 36,961 patients aged ≥65 years with an IHCA at 517 hospitals between 2000 and 2011. (National … Read more Early epinephrine and defibrillation save lives
The FDA approved angiotensin-II (Giapreza) as a new intravenous vasopressor for septic shock and other forms of distributive shock. The first new FDA-approved vasopressor in decades. This is based on recent trial, which was discussed here. https://wp.me/padfoC-7C
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 … Read more Elusive answer : Balanced fluids vs saline in critical care
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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 … Read more Timing of intubation for in hospital cardiac arrest ?