ACORN RCT – Piperacillin-Tazobactam or Cefepime?
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In this randomized control trial of patients receiving cefepime or piperacillin-tazobactam, there was no difference in risk of acute kidney injury between the two groups. However, those who received cefepime were more likely to have neurologic side effects.
Source
Cefepime vs Piperacillin-Tazobactam in Adults Hospitalized With Acute Infection: The ACORN Randomized Clinical Trial. JAMA. 2023 Oct 14:e2320583. doi: 10.1001/jama.2023.20583. Online ahead of print.
AHA Guideline | 10 Tips Life-Threatening Toxicity From Poisoning
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Here are ten tips from the AHA for the next super-sick poisoned patient you encounter.
How Useful Is Lactate Clearance Anyway?
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Don’t hang your hat on lactate clearance to assess therapeutic response to resuscitation in sepsis; there are too many confounders, and initial clearance does not necessarily project clinical course.
Source
Initial Lactate Clearance Is Confounded Highly by Comorbidities and Poorly Predicts Subsequent Lactate Trajectory. Chest. 2023 Sep;164(3):667-669. doi: 10.1016/j.chest.2023.04.023. Epub 2023 Apr 20.
Hot Topics in RSI – Guidelines from The Society of Critical Care Medicine
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Positioning, preoxygenation, medication selection, and other questions surrounding emergent rapid sequence intubation (RSI) are addressed by an expert panel.
1-Plane, 2-Plane, X-plane? Ultrasound-Guided Central Lines
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In a small, randomized trial, placing an ultrasound-guided central venous catheter (CVC) using 2 planes simultaneously was more likely to be successful on the first attempt and performed more quickly. Both groups had a 100% procedural success rate.
Peripheral Pressors Prevent Patient Pokes
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This prospective observational cohort study found implementing a protocol for peripheral norepinephrine (NE) decreased median number of central venous catheter (CVC) days per patient by one, and 51.6% avoided a CVC entirely.
Source
Peripheral administration of norepinephrine: a prospective observational study. Chest, S0012-3692(23)05350-3. 21 Aug. 2023, doi:10.1016/j.chest.2023.08.019
How to Manage Blast Injuries
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Blast injuries combine common polytrauma mechanisms - blunt, penetrating, burns - with the unique pathophysiology of blast wave injuries, and mass casualty scenarios. While rare, these patients are resource-intensive, prone to delayed yet rapid clinical deterioration, and carry high morbidity and mortality.
Source
High risk and low prevalence diseases: Blast injuries. Am J Emerg Med. 2023 Aug;70:46-56. doi: 10.1016/j.ajem.2023.05.003. Epub 2023 May 5.
Do We Need to Reconsider the Word… Need?
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Need in medicine describes what is missing and the necessary corrective action (i.e. you need a transfusion), but this wording allows little latitude for discussion with patients and families. However, saying, "Can we talk about what this means and what to do next?" allows for dialogue without presuming the desired course of action.
Source
Reconsidering the Language of Serious Illness. JAMA. 2023 Aug 15;330(7):587-588. doi: 10.1001/jama.2023.11409.
Does Low Dose Ketamine or Etomidate Prevent Post-Induction Hypotension in Unstable Patients?
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There is no association between the weight-based drug dose of etomidate or ketamine and post-intubation hypotension.
Source
Sedative Dose for Rapid Sequence Intubation and Postintubation Hypotension: Is There an Association? Ann Emerg Med. 2023 Jun 30;S0196-0644(23)00379-7. doi: 10.1016/j.annemergmed.2023.05.014. Online ahead of print.
Can We Draw Blood Cultures from an Arterial Line?
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In this multicenter prospective diagnostic study, the proportion of contaminated blood cultures obtained from arterial catheters was noninferior to blood cultures obtained via venipuncture.
Source
Contamination of Blood Cultures From Arterial Catheters and Peripheral Venipuncture in Critically Ill Patients: A Prospective Multicenter Diagnostic Study. Chest. 2023 Jul;164(1):90-100. doi: 10.1016/j.chest.2023.01.030. Epub 2023 Jan 30.