EM Journal Update Journal Reviews

Tenecteplase vs Alteplase Before Endovascular Therapy for Ischemic Stroke (EXTEND-IA TNK)

This review is cross-posted on REBEL EM.

Alteplase is a tissue plasminogen activator that is approved for use prior to thrombectomy in ischemic strokes with the goal of reperfusion to ischemic areas of the brain. Tenecteplase is a recombinant enzyme derived from alteplase that is more specific to fibrin and more resistant to inactivation by alteplase inhibitors.
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Succinylcholine vs. Rocuronium for 1st Pass Success Rate

This post was also featured on REBEL EM.

Administration of a neuromuscular blocker (NMB) is an essential part of Emergency Department  (ED) airway management for facilitating ideal airway conditions and is most commonly performed with either succinylcholine or rocuronium. Despite extensive debates between providers, one agent has not been shown to be superior to other.
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Tags: , , May 31st, 2018 Leave a Comment

Corticosteroids in Pharyngitis – Systematic Review + Meta-Analysis

Sore throat is among the most common complaints in the emergency department (ED). Sometimes, the etiology is bacterial, and in those cases antibiotics may shorten the duration of disease and provide symptomatic relief. The majority of cases are viral and though most are appropriately treated with symptom management in the forms of NSAIDS and acetaminophen,
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Balanced Solutions vs 0.9% Saline in Critical Care (SMART)

Although 0.9% sodium chloride (“normal” saline) is traditionally the most commonly used intravenous fluid, it is unclear if “normal” saline is the best fluid. Data from prior studies suggests 0.9% saline use may result in hyperchloremic acidosis. Additionally, 0.9% saline is associated with the development of acute kidney injury (AKI). There have been several observational studies and a before-and-after trial comparing 0.9% saline and “balanced” crystalloids like lactated Ringer’s and Plasma-Ltye A,
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The VAN Assessment to Identify Large Vessel Occlusion Strokes

This review is cross-posted on REBEL EM.

Over the last three years, we have seen the rise of neurointerventional therapies for patients with ischemic strokes due to large vessel occlusions (LVOs). This group of strokes typically includes patients with occlusion of the distal intracranial carotid artery, middle cerebral artery or anterior cerebral artery.
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May 10th, 2018 Leave a Comment

SALT-ED: Balanced Solutions vs 0.9% Saline in the ED

Intravenous fluid administration is a staple of modern medical care. The advantage of crystalloid over colloid solutions is well established in the literature. However, few studies have examined differences in outcomes between “normal” saline solution (0.9% NaCl) and more “balanced” solutions such a Ringer’s Lactate or Plasma-Lyte A, which seek to more closely replicate “physiologic” conditions.
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ADRENAL – Corticosteroids in Septic Shock

During physiological stress, hypotension, or severe infection, the hypothalamic-pituitary-adrenal (HPA) axis is activated. The hypothalamus secretes corticotrophin-releasing hormone (CRH) stimulating the release of adrenocorticotrophin hormone (ACTH) from the anterior pituitary. This results in cortisol secretion from the adrenal glands, and as a result, serum cortisol increases.

Endogenous cortisol is thought to have many benefits in physiologic stress1.
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Tags: , , April 26th, 2018 Leave a Comment

The HEAVEN Difficult Airway Prediction Tool

This review was previously posted on REBEL EM here.

Predicting an anatomically and/or physiologically challenging airway is not a straightforward task by any stretch of the imagination.  There are some existing difficult-airway prediction tools available (i.e. LEMON = Look externally, Evaluate 3-3-2 rule, Mallampati score, Obstruction, Neck mobility), but many of them were derived in an elective surgery setting and may not be as applicable to emergency airway management. 
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