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Showing posts from January, 2016

Acetaminophen for Fever in Critically Ill Patients with Suspected Infection

Methodology Score: 4/5                  Usefulness Score: 2/5
Young P, Saxena M, Bellomo R, et al. N Engl J Med. 2015 Oct 5. 
Abstract Link This multicentre, ICU RCT received a methodology score of 4/5 and 2/5 for usefulness. They concluded that early treatment of fever with acetaminophen in suspected or confirmed infection results in moderate reduction in temperature, but does not affect the number of ICU-free days which was a composite endpoint combining mortality and ICU length of stay. Also, there was no statistically significant difference between acetaminophen versus placebo with respect to 28d mortality, 90d mortality, or survival time to day 90. By: Dr. Gauri Ghate (Presented December 2015)



Epi Lesson: Adjustment of Confidence Intervals for Interim Analyses
Interim analyses are commonly planned in large studies. This can be useful, for example, to ensure patient safety (either by finding a significant benefit or harm early on), or as a cost saving measure by stopping the study early if…

What is Optimal Chest Compression Depth During Out-of-Hospital Cardiac Arrest Resuscitation of Adult Patients?

Methodology Score: 4/5 Usefulness Score:4/5
Stiell IG, Brown SP, Nichol G, et al. Circulation. 2014 Nov 25;130(22):1962-70
Full Article
This observational study found that an optimal CPR chest compression depth of 40 -  55 mm was strongly associated with improved survival to hospital discharge, although survival declines beyond this upper limit. The group agreed that this was a practice changing study that led to a change in the 2015 AHA Guidelines; there was also discussion about the utility of CPR feedback devices in the ED setting

LVAD's 101 !

Guest post by Dr. Shahbaz Syed

Have a crashing Left Ventricular Assist Device (LVAD) patient in your Emergency Department? Need some help? Want to challenge your residents? The following should help you in your bedside assessment and treatment of the critically ill LVAD patient.
For a thorough description of components, functionality and indications for LVAD's, check out EDECMO's blog post for an excellent LVAD overview. Below is a more in depth approach to the complications seen in LVAD patients, and what we can do for them in the emergency department. It goes without saying that one of the most important steps in the management of the LVAD patient is to contact their coordinator or surgeon immediately!


LVAD Complications and TreatmentsDevice MalfunctionEnsure that the controller is connected, driveline is in place and that the batteries are operational.One of the more common reasons for device malfunction is disconnection or battery malfunction/depletion. The controller will d…