Defibrillating the Data

CONCLUSION: The 60-min HACOR score discriminates HFNO failure well, with no evidence of miscalibration, in an unselected ED cohort, substantially outperforming the admission score. The >5 threshold remains the reference for ruling out failure; the ≥8 threshold derived here is exploratory and requires prospective validation.

This clinical policy from the American College of Emergency Physicians addresses key issues related to direct oral anticoagulants in adults presenting to the emergency department. A writing committee conducted a systematic review of the literature to derive evidence-based recommendations to answer the following clinical question: In adult emergency department or intensive care unit patients on direct oral anticoagulants with acute major symptomatic bleeding, does using an agent-specific antidote compared with...

Contemporary practice incorporates refined indications, clearer survival windows, improved understanding of traumatic pathophysiology and enhanced operational, human factors and safety considerations. It integrates current international guideline recommendations with two decades of operational experience, offering detailed procedural steps, troubleshooting strategies and pragmatic considerations for clinicians who may rarely perform the procedure. This guide aims to support safe, timely and effective...

Policy statements and clinical policies are the official policies of the American College of Emergency Physicians and, as such, are not subject to the same peer review process as articles appearing in the journal. Policy statements and clinical policies of ACEP do not necessarily reflect the policies and beliefs of Annals of Emergency Medicine and its editors.

Sperry JL, Guyette FX, Cotton BA, et al. Prehospital Resuscitation with Type O Whole Blood for Trauma and Hemorrhage.

The primary outcome was improvement in the VNRS score at 30 min. The secondary outcomes included the need for rescue therapy (intravenous fentanyl 0.5 µg/kg) and the incidence of adverse events. Conclusion PENG block is a highly effective and safe alternative to intravenous morphine for managing acute hip fracture pain, particularly in older adults.

Policy statements and clinical policies are the official policies of the American College of Emergency Physicians and, as such, are not subject to the same peer review process as articles appearing in the journal. Policy statements and clinical policies of ACEP do not necessarily reflect the policies and beliefs of Annals of Emergency Medicine and its editors.

Endovascular treatment of medium-vessel-occlusion strokes (ORIENTAL-MeVO) by Hu et al Topic: stroke Outcome rating: head turner Evidence for endovascular thrombectomy in medium-vessel occlusion stroke has been inconsistent, despite these occlusions accounting for 25%–40% of ischaemic strokes. Endovascular treatment in acute intracranial distal medium vessel occlusion stroke (ORIENTAL-MeVO) was an open-label, blinded-outcome RCT conducted at 48 centres in China. Adults treated within 24 hours of symptom onset with...

Guidance is required for UK prehospital care providers managing patients with suspected crush injury to minimise preventable morbidity and mortality. This consensus statement gives relevant and practicable recommendations following a structured evidence review and a consensus process. Differences between this and previous guidance reflect, in part, the context for which these recommendations are intended.

We are writing to make emergency physicians, trauma specialists, and emergency medical services (EMS) medical directors aware of a potential complication of a new device being marketed to out-of-hospital providers. The North American Rescue Simplified Pneumothorax Emergency Air Release (SPEAR) is a 3.75 inch (9.5 cm) 10-gauge catheter-over-needle device intended for blind placement anteriorly or laterally in patients with potential, although usually unconfirmed, pneumothorax. To decrease the risks, the...

PECARN's phase 3 STArT trial of intravenous arginine for sickle cell acute pain episodes was halted early for futility. The lesson is in the 61-hour spread in time to crisis resolution between children's hospitals, and in what the trial actually enrolled. The post Sickle Cell Acute Pain Episodes: Lessons Learned from the Prematurely Halted PECARN STArT Trial appeared first on ALiEM .

Non-survivors had a longer median NE time (98.5 min (IQR 60.0–131) vs 49.5 min (IQR 25.5–75.0), p Conclusion NE time was associated with the 28-day all-cause mortality in sepsis patients. Commencing NE therapy within the first 60 min following the onset of hypotension was associated with a reduced risk of 28-day all-cause mortality. Trial registration number TCTR20221103005.

I dive deep into member-submitted airway nightmares, breaking down how to manage petrified "airway concrete" and high-risk hypoxemia. Learn how to apply the CHOP criteria, avoid physiological arrest during induction in cardiogenic shock, and handle extreme metabolic acidosis. EMCrit Project by Scott Weingart, MD FCCM .

In patients with hip fractures, use of regional anaesthesia is recognised as a safe, effective and opiate-sparing analgesic strategy, but is it more effective? In our Editor’s choice, Sri-on and colleagues present their randomised trial examining pericapsular nerve group (PENG) blocks versus intravenous morphine for hip fractures. Their findings suggest that the PENG block is safer and more effective at providing earlier and longer-lasting analgesia.

St.Emlyn's - Emergency Medicine #FOAMed Manual pressure augmentation reduces transthoracic impedance during defibrillation, but does that translate into better outcomes? We review the AUGMENT-VA randomised trial and revisit our previous BestBET on this intervention. The post JC: Manual pressure augmentation during cardiac arrest: another lesson in physiology versus outcome appeared first on St.Emlyn's .

The advent of life-saving endovascular resuscitation techniques in both medical and traumatic disease, along with the inherent advantages of central arterial pressure monitoring in the severely haemodynamically compromised patient, mandates the prioritisation and deliberate practice of this procedure. CFA access facilitates central invasive arterial pressure monitoring as well as Seldinger-guided sheath insertion through which a number of resuscitation devices may be inserted further into the arterial system and...

Zhang and Guo1 for taking an interest in our article2 and for their thoughtful comments. Our manuscript assesses the association between accuracy of emergency department (ED) triage and timeliness of care. In a cohort of over 5.3 million encounters across 21 community EDs, we found that just over one-third of the sickest patients were undertriaged, and that undertriage of these critically ill patients was associated with delays in care (median 8 minutes) compared with correctly triaged high-acuity patients.

The PECARN PRoMPT BOLUS shows both normal saline and balanced crystalloids are safe and effective. The post Clinical Trial Probes Fluid Choice in Suspected Pediatric Septic Shock appeared first on ACEP Now .

Editor’s note: EMJ has partnered with the journals of multiple international emergency medicine societies to share from each a highlighted research study as selected by their editors. This edition will feature an abstract from each publication. Annals of Emergency Medicine Official Journal of the American College of Emergency Physicians Intranasal versus subcutaneous ketamine for the treatment of acute traumatic pain in the ED: a randomised clinical trial Randa Dhaoui, Cyrine Kouraichi, Marwa Toumia, Khaoula Bel...

We read with interest the recent article by Gutierrez and Brenner.1 Intermittent failure of the ECG machine to record is more likely the reason for the noted pauses. One would expect to see slight baseline quivering, as noted in the TP (baseline between a T wave and a P wave) segment in the rest of the ECG. The second clue noted best in V1 rhythm strip is the presence of a T wave (albeit deformed) prior to the inscribed second sinus beat without a preceding QRS complex.