Wake-Up Strokes Are Similar to All Other Ischemic Strokes

In a large population-based study, demographic characteristics, stroke risk factors, and outcomes were similar between patients with wake-up ischemic strokes and those with all other strokes.

Antibiotics Are Not Equal to Appendectomy for Appendicitis

The incidence of peritonitis at 30 days was higher in the antibiotic group than in the surgery group; 68% of patients treated with antibiotics did not require appendectomy.

Staff Education Improves Compliance with Pediatric Septic Shock Guidelines

Children with septic shock were identified and treated earlier after a staff education program was implemented at a single pediatric emergency department.

Ultrasound Better Than Landmark Guidance for Subclavian Vein Cannulation

In a direct comparison, ultrasound guidance was faster, more successful, and associated with fewer complications.

Ultrasound-guided procedures are becoming increasingly common in the emergency department, but do they improve outcomes? Investigators in Greece prospectively randomized 463 sedated and ventilated intensive care unit patients to undergo infraclavicular subclavian vein cannulation guided by real-time ultrasound or the landmark method; 62 patients in the landmark group were converted to the ultrasound group because of technical difficulties and were excluded.

Ultrasound-Guided Central Line Placement: No X-Ray Needed

No pneumothoraces were detected on chest x-ray in 1202 asymptomatic patients after ultrasound-guided central venous line placement.

Warming reduces pain, even when the anesthetic is buffered.

Injection of local anesthetics causes pain at the injection site before providing anesthesia. Postulated methods to mitigate this pain include slowing the rate of injection; avoiding epinephrine, when possible; buffering; and warming the local anesthetic to body temperature prior to injection. These authors assessed injection pain in a meta-analysis of 18 randomized studies involving 831 patients who received either warmed (body temperature) or unwarmed (room temperature) subcutaneous or intradermal local anesthetic injections. The anesthetic was unbuffered in ten studies.

Emergency Department Patients on Warfarin Often Have Nontherapeutic INRs

In a study at a single ED, 30% of patients who presented on warfarin were given or prescribed medications that could affect anticoagulation response or bleeding risk.

Does Use of an Impedance Threshold Device During CPR Make a Difference?

In a randomized study, the device provided no survival benefit during out-of-hospital cardiac arrest.

Obtaining only one electrocardiogram would have missed 15% of patients with STEMI in a single prehospital system.

Prehospital detection of acute ST-segment-elevation myocardial infarction (STEMI) facilitates transport of patients directly to percutaneous coronary intervention (PCI)-capable centers, and earlier detection lowers mortality. To assess whether performance of serial electrocardiograms (ECGs) improves detection of STEMI, researchers reviewed records for 325 consecutive patients with STEMI who were transported by the Toronto emergency medical services (EMS) system during 1 year.