The American journal of emergency medicine
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Review Meta Analysis
Optimal wrist positioning for radial arterial cannulation in adults: A systematic review and meta-analysis.
Wrist extension is commonly taught as part of the radial artery cannulation technique. Currently the degree of wrist extension required to optimize cannulation success remains inconclusive. This is the first meta-analysis to investigate optimal wrist positioning for radial artery cannulation. ⋯ This review found moderate evidence in support of a 45° wrist angulation to facilitate arterial cannulation, however the results are largely limited by the external validity of the data collected given the restrictive populations studied. Any further studies investigating the effect of altering wrist angulation on radial artery cannulation should focus on populations who are either likely to require arterial cannulation or predisposed to difficult access.
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This review aimed to analyze published literature to introduce the use and implementation of standard operating procedures (SOPs) and checklists in prehospital emergency medicine and their impact on guideline adherence and patient outcome. ⋯ The use and implementation of SOPs and checklists in prehospital emergency medicine have shown some benefits of improving guidelines adherence and patient outcomes in airway management, patient records, identification and triage, and other prehospital interventions. More research in this area is necessary to optimize the future use and implementation of SOPs and checklists to improve emergency personnel performance and patient outcomes.
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Dehydration is associated with acute ischemic stroke. However, the relationship between hydration therapy given during acute ischemic stroke and clinical outcomes remains unclear. ⋯ Blood urea nitrogen/Cr ratio-based saline hydration therapy in patients with acute ischemic stroke significantly increased the rate of favorable clinical outcome with functional independence at 3 months after stroke.
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Delay in appropriate antibiotic therapy is associated with an increase in mortality and prolonged length of stay. Automatic dispensing machines decrease the delivery time of intravenous (IV) antibiotics to patients in the emergency department (ED). However, when IV antibiotics are not reviewed by pharmacists before being administered, patients are at risk for receiving inappropriate antibiotic therapy. The objective of this study was to determine if a difference exists in the time to administration of appropriate antibiotic therapy before and after implementation of prospective verification of antibiotics in the ED. ⋯ Prompt administration of the appropriate antibiotics is imperative in patients with infections presenting to the ED. The impact of prospective verification of antibiotics by pharmacists led to significant improvement on both empiric selection of and time to appropriate antibiotic therapy.