The American journal of emergency medicine
-
This study aims to provide a comprehensive review of the current evidence on accurate and rapid diagnostic methods, effective and safe shoulder dislocation reduction techniques, pharmacological treatment, and post-reduction care for acute anterior shoulder dislocation in the emergency department (ED). ⋯ Emergency physicians managing anterior shoulder dislocation should employ POCUS for diagnosis, prioritize intra-articular anesthesia, master various reduction techniques including the FARES method, refer patients to an orthopedic surgeon for follow-up and potential surgery to prevent redislocation, and be vigilant about nerve damage.
-
Randomized Controlled Trial Comparative Study
A high-flow nasal cannula versus noninvasive ventilation in acute exacerbations of chronic obstructive pulmonary disease.
We investigated the efficacy and safety of a high-flow nasal cannula (HFNC) at different flow rates compared to noninvasive ventilation (NIV) in patients with acute chronic obstructive pulmonary disease (COPD) exacerbations. ⋯ HFNC was not inferior to NIV in improving arterial blood gas parameters, particularly PaCO2 in patients with COPD exacerbations, especially those with hypercarbia. Moreover, HFNC at a flow rate of 30 L/min was superior to NIV for reducing PaCO2 levels at 60 min.
-
Meta Analysis
What's the optimal temperature control strategy in patients receiving ECPR after cardiac arrest? A network meta-analysis.
The optimal temperature control strategy in extracorporeal cardiopulmonary resuscitation (ECPR) patients is unknown, and several trials have reported conflicting results regarding its effectiveness. We aimed to conduct a systemic review and network meta-analysis (NMA) to assess the efficacy of temperature control in ECPR patients. ⋯ Direct evidence suggests that moderate hypothermia might be associated with improved neurological outcomes in ECPR patients. However, no significant differences in survival outcomes were observed in either the direct or NMA results. Given the lower level of the evidence, interpretation should be made with caution.
-
Randomized Controlled Trial Comparative Study
Handheld ultrasound versus standard machines for placement of peripheral IV catheters: A randomized, non-inferiority study.
Ultrasound guided IV catheter (USGIV) access occurs frequently in Emergency Departments (EDs). This task is often performed using large, expensive, cart-based ultrasound systems (CBUS) which are frequently needed for other ED ultrasound functions and can be cumbersome to use and store. Handheld ultrasounds (HHUs) may be able to meet this need, but it is unknown if they function interchangeably with CBUS for USGIV placement. We performed a prospective, randomized, noninferiority study to compare the success rate of HHUs to CBUSs for placing USGIVs. ⋯ HHU was noninferior to CBUS for successful USGIV placement. There was no difference in the rate of first attempt success at placement or USGIV survival to a patient's ED disposition between groups. No significant additional training was required for ED providers of all levels to use the HHUs.