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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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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Multicenter Study
Incidence and clinical features of intracranial hemorrhage causing out-of-hospital cardiac arrest: a multicenter retrospective study.
The general incidence of intracranial hemorrhage (ICH) as a cause of out-of-hospital cardiac arrest (OHCA) remains unclear, although the incidence of subarachnoid hemorrhage has been determined to be 4% to 18%. The main objectives of our study were to describe the incidence of ICH in OHCA and the different laboratory findings between ICH and non-ICH groups. ⋯ OHCA patients with confirmed ICH were identified in about 11% of cases after return of spontaneous circulation. Gender, age, higher glucose, and lower potassium and Po2 levels during CPR were associated with ICH.
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Comparative Study
Accuracy of rapid sequence intubation medication dosing in obese patients intubated in the ED.
There are limited data regarding appropriateness of sedative and paralytic dosing of obese patients undergoing rapid sequence intubation (RSI) in the emergency department. The goal of this study was to compare rates of appropriate succinylcholine and etomidate doses in obese and nonobese patients. ⋯ Obese patients were more likely to be underdosed during RSI compared with nonobese patients, whereas nonobese patients were more likely to be overdosed with RSI medications. Most obese and nonobese patients were inappropriately dosed with RSI medications, suggesting that physicians are not dosing these medications based on weight.