The American journal of emergency medicine
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Randomized Controlled Trial Multicenter Study
Emergency physician performed ultrasound-assisted lumbar puncture in children: A randomized controlled trial.
Lumbar puncture (LP) is one of the most common procedures performed in pediatric emergency departments but first-attempt success rates remain low and traumatic LP remains frequent. The aim of this study was to determine if ultrasound performed by emergency physicians improves the probability of first-attempt success for lumbar puncture in children. ⋯ Our study does not support the routine use of ultrasound for performing lumbar puncture in children. Considering the minimal harm and ease of performance, ultrasound may be used as an adjunct and teaching tool in certain clinical situations.
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Randomized Controlled Trial
Innovation in resuscitation: A novel clinical decision display system for advanced cardiac life support.
The Advanced Cardiac Life Support (ACLS) Clinical Decision Display System (CDDS) is a novel application designed to optimize team organization and facilitate decision-making during ACLS resuscitations. We hypothesized that resuscitation teams would more consistently adhere to ACLS guideline time intervals in simulated resuscitation scenarios with the CDDS compared to without. ⋯ This study demonstrates that the CDDS improves the accuracy and precision of timed ACLS interventions in a simulated setting. Resuscitation teams were strongly in favor of utilizing the CDDS in clinical practice. Further investigations of the introduction of the platform into real time clinical environments will be needed to assess true efficacy and patient outcomes.
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Multicenter Study
Surviving traumatic cardiac arrest: Identification of factors associated with survival.
The endpoint of resuscitative interventions after traumatic injury resulting in cardiopulmonary arrest varies across institutions and even among providers. The purpose of this study was to examine survival characteristics in patients suffering torso trauma with no recorded vital signs (VS) in the emergency department (ED). ⋯ Over a recent nine-year period in the United States, nearly 25,000 trauma patients were treated at trauma centers despite lack of VS. Of these patients, only 73 were discharged home. A trauma center would have to attempt over one hundred resuscitations of traumatic arrests to save one patient, confirming previous reports that highlight a grave prognosis. This creates a dilemma in treatment for front line workers and physicians with resource utilization and consideration of safety of exposure, particularly in the face of COVID-19.
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Helicopter medical transport of prisoner patients has unique logistical and medical challenges, as well as potential risks to healthcare providers. Prisoners have specific requirements for safe transport, and it is of paramount importance to know the variables related to transport related mortality since most prisoners that need air evacuation are critically ill. Because we understand that there is a potentially dangerous nature of transport of this population, and because of the unique nature of them, we aimed to provide a detailed insight on predictors of outcome in prisoners who were injured as a result of trauma and that needed to be transported via air medical transport in Mexico City. ⋯ As dangerous and challenging as it may seem, air medical transport of prisoners by a police crew physician, may be safe and reliable, since no complications or safety events were observed.
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Meta Analysis
Effect of antiplatelet treatments on patients with COVID-19 infection: A systematic review and meta-analysis.
Despite the rationale that early anti-platelet would lower the risk of major organ dysfunction, the effectiveness of this approach remains controversial. Therefore, we perform a systematic review and meta-analysis to investigate the effect of antiplatelet treatments on patients with COVID-19 infection. An electronic search was carried out in Pubmed, Embase, Cochrane library, Web of Science, MEDLINE, Wanfang and China National Knowledge Infrastructure (CNKI). ⋯ The meta-analysis showed antiplatelet agents were not associated with higher risk of severe COVID-19 disease (OR = 0.98, 95%CI: 0.64 to 1.50, P = 0.94; I 2 = 65%), while an adjusted analysis indicated that antiplatelet agents was not associated with an increased risk of mortality (OR = 0.65, 95%CI: 0.40 to 1.06, P = 0.498; I 2 = 0%). The results of this study reveal that while there is no significant benefit on mortality demonstrated with the use of antiplatelet agents, the upper bound of the confidence interval suggests that there is unlikely to be a compelling risk of harm associated with this practice. The benefit and risk of the use of antiplatelet agents should be fully considered especially in the presence of thrombocytopenia status in patients with COVID-19.