Resuscitation
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Review Meta Analysis
Should a benzodiazepine antagonist be used in unconscious patients presenting to the emergency department?
Patients in coma with suspected drug poisoning are commonly encountered in the emergency department. Benzodiazepines are one of the most commonly used drugs in self-poisoning. Flumazenil, a benzodiazepine antagonist has been suggested as a diagnostic and treatment tool in suspected poisoning of unclear cause, but caution is required due to potential side effects. No systemic review of this literature has been done on this topic. ⋯ Current evidence shows that flumazenil may be effective in the reversal of coma in patients presenting to the emergency department with coma from suspected drug poisoning.
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Following the publication of the Leuven Intensive Insulin Therapy (IIT) study in 2001, tight glycemic control has become regarded as the standard of care in intensive care units throughout the world. The Leuven IIT study, was however, an unblinded, single center study with unique patient and institutional characteristics that may not extrapolate to practice elsewhere in the world. Indeed, recent randomized controlled studies have been unable to demonstrate any benefit from tight glucemic control. We suggest that the widespread adoption of tight glycemic control be abandoned at this time.
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Review
Drug administration in animal studies of cardiac arrest does not reflect human clinical experience.
To date, there is no evidence showing a benefit from any advanced cardiac life support (ACLS) medication in out-of-hospital cardiac arrest (OOHCA), despite animal data to the contrary. One explanation may be a difference in the time to first drug administration. Our previous work has shown the mean time to first drug administration in clinical trials is 19.4min. We hypothesized that the average time to drug administration in large animal experiments occurs earlier than in OOHCA clinical trials. ⋯ Shorter drug delivery time in animal models of cardiac arrest may be one reason for the failure of animal studies to translate successfully into the clinical arena.