Emergency medicine journal : EMJ
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Randomized Controlled Trial Multicenter Study
Balanced crystalloids (RInger's lactate) versus normal Saline in adults with diabetic Ketoacidosis in the Emergency Department (BRISK-ED): a pilot randomised controlled trial.
Current diabetic ketoacidosis (DKA) treatment guidelines recommend using normal saline (NS); however, NS may delay DKA resolution by causing more hyperchloremic metabolic acidosis compared with balanced crystalloids. This study's objective was to determine the feasibility of a future multicentred randomised controlled trial (RCT) comparing intravenous Ringer's lactate (RL) with NS in managing ED patients with DKA. ⋯ This pilot trial demonstrated our protocol's feasibility by exceeding our target recruitment rate. Our results may be used to inform future multicentre trials to compare the safety and efficacy of RL and NS in managing DKA in the ED.
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Review
RCEM best practice guideline: suspected cannabinoid hyperemesis syndrome in emergency departments.
Cannabinoid hyperemesis syndrome (CHS) is an episodic syndrome of cyclic vomiting in the context of the prolonged use of cannabis. The Royal College of Emergency Medicine Toxicology Special Interest Group has produced guidance to support emergency medicine clinicians with the recognition and treatment of people experiencing CHS. Considerations regarding recognition, investigation and communication are discussed, and recommendations regarding treatment options (which include haloperidol and capsaicin) are made. There is a focus on making recommendations on the best available evidence.
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Randomized Controlled Trial Comparative Study
Airtraq optical laryngoscope: tracheal intubation by novice laryngoscopists.
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Right ventricular (RV) dysfunction is the main cause of death in patients with normotensive acute pulmonary embolism (PE). The optimal management for this subset of patients remains uncertain. This systematic review and meta-analysis focused on the comparison of diuretics and fluid expansion in patients with acute PE presenting with RV dysfunction and haemodynamic stability. ⋯ Very few studies have compared the efficacy and safety of diuretics and fluid expansion in normotensive patients with acute PE with RV failure. Overall, furosemide appears to reduce RV dysfunction in this subset of patients compared with fluid expansion. Further research is required to confirm these findings.
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Multicenter Study
Derivation and validation of a risk-stratification model for patients with probable or proven COVID-19 in EDs: the revised HOME-CoV score.
The HOME-CoV (Hospitalisation or Outpatient ManagEment of patients with SARS-CoV-2 infection) score is a validated list of uniquely clinical criteria indicating which patients with probable or proven COVID-19 can be treated at home. The aim of this study was to optimise the score to improve its ability to discriminate between patients who do and do not need admission. ⋯ The revised HOME-CoV score, which does not require laboratory testing, may allow accurate risk stratification and safely qualify a significant proportion of patients with probable or proven COVID-19 for home treatment.