Underuse in poor countries and overuse in rich countries. bmj
” the vision of a world with equitable and universal access to quality healthcare also concerns caesarean section”.
While earlier is better, no benefit to prehospital administration of antibiotics in sepsis link
Similar findings found in the past for prehospital advanced airway management, and the ubiquitous use of oxygen for nonhypoxic patients seems to harm MI and stroke patients.
Fluid overload or excess positive balance in pediatric critical illness is associated with adverse outcomes – mortality, lung and kidney injury, length of stay. jama
While there are lots of caveats – observational, retrospective meta analysis, and association is not causation, the study joins the growing adult consensus that after aggressive early shock resuscitation, fluids should then be judiciously/conservatively administered and monitored.
APRV is an open lung concept that has been short on evidence. A single centre study that needs replication suggests dramatic fewer ventilation days in ARDS patients. It is at least worth considering. link
Some commentary here Bottomline
And if you’re new to it, a description of the parameters to set here
e-cigarettes’ effects need further research, but while they may increase transition to smoking in youths, they may also aid smoking cessation in adults. Either way, nicotine is addictive. link
Anti thyroid medications in the first trimester may increase congenital birth defects link
Interest in ketogenic diet for sustained weight loss link
Triple antiplatelet therapy in acute stroke doesn’t help and increases bleeding. Choose aspirin with dipyridamole, or clopidogrel alone.link
Seafood may help Alzheimer’s, despite the mercury concern link
Worsening anxiety-depressive symptoms a marker for preclinical Alzheimer’s link
Paintball, BB and pellet guns pose eye injury danger to kids. Who’d have guessed? NYtimes link
Extended release Naltrexone and Suboxone equally effective in preventing opioid relapse (but 28% of Nal group relapsed waiting to detox until Naltrexone could be started) jama link
A troubling 1 in 3 women don’t have their Cervical smear test because of embarrassment link
Gynecological but not medical complications increased over 1 and 3 year after hysteroscopic vs laparoscopic sterilization. Hysteroscopic seems to have too many gyn complications to replace lap yet, including higher pregnancy link
Influenza associated with a sixfold greater risk of myocardial infarction acutely nejm
For stroke, Endovascular Thrombectomy (plus medical Rx) for internal carotid or proximal middle cerebral artery occlusion with favourable perfusion findings benefits up to 16 hours and AHA extends time window to 24 hours nejm
Much hype about ‘liquid biopsy’ blood test “CancerSEEK” detecting multiple cancers using cfDNA and protein biomarkers, specific but not always sensitive (many false negatives) and yet to show value in Stage I cancer, where we really need it for early detection Hopkins link
Parents who supply alcohol to their teenagers just increase their risk of alcohol-related harm lancet link
Prior use of NOACs, compared with prior use of warfarin, was associated with lower risk of in-hospital mortality in intracerebral hemorrhage Jama
Use paracetamol (acetaminophen) for most sore throats, says NICE NICE guidelines
FDA approves Angiotensin II for septic or vasodilatory shock (Giapreza).
But it notes:
”Giapreza can cause dangerous blood clots with serious consequences (clots in arteries and veins, including deep venous thrombosis); prophylactic treatment for blood clots should be used”.
Updated checklist for local anesthetic systemic toxicity (LAST) from ASRA.
<1mcg/kg Epi bolus doses and no B-Blockers, CCBs, lidocaine or vasopressin
Always worth revising the short document ASRA link
LAST c. 1/1000 in this arthroplasty study link
– same issue notes seizures the most common presentation
You’re not a dinosaur if using epidural loss of resistance to air rather than saline. No difference link
Dural puncture epidural is a CSE technique where no intrathecal meds are given, just a 26g puncture to aid spread of the epidural dose. Small gain in onset time, not sure if clinically all that significant link