RAP 89

1) Pulse Detection in Cardiac Arrest

Review Summary

  • Source: EMCrit
  • Authors: Scott Weingart, MD FCCM, Sam Ghali, MD
  • Reviewer: Alex Laughlin, DO
5
/ 7
BEEM Rater Scale
5
/ 7
Educational Utility
4
/ 7
Evidence Based Medicine

Takeaway

Pulse detection with ultrasound doppler is far superior than manual palpation in cardiac arrest, specifically PEA.

2) Biphasic Anaphylaxis

Review Summary

  • Source: EMRAP
  • Author: Mike Menchine, MD
  • Reviewer: Thomas Meland, MD
2
/ 7
BEEM Rater Scale
3
/ 7
Educational Utility
3
/ 7
Evidence Based Medicine

Takeaway

Patients without risk factors do not require extended periods of hospital observation (> 6-8 hours) for biphasic anaphylaxis after initial treatment.

3) TXA Complications

Review Summary

  • Source: The Skeptics’ Guide To EM
  • Author: Ken Milne, MD
  • Reviewer: Lexi Gruenhagen, MD
3
/ 7
BEEM Rater Scale
5
/ 7
Educational Utility
3
/ 7
Evidence Based Medicine

Takeaway

TXA remains appropriate for early use in bleeding trauma patients but there are possible increased risk of thromboembolic events that warrants further studies — not change in practice.

4) RSI: Ketamine vs Etomidate

Review Summary

  • Source: The Skeptics’ Guide To EM
  • Authors: Ken Milne, MD, Scott Weingart, MD FCCM
  • Reviewer: Kurt Isenberger, MD
6
/ 7
BEEM Rater Scale
6
/ 7
Educational Utility
6
/ 7
Evidence Based Medicine

Takeaway

Large multicenter RCT.  Mortality was similar with Ketamine and Etomidate used for RSI induction. Ketamine caused more peri-intubation hypotension and vasopressor use.  Etomidate’s adrenal suppression did not increase mortality.