Premixed vasopressin and amiodarone both under recall, and the resuscitation trolley is the place to check

The edition in brief

Two of the drugs kept ready-to-use for the sickest patients are under ongoing Class II recall for manufacturing deviations: premixed vasopressin in both 20 units and 40 units per 100 mL presentations, and a ready-to-use amiodarone infusion. Class II means temporary or reversible harm is possible and serious harm remote, so neither is a safety finding about the drug - but both move a calculation back to the bedside at precisely the moment nobody has time for one. An analysis of 167 emergency departments across 2191 site-quarters tested a long-held assumption: that paying emergency physicians by relative value unit rather than by the hour changes what they do. Using two-way fixed effects and staggered difference-in-differences models, the switch had no significant effect on RVUs per patient, patients per hour, or left-without-being-seen rates, and no effect on length of stay, admission rates, 72-hour returns with admission, CT usage, critical care billing, clinician satisfaction or attrition. Advanced practice provider hours rose relative to physician hours in some models. A systematic review of 102 cluster randomised trials in critical care from 2004 to 2022 found persistent ethical and methodological gaps: only 46% justified using cluster randomisation, only 23% of trials treating healthcare providers as participants reported on their consent, and only 13% of trials with fewer than 40 clusters applied a small-sample correction. A meta-analysis of 163 PTSD studies reports large effects for both prolonged exposure and cognitive processing therapy.