The edition · Emergency & Critical Care
Premixed amiodarone under recall, and half of paediatric sepsis was seen the week before
A Class II recall covers Nexterone premixed amiodarone bags for manufacturing deviations; 53.5% of children admitted with sepsis had been seen somewhere in the preceding seven days; and adding lung views to resuscitative transoesophageal echo raised the rate at which operators named a cause of shock.
The edition in brief
The FDA has recorded an ongoing Class II recall of Nexterone premixed amiodarone 360 mg/200 mL in GALAXY single-dose containers, made by Baxter Healthcare, for deviations from current good manufacturing practice. Class II means temporary or medically reversible harm is possible and serious harm unlikely; the recall is not a finding about amiodarone itself. Units that stock premixed bags on resuscitation trolleys should check lot numbers against the FDA listing. In a retrospective claims cohort of 6,928 paediatric sepsis hospitalisations between 2016 and 2022, 53.5% had a healthcare encounter in the preceding seven days — 33.7% outpatient, 28.2% in an emergency department, 6.2% inpatient. Among those with any prior encounter, 38.9% had an infection-related diagnosis recorded at it. Mechanical ventilation, ICU use and length of stay did not differ between children who had been seen and those who had not. Nearly two-thirds had a complex chronic condition. Across 23 hospitals in a resuscitative transoesophageal echocardiography registry, 96 of 379 shock examinations included transoesophageal lung ultrasound. Operators reported identifying the cause of shock in 86.5% with the lung views against 75.3% without (odds ratio 1.95, 95% CI 1.02 to 3.72), at a cost of 2.5 minutes. A meta-analysis of ten studies found erector spinae plane block gave lower pain scores than intercostal nerve block at 1, 24 and 48 hours, with no difference in opioid use or length of stay. A review of 56 publications and 6,979 patients found sonographic plasma-leakage signs predict severe dengue.
Premixed amiodarone bags recalled for manufacturing deviations
If you stock premixed amiodarone bags, check the lot numbers on resuscitation trolleys today.
Half of children admitted with sepsis had been seen in the previous week
Treat a healthcare visit in the previous week as part of the risk assessment, not as evidence the child has already been checked.
Adding lung views to resuscitative TOE named more causes of shock
If you already perform resuscitative transoesophageal echo, adding lung views is quick and safe — but judge their value on your own outcomes, not on this.
Erector spinae block beat intercostal block on pain, not on opioids
Where both are available and the operator is competent in it, erector spinae plane block is the reasonable first choice for chest wall trauma pain.
Say the time out loud in a resuscitation
Name a timekeeper at the start of every resuscitation and have them call intervals aloud.
Sonographic plasma leakage marks the dengue patient who will get worse
In suspected dengue, scan for plasma leakage as part of the severity assessment rather than waiting for haemodynamic signs.
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