The edition · Emergency & Critical Care
Cardiac arrest arrivals: analysing the rhythm on the paramedics' pads saved over two minutes
A video-review study questions the reflex to switch defibrillators at the door. Also: a recall of premixed vasopressin bags, what VExUS can and cannot tell you, diabetes-specific tube feeds, and driving after critical illness.
The edition in brief
In a single-centre video review of 223 adults arriving in out-of-hospital cardiac arrest, using the ambulance crew's monitor and pads for the first emergency department rhythm check was associated with a first analysis 143 seconds sooner and first defibrillation about 132 seconds sooner than switching to department equipment. The FDA lists a Class II recall of Baxter's premixed vasopressin 20 units/100 mL bags for manufacturing-practice deviations. A meta-analysis of 32 studies found the VExUS venous congestion score has moderate to good accuracy for raised right atrial pressure and, in cardiac patients, a grade of 2 or more was associated with acute kidney injury (OR 4.44) and death, but not in general critically ill patients. Diabetes-specific tube feeds lowered mean glucose in critically ill patients by 0.54 mmol/L, a modest effect. In 33 UK ICU survivors assessed three months after discharge, 79% were fit to drive but only 45% had started again.
VExUS: a reasonable gauge of venous pressure, a weak predictor outside cardiac patients
Treat a VExUS grade of 2 or more as a reason to stop giving fluid, but not as a validated prognostic score in general ICU patients.
Class II recall: Baxter premixed vasopressin 20 units/100 mL
Check stock for affected Baxter premixed vasopressin and standardise concentration if you switch to locally prepared infusions.
Diabetes-specific tube feeds modestly lowered glucose in critically ill patients
Diabetes-specific tube feeds may smooth glucose control in ventilated patients, but the effect is small and outcome benefit is unproven.
After ICU, most survivors were fit to drive — but fewer than half had gone back to it
Discuss driving at ICU discharge and follow-up; most survivors can return, and a formal assessment helps those unsure.
When to add vasopressin in septic shock
Add fixed-dose vasopressin at 0.03 units/min when noradrenaline reaches about 0.25–0.5 µg/kg/min, rather than escalating further.
Out-of-hospital arrest: do the first ED rhythm check on the ambulance pads
For cardiac arrest arrivals, analyse the first rhythm on the paramedics' defibrillator and swap equipment later.
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