The edition · Emergency & Critical Care
Saline or balanced fluid for children in septic shock: no difference in kidney outcomes or death
PRoMPT BOLUS, in over 8,000 children, found balanced crystalloid no better than 0.9% saline; bedside ultrasound signs of plasma leakage flag severe dengue; and AI read large-vessel occlusion on plain CT more sensitively than clinicians in retrospective studies.
The edition in brief
PRoMPT BOLUS randomised 8,482 analysed children with suspected septic shock at 47 emergency departments in five countries to balanced crystalloid or 0.9% saline for up to 48 hours. Death, new renal replacement therapy or persistent kidney dysfunction at 30 days occurred in 3.4% versus 3.0% (RR 1.10, 95% CI 0.88–1.40); saline caused more hyperchloraemia but no worse outcomes. A systematic review of 56 studies, 44 of them in dengue, found ultrasound signs of plasma leakage — gallbladder wall thickening, ascites, pleural and pericardial effusions — associated with severe disease. A network meta-analysis of 10 retrospective studies found AI reading non-contrast CT detected anterior large-vessel occlusion with sensitivity 0.78 against 0.62 for expert readers, with similar specificity; this is accuracy evidence only. A randomised trial of 1,028 adults with non-traumatic headache found adding 2 g IV magnesium to paracetamol increased response from 65% to 79%, but pain-score differences were below the threshold of clinical importance. And the FDA recorded a Class II recall of Baxter's premixed Nexterone amiodarone infusion for manufacturing-practice deviations.
Ultrasound signs of plasma leakage help identify severe dengue
Point-of-care ultrasound signs of plasma leakage — gallbladder wall thickening, ascites, effusions — flag dengue patients at risk of severe disease.
AI on plain CT detected large-vessel occlusion more often than clinicians — in retrospective data
AI reading plain CT may catch more large-vessel occlusions than clinicians, but it should prompt CT angiography, not replace it.
IV magnesium added to paracetamol for headache: more responders, but not a clinically important pain difference
IV magnesium added to paracetamol increases headache responders and reduces rescue analgesia, but the pain difference is small.
FDA Class II recall: Baxter's premixed Nexterone amiodarone infusion
A Class II recall of Baxter's premixed Nexterone amiodarone bags affects that product only; amiodarone from vials is unaffected.
Dengue: the dangerous day is when the fever goes
In dengue, review patients closely as the fever settles — that is when plasma leakage and shock usually begin.
Balanced crystalloid was no better than 0.9% saline for children in septic shock
For children in septic shock, 0.9% saline and balanced crystalloid are equally acceptable — choose what is to hand and resuscitate promptly.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for emergency & critical care, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free