ED ketamine looks very safe in children, and bicarbonate fails in shock

The edition in brief

Five findings for emergency physicians and intensivists. A systematic review of 58,752 children receiving intravenous ketamine for emergency-department procedural sedation found no deaths or permanent harm, sentinel events in about 1 per 24,000, and serious adverse events in 0.33%, with only modest predictors (age 10 or over, upper respiratory infection, co-administered opioids). A cohort of 2,085 adolescents with a positive emergency-department suicide screen found 11.6% attempted suicide within three months, with a recent attempt, prior mental-health hospitalisation, past non-suicidal self-injury and hopelessness marking higher risk. The FDA cleared a supplement for a generic adrenaline, an administrative supply approval. A pearl covers prompt intramuscular adrenaline in anaphylaxis. The practice-changer is SODa-BIC: in 500 critically ill adults with metabolic acidosis receiving vasopressors, sodium bicarbonate did not reduce major adverse kidney events versus placebo (40.2% vs 39.4%), with no benefit on renal-replacement therapy or mortality, arguing against routine bicarbonate for acidosis in shock.