The edition · Emergency & Critical Care
AI flags large-vessel stroke on the first CT, and amiodarone bags are recalled
AI matched or beat readers at spotting large-vessel occlusion on plain CT, low-dose ketamine spared opioids in ventilated patients, a premixed amiodarone product is under recall, and a measured look at when to beta-block the critically ill.
The edition in brief
Today's emergency and critical care edition leads with a diagnostic meta-analysis of AI for large-vessel occlusion on non-contrast CT: pooled across 3,632 patients, imaging AI reached a sensitivity of 0.78 versus 0.60-0.62 for human readers, with similar specificity, supporting its use as a prompt for expert review and faster CT angiography or transfer, though the evidence is retrospective and does not yet prove better outcomes. A double-blind trial found low-dose ketamine reduced hourly opioid requirements in ventilated adults, a modest opioid-sparing effect without more delirium. A Class II recall of a premixed Nexterone (amiodarone) product for manufacturing deviations is a supply and quality issue, not a drug-safety signal. A pearl covers early tranexamic acid in major trauma haemorrhage. The edition closes on a state-of-the-art review of beta-blockade in critical illness, where benefit is clear in selected scenarios but uncertain or harmful in septic shock, traumatic brain injury and acute heart failure, arguing for a phenotype-driven, physiology-guided approach.
AI on the first CT can flag the large-vessel stroke before the angiogram
Treat an AI large-vessel-occlusion flag on the first non-contrast CT as a prompt to accelerate CT angiography, tele-stroke review or transfer, not as a diagnosis.
Low-dose ketamine spared opioids in ventilated adults
Consider adding low-dose ketamine as an opioid-sparing adjunct in ventilated adults needing escalating opioid analgosedation.
A premixed amiodarone product is under Class II recall
Check resuscitation and pharmacy stock for the recalled premixed amiodarone lots and confirm an alternative preparation is available.
Give tranexamic acid early in major traumatic haemorrhage
In major trauma haemorrhage, give tranexamic acid as early as possible and within three hours of injury.
Beta-blockade in critical illness: useful in some settings, risky in others
Use beta-blockade selectively in critical illness, guided by phenotype and haemodynamics, and avoid reflexive de novo initiation in shock.
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