ACEP guidelines for sedation in ED – don’t worry about fasting?

  • March 15, 2014

sedationACEP guidelines for ED sedation suggest that fasting is not strictly necessary, that capnography ‘may’ be used, and that a useful distinction is made between ‘deep sedation’ and general anaesthesia!

American winter flu experience

  • March 9, 2014

swine-flu

This Winter saw a resurgence of the 2009 strain of H1N1 in the USA.  This paper gathers together stats and lessons learned from 2009, such as:
Beware a high incidence of ARDS, secondary bacterial infection and rhabdomyolysis.
Steroids seem more than unhelpful.
And protect your staff!

Worrying news about PPIs on ICU

  • March 4, 2014

GI ulcer

GI haemorrhage, pneumonia and C.diff seem to be more frequent in those on PPIs, rather than H2 blockers, in this cohort study done over 5 years in 71 hospitals.

Intubating the critically ill? MACOCHA!

  • March 3, 2014

 

intubation

Acknowledge that intubation of critically ill patients is more difficult. This prospective study  from last year suggests that coma, hypoxia and ‘non-anaesthetist’ status need to be taken into account.

Hyponatraemia – THE authoratative guideline

  • March 1, 2014

hyponatraemiabrainEuropean guideline development group recommendations on managing low sodium. Everything you need to know, science, equations and algorithms.

Not all delirium is bad news

  • February 18, 2014

Delirium cartoon

The subset of patients with rapidly reversible, sedation-related delirium appear to have a better prognosis than other types, according to Patel et al.

Lethal underdose – antimicrobials in ICU

  • February 17, 2014

MIC graphKnow about fT>MIC? It’s becoming increasingly obvious that our antibiotic dosing in ICU is suboptimal in a considerable number of critically ill patients – 16% in this study.

Should we be giving these drugs differently? Continuous infusion or extended intermittent infusions are probably the way forward for many cases. Bling II should help to clear this up.

Always include macrolides for severe CAP?

  • February 16, 2014

macrolide gifMeta-analyse the evidence for macrolides in critically unwell CAP and they look impressive. There’s basic science regarding anti-inflammatory properties and there’s outcome benefit – shouldn’t we use them every time. But keep an eye on the QTc!