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2018 AHA PALS Update – Nothing New


The optimal sequence of PALS interventions, including administration of antiarrhythmic drugs during resuscitation, and the preferred manner and timing of drug administration in relation to shock delivery are still not known. One study reported a statistically significant improvement in return of spontaneous circulation when lidocaine administration was compared with amiodarone for pediatric ventricular fibrillation/pulseless ventricular tachycardia cardiac arrest. However, no difference in survival to hospital discharge was observed among patients who received amiodarone, lidocaine, or no antiarrhythmic medication.

All you need to know about emergency care in Kenya
Kakamega County Referral Hospital Emergency Department

The Ministry of Health in Kenya reported that in 2016, about 13,159 people were seriously injured on the road. It is not just road traffic accidents, but also tens of thousands others lose their lives due to other emergencies such as heart attacks, stroke, maternity cases such as the killer pregnancy-induced blood pressure and falls from buildings.

Dual antiplatelet therapy (DAPT) improves outcomes in patients with high-risk TIA or minor ischemic stroke

In patients with minor ischemic stroke or high-risk TIA, those who received a combination of clopidogrel and aspirin had a lower risk of major ischemic events but a higher risk of major haemorrhage at 90 days than those who received aspirin alone. However, the relative reduction in recurrent stroke occurred almost entirely during the first week, whereas bleeding events (most of which were not intracranial) were distributed fairly evenly throughout 90-day follow-up. Thus, it appears that one can maximize benefit and minimize harm by confining DAPT to just a few weeks 

Parental Guidance in the Pediatric ED
  • My Emergency Medicine training taught me the importance of “return precautions.”
    • Educate the patients/families about the warning signs of impending doom.
    • Essentially, “come back if things get worse.”
  • In the Pediatric ED (or during acute care related complaints), I find that the combination fo the two is helpful.
    • In the ED, we are seeing only a brief period of time of the illness process. 
      • At the time you are seeing the kid, there may be no obvious emergent danger or urgent condition warranting therapy… but… 
      • Anticipate the potential trajectories that may exist and educate about them.
Oxygen therapy for acutely ill medical patients: a clinical practice guideline

What you need to know

  • It is a longstanding cultural norm to provide supplemental oxygen to sick patients regardless of their blood oxygen saturation
  • A recent systematic review and meta-analysis has shown that too much supplemental oxygen increases mortality for medical patients in the hospital
  • For patients receiving oxygen therapy, aim for peripheral capillary oxygen saturation (SpO2) of ≤ 96% (strong recommendation)
  • For patients with acute myocardial infarction or stroke, do not initiate oxygen therapy in patients with SpO2 ≥ 90% (for ≥ 93% strong recommendation, for 90-92% weak recommendation)
  • A target SpO2 range of 90-94% seems reasonable for most patients and 88-92% for patients at risk of hypercapnic respiratory failure; use the minimum amount of oxygen necessary

Emergency Medicine

Emergency medicine is a field of practice based on the knowledge and skills required for the prevention, diagnosis and management of acute and urgent aspects of illness and injury affecting patients of all age groups with a full spectrum of episodic undifferentiated physical and behavioural disorders (IFEM) - WATCH VIDEO

Emergency Topics

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