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Bug Juice Potpourri
In this month's Journal Club, we covered several articles that looked at the use of antibiotics in the Emergency Department. Does adding Trimethoprim-Sulfamethoxazole to Cephalexin increase the rates of clinical cure in uncomplicated cellulitis? For patients receiving Vancomycin in the ED, how many are appropriately dosed and how many receive a sufficient number of doses to hopefully limit the emergence of resistant bacteria? Are patients receiving Vancomycin and Piperacillin-Tazobactam really at increased risk of acute kidney injury?
The Last Gasp
It is undoubted that effective airway management is a critical link in the care of patients with both in-hospital cardiac arrest and out-of-hospital cardiac arrest. But how exactly should one manage the airway? What results in the best outcomes for our patients? Should we be aiming to intubate every patient? Or, are extraglottic devices as effective (or more effective)? What about the good old bag-valve mask? In our most recent Journal Club we explored the evidence surrounding airway management in cardiac arrest, covering 3 high impact articles. We also touch on an abstract presented at the 2018 SAEM Academic Assembly which should add significantly to the body of literature when it is published in full. Take a listen to our recap podcast below and/or read on for the summaries and links to the articles.
Whole Blood - More than the Sum of Its Components?
Q: For a patient in hemorrhagic shock from acute blood loss, what is the best resuscitative fluid?
A: If they've lost blood, give them blood.
It's never quite that simple though right? For a generation now, we have practiced primarily by transfusing patient's with acute blood loss varying ratios of blood product components. Thanks to the PROPPR trial, we most recently arrived on a generally accepted ratio of 1:1:1 for Plasma, Platelets, and Red Blood Cells for severely injured bleeding trauma patients. Recent military literature however, suggests that there may be another strategy (which is in and of itself a bit of a throwback) that could offer additional benefits over a component transfusion strategy. If were are trying to recreate a whole blood with a 1:1:1 plasma:platetel:PRBC ratio, why not just give whole blood?