First10EM Journal Club: October 2022

Ketamine vs etomidate in ICU intubation?

Matchett G, Gasanova I, Riccio CA, Nasir D, Sunna MC, Bravenec BJ, Azizad O, Farrell B, Minhajuddin A, Stewart JW, Liang LW, Moon TS, Fox PE, Ebeling CG, Smith MN, Trousdale D, Ogunnaike BO; EvK Clinical Trial Collaborators. Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial. Intensive Care Med. 2022 Jan;48(1):78-91. doi: 10.1007/s00134-021-06577-x. Epub 2021 Dec 14. PMID: 34904190

Not surprisingly, this paper has been covered by basically everyone who talks about research, so if you want to hear some other opinions, check out the SGEM, REBEL EM, or St. Emlyn’s

Bottom line: Although this RCT demonstrates a 7 day mortality benefit of using ketamine over etomidate, the level of certainty in the results is low. 

The PEACH trial: Nobody had a fit, so… we have no clue

Peter-Derex L, Philippeau F, Garnier P, et al. Safety and efficacy of prophylactic levetiracetam for prevention of epileptic seizures in the acute phase of intracerebral haemorrhage (PEACH): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Neurol. 2022 Sep;21(9):781-791. doi: 10.1016/S1474-4422(22)00235-6. PMID: 35963261

Breaking good news: an essential skill for avoiding too much medicine?

Danczak A. Breaking good news: an essential skill for avoiding too much medicine? BMJ. 2018 Sep 11;362:k3843. doi: 10.1136/bmj.k3843. PMID: 30206143

Less is more when it comes to intravenous fluids

de-Madaria E, Buxbaum JL, Maisonneuve P, et al. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis. N Engl J Med. 2022 Sep 15;387(11):989-1000. doi: 10.1056/NEJMoa2202884. PMID: 36103415

Bottom line: Less is more when it comes to intravenous fluids.

Face masks stop you picking your nose… so yeh

Joshi A, Jiang Y, Jones P. Does wearing a surgical mask influence face touching by healthcare workers? A retrospective cohort study. Emerg Med Australas. 2022 Sep 18. doi: 10.1111/1742-6723.14082. Epub ahead of print. PMID: 36117397

It areas, because they are covered. In future pandemics, we should require infection control practitioners to base their recommendations on science. 

Tips for radial artery art lines

Imbrìaco G, Monesi A, Spencer TR. Preventing radial arterial catheter failure in critical care – Factoring updated clinical strategies and techniques. Anaesth Crit Care Pain Med. 2022 Aug;41(4):101096. doi: 10.1016/j.accpm.2022.101096. Epub 2022 Apr 28. PMID: 35490863

Hands on defibrillation: Even if it’s safe, would it actually help?

Stephens AF, Šeman M, Nehme Z, Voskoboinik A, Smith K, Gregory SD, Stub D. Ex vivo evaluation of personal protective equipment in hands-on defibrillation. Resusc Plus. 2022 Aug 3;11:100284. doi: 10.1016/j.resplu.2022.100284. PMID: 35942482

earing gloves, hands on defibrillation is probably safe. However, I think we need to question its overall value before adopting such a practice.

Suturing doesn’t need sterile gloves

Zwaans JJM, Raven W, Rosendaal AV, Van Lieshout EMM, Van Woerden G, Patka P, Haagsma JA, Rood PPM. Non-sterile gloves and dressing versus sterile gloves, dressings and drapes for suturing of traumatic wounds in the emergency department: a non-inferiority multicentre randomised controlled trial. Emerg Med J. 2022 Jul 26:emermed-2021-211540. doi: 10.1136/emermed-2021-211540. Epub ahead of print. PMID: 35882525

Bottom line: Gloves from that box on the wall are good enough for suture repair.

Warm is the new cold?

Wolfrum S, Roedl K, Hanebutte A, Pfeifer R, Kurowski V, Riessen R, Daubmann A, Braune S, Söffker G, Bibiza-Freiwald E, Wegscheider K, Schunkert H, Thiele H, Kluge S. Temperature Control After In-Hospital Cardiac Arrest: A Randomized Clinical Trial. Circulation. 2022 Sep 28:101161CIRCULATIONAHA122060106. doi: 10.1161/CIRCULATIONAHA.122.060106. Epub ahead of print. PMID: 36168956

Bottom line: Despite the significant imperfections of this trial, it is important data (as we lack data on hypothermia after inpatient cardiac arrest), and it adds to the growing body of evidence that suggests hypothermia provides no benefit. 

Ortho vs Anaesthesia – bigger, stronger and smarter!

Subramanian P, Kantharuban S, Subramanian V, Willis-Owen SA, Willis-Owen CA. Orthopaedic surgeons: as strong as an ox and almost twice as clever? Multicentre prospective comparative study. BMJ. 2011 Dec 15;343:d7506. doi: 10.1136/bmj.d7506. PMID: 22174322

Read Justin’s full written Articles of the Month at First10EM

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