EMCORE Newsletter 15/02/24
This week I’m back after a good break and ready for some more teaching:
- RESUSCORE Bali has just been announced and EMCORE London is over 50% full and EMCORE Fiji will be amazing. See you there.
- Do steroids decrease mortality in severe community acquired pneumonia? A new randomised trial finds something new.
- Airway in cardiac arrest has always been a little bit of a mystery. The BVM has been intensely spoken about and some centres are using smaller volume BVMs to decrease the volumes delivered during resuscitation. A new study gives some interesting findings.
- “Doctor, I can’t feel my feet pressing the pedals in my car”. Guillain-Barre, the mimic. In this Minutes to Mastery Video we briefly cover the many presentations of this low incidence high consequence disease.
Do steroids decrease mortality in severe community acquired pneumonia
Here is a controversial paper with mortality findings very different to what has been published before.
The Community-Acquired Pneumonia: Evaluation of Corticosteroids (CAPE COD) Trial, was a double-blind, randomised, controlled, superiority trial, conducted in 31 French ICUs.
Intravenous hydrocortisone, 200mg, was given within 24 hours of onset of severity criteria (median time < 15 hours). The results were very different to the previous study conducted in 42 ICU centres.
You can also listen on Apple Podcasts
Read the summary of this topic
Small Volume BVMs. Do they make a difference in achieving ROSC?
Airway in Cardiac Arrest is still a bit of a mystery. We don’t really know if we should intubate early. Contrary to prior studies showing no benefit of intubation over BVM or SGA, new evidence may be pointing in a different direction. We don’t know the correct rate of breaths or volume of breaths or FiO2. Small animal studies and ‘expert’ opinion restrict our delivery of breaths to a maximum of 10 per minute and the volume of each breath to about 500 mL.
This has resulted in some centres now using paediatric BVMs for adult resuscitation. Do these work? Previous studies may have shown no inferiority, but here is a new study, that suggests that traditional BVMs may be better.
Listen to Apple Podcasts or Spotify
Guillain-Barre Syndrome can present in so many ways. Here’s how not to miss it.
A patient presents with a complaint of..”Doctor, I can’t feel my feet pressing the pedals in my car”. You find sensory loss and ascending muscle weakness. It’s Guillain-Barre Syndrome. Slam Dunk! But it’s not always that easy. What about the patient who presents with upper limb weakness, only with sensory loss, or those with ptosis or ophthalmoplegia? Does LP diagnose them all? You might be surprised to know that cytoalbuminologic dissociation only occurs in about 50% of patients when an LP is done early in the disease.
Watch the 5 Minutes to Mastery Video on this topic below.
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That’s all I’ve got for you this week. Enjoy and see you soon at EMCORE
Peter Kas
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