All posts by Cliff

Ketamine lowered ICP in brain-injured kids

Ketamine lowered ICP in brain-injured kids
Ventilated children between the ages of 1 and 16 with traumatic brain injury and elevated intracranial pressure (ICP) were given ketamine and effect on cerebral perfusion pressure (CPP) and ICP was measured. Ketamine decreased ICP while maintaining blood pressure and CPP.
These results refute the notion that ketamine increases ICP. The authors conclude: “Ketamine is a safe and effective drug for patients with traumatic brain injury and intracranial hypertension, and it can possibly be used safely in trauma emergency situations”

Effectiveness of ketamine in decreasing intracranial pressure in children with intracranial hypertension
J Neurosurg Pediatr. 2009 Jul;4(1):40-6 (Full text)

Preparing your emergency department for pandemic 'flu

Ten points to consider in preparation for pandemic influenza
* Ensure emergency department representation at the Trust level.
* Talk about pandemic flu with your staff.
* Establish a process for fit testing all your staff.
* Institute a training programme for staff in the use of personal protection equipment (PPE).
* Consider stockpiling PPE.
* Agree the processes for managing potentially infected patients within the emergency department.
* Consider how roles in the hospital and within the emergency department may change during a pandemic.
* Establish a method for communicating with staff during a pandemic.
* Consider what you can do to improve staff morale.
* Consider and discuss the ethical decisions we will be required to make.
Emergency Medicine Journal 2009;26:497-500

Acute Kidney Injury Survivors – What happens next?

What happens to acutely ill patients with acute kidney injury requiring in-hospital dialysis after their acute admission? How many recover and how many require chronic dialysis? A Canadian study of 3769 such patients followed up for an average of 3 years demonstrated that the incidence rate for chronic dialysis was only 2.63 per 100 person years, and that all cause mortality compared with matched controls was unchanged.
JAMA. 2009 Sep 16;302(11):1179-85

Immediate vs Delayed Intervention for NSTEACS

An early invasive strategy is recommended for high risk non-ST elevation acute coronary syndrome (ST/T wave changes, ongoing symptoms, or troponin rise) but how early is early? The French ABOARD study randomised 352 patients to an early (median time of randomisation to sheath insertion 70 mins) or delayed (21 hours) strategy. No difference in the primary outome measure of troponin elevation was observed. Good news for busy cardiologists who won’t have to get up at night for this type of patient.
JAMA. 2009 Sep 2;302(9):947-54

Clopidogrel and PPIs

PPIs such as omeprazole affect the pharmacodynamics of thienopyridines such as clopidogrel, but this does not seem to affect clinical outcomes for most patients. Pantoprazole and esomeprazole have less of an effect on the platelet response to clopidogrel.
Pharmacodynamic effect and clinical efficacy of clopidogrel and prasugrel with or without a proton-pump inhibitor: an analysis of two randomised trials

Lancet editorial (Lancet subscription required)

Sensitive troponin improves early detection of AMI

Newer sensitive troponin assays (detecting 0.04 ng/ml troponin I) showed better senstivity at detecting acute myocardial infarction at 0 amp; 3 hours compared with standard assays. Specificity was however slightly lower than standard assays, suggesting non-AMI pathologies that produce a degree of cardiomyocyte injury will also be detected. Senstivity and specificity for AMI at baseline were both around 90%. Troponin I 0.04 ng/ml was an independent risk factor for adverse events at 30 days.br /br /a href=”http://content.nejm.org/cgi/content/short/361/9/868″http://content.nejm.org/cgi/content/short/361/9/868/a