Thirty-eight post-cardiac arrest patients were effectively cooled to the target temperature range of 32-34 celsius using intravenous cold saline and ice packs to groin, axillae, and neck. The ice packs were frozen 250 ml saline bags wrapped in pillow cases. If shivering occurred muscle relaxation with rocuronium was used until the target temperature was reached. Interestingly, rebound hyperthermia occurred in 8/34 patients.
Although a small study, these data reassure those of us who induce therapeutic hypothermia without the use of dedicated cooling equipment.
Cold saline infusion and ice packs alone are effective in inducing and
maintaining therapeutic hypothermia after cardiac arrest
Resuscitation 2010;81:15–19
Early Management of Patients with Head Injury
The 2009 SIGN Guidelines on Early Management of Patients with Head Injury contain extensive additional resources, such as documentation proformas for adults and children, discharge instructions, and guidance on returning to sport after head injury.
Venous thromboembolism – UK guidelines
New NICE guidelines for England and Wales
Venous thromboembolism – reducing the risk: quick reference guide
Asthma guidelines (in pregnancy) 2009 revision
A reminder of the British Thoracic Society guidelines on the management of asthma, revised June 2009
Asthma guidelines (paediatric) 2009 revision
A reminder of the British Thoracic Society guidelines on the management of asthma, revised June 2009
Asthma guidelines (adult) 2009 revision
A reminder of the British Thoracic Society guidelines on the management of asthma, revised June 2009
Bulging fontanelle in febrile infants
In a study of febrile infants with a bulging fontanelle, only one out of 153 infants had bacterial meningitis. Other diagnoses included aseptic meningitis (26.7%), upper respiratory tract infection (18.3%), viral disease NOS (15.6%), roseola infantum (8.5%) and acute otitis media (6.5%).
In this study, most infants with fever and a bulging fontanelle had benign and self-limited disease.
Bulging fontanelle in febrile infants: is lumbar puncture mandatory?
Arch Dis Child. 2009 Sep;94(9):690-2
Updated Nutrition Guidelines
The Canadian Clinical Practice Guidelines for nutrition in the critically ill patient were updated in 2009 and the summary can be found here
Steroids and insulin in septic shock – more data
In a multicentre RCT of patients with septic shock who were receiving steroids (hydrocortisone) for the septic shock, intensive insulin therapy did not affect outcome but was (once again) associated with a higher incidence of hypoglycaemia. Also, the addition of (enteral) fludrocortisone did not provide benefit compared with hydrocortisone alone.
Corticosteroid Treatment and Intensive Insulin Therapy for Septic Shock in Adults
JAMA. 2010;303(4):341-348
LA toxicity guidelines
The Association of Anaesthetists of Great Britain & Ireland has produced updated guidelines on the Management of Severe Local Anaesthetic Toxicity, which can be found at http://www.aagbi.org/publications/guidelines/docs/la_toxicity_2010.pdf
20% lipid emulsion should be available (eg. Intralipid). The recommended regimen (after supportive measures have been instituted) includes:
