All the Resuscitation and Critical Care Literature Goodness for March 2025
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Editor-in-Chief, at EMCrit.org
An ED Intensivist from NY.
Professor
Nassau University Medical Center
No conflicts of interest (coi).
Professor
Nassau University Medical Center
No conflicts of interest (coi).
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I tried esketamine a few times, and in Europe we even have Levetiracetam before propofol. So both after 8-10 mg Mida + 3-4 g LEV and also in propofol-resistant status it worked (as confirmed by EEG), but n is < 10. The Neuro folks in our hospital claim that ketamine has worse data regarding recurrence of seizures compared to propofol, but I don’t know the papers myself. As for the ventilation via tube in pharynx, I‘d like to see data against BMV using an upper airway, cause I wouldn’t ventilate a big patient without one. Great alternative for patients with… Read more »
Hey Scott I love ketamine as much as the next person, and theoretically think it is an amazing drug for seizures, and have also been waiting with baited breath for any decent clinical data supporting its use. However, I don’t think this trial counts as that data. When I heard you talk about the paper, I couldn’t understand the 20% success rate with midazolam. That is just wrong, and clearly highlights a big source of bias in this paper. I think the obvious answer is that these patients were seizing for an average of 35 minutes without any treatment before… Read more »
The calcium pre-treatment study is funny. If you think about it since our actual goal is HR control, they showed that you actually have worse HR control with Ca pretreatment! Yeah your BP was a little higher but without clinical significance. So this means that no matter what mechanisms are responsible for why calcium blunts the effects of Dilt, could probably just give less Dilt and get the same result as higher dose with pre-treatment. But really the fact that they were looking at this 15 mins out and stopping there just makes it so irrelevant. I’ve always felt it… Read more »