Michael E. Winters, MD, FACEP, associate professor of emergency medicine and medicine, and co-director of the combined emergency medicine/internal medical/critical care program at the University of Maryland School of Medicine in Baltimore, shared his top picks for recent articles involving the critical care of the emergency patient.
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He noted that, over the past decade, critical care delivered in the emergency department has increase by more than 200 percent. “We are the first intensivists to see these patients,” he said. “If we can intervene in those first few hours, we can make the difference between life and death.”
He presented the results from a recent study, “Guidelines for Management of Spontaneous Intracerebral Hemorrhage (ICH); A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association,” by Hemphill et al, published in 2015. The study compared the efficacy of standard blood pressure treatment versus intensive therapy.
“The take home message is that there is no difference,” Dr. Winters said. Rapid reduction in systolic blood pressure doesn’t decreases death or disability in this patient population.
Standard treatment for these patients is a platelet transfusion. A 2016 randomized, open-label, parallel-group trial published in Lancet, called “Platelet Transfusion Versus Standard Care After Acute Stroke Due to Spontaneous Cerebral Hemorrhage Association With Antiplatelet Therapy (PATCH),” assessed whether platelet transfusion reduces death or dependence.
Despite receiving a transfusion within six hours of symptom onset, the results found a lower three-month survival, more patients with disability, and more adverse events among the platelet group. “We really need to rethink reflexively ordering platelet transfusion in patients with an ICH taking antiplatelet therapy,” Dr. Winters said.
The next study involved cardiac arrest patients “These are the most critical patients we encounter and ones we can routinely hope to save,” he said. The study focused on three areas including minimizing hands-off time during compressions, when to intubate, and which intubation tool to use. “The Video Laryngoscopy vs. Direct Laryngoscopy: Which Should Be Chosen for Endotracheal Intubation During Cardiopulmonary Resuscitation? A Prospective Randomized, Controlled Study of Experienced Intubators,” was published this year in Resuscitation.
Dr. Winters noted that experienced intubators included those who had more than 50 emergency tracheal intubations.
The study found that there was no difference in the success rate or esophageal intubations between direct laryngoscopy (DL) versus video laryngoscopy (VL), but there were significant interruptions in compressions for DL. “If you have both available…consider when to intervene and what equipment you use to avoid detracting from chest compressions.” Dr. Winters said.