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Cerebral Edema and Diabetic Ketoacidosis: Rebaked

Pediatric EM Morsels

2004 Jul;27(7):1541-6. Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema. Is your patient hyperglycemic, acidotic, with ketonuria? Then we’ve likely got DKA. Triple bag, triple bag, triple bag! Diabetes Care. PMID: 15220225.

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Glasgow Coma Scale in Children

Pediatric EM Morsels

Motor Fingernail bed pressure with a pencil first If flexion outcome, then apply painful stimulus to neck or head (trapezius or supraorbital notch) to look for localization Spinal reflex can result in a falsely elevated score if lower extremity pain induced Verbal Orientated- Able to answer all questions. A practical scale. PMID: 4136544.

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SGEM#450: Try Again – Andexanet for Factor Xa Inhibitor–Associated Acute Intracerebral Hemorrhage

The Skeptics' Guide to EM

INTERACT-2 demonstrated that in patients with ICH, intensive lowering of blood pressure did not result in a significant reduction in the rate of the primary outcome of death or severe disability (SGEM#73). Reversal of Warfarin: Freeman et al. Reversal of Warfarin: Freeman et al.

Stroke 90
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Blood Pressure Management in Neurologic Emergencies: What Does the Evidence Say?

EMDocs

Finally, anticipating and addressing known complications such as seizures, increased intracranial pressure, or cerebral edema with appropriate measures, including antiepileptic drugs or osmotic agents, is essential for improving patient outcomes. Lowering the MAP may mitigate these risks and possibly improve outcomes. Epub 2004 Jan 15.

Stroke 101
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When Studies Can't Answer an Important Question (but are still published)

Sensible Medicine

The title gives away the results: Here is what they did: They took 159 patients who had severe TR and were operated on from 2004-2018. They then looked at a primary outcome of death. Earlier surgery may improve outcomes in these high-risk patients. These were operations solely for the tricuspid valve. vs 18.2% ; P =.036).

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Adjunctive Methylene Blue in Septic Shock?

RebelEM

Without larger studies and a patient centered outcome, the addition of methylene blue within 24 hours of septic shock should still not be part of a general approach but rather an adjunct in specific circumstances (i.e. NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9% 95% CI 15.4 NaCl over 6hrs once daily x3 doses Placebo: 500mL of 0.9%

Shock 145
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Peri-Intubation Hypotension – Dose Induction Dose Matter?

RebelEM

This approach has been shown to benefit patients when agents like propofol and midazolam are used. ( Russotto 2022 , Choi 2004 ). Outcomes: Primary: Postintubation hypotension (SBP < 100 mm Hg) 15 minutes post-intubation. However, there is scant evidence on the more common induction agents ketamine and etomidate. mg/kg 1.33