A systematic review of extravasation and local tissue injury from administration of vasopressors through peripheral intravenous catheters and central venous catheters
This review article evaluated adverse events associated with giving vasopressors through peripheral IV catheters versus central lines, as it is standard practice not to give vasopressors through peripheral lines. The majority of the 85 articles examined were case reports. 318/325 adverse events were events that occurred with peripheral administration of pressors, most of which were at sites distal to the antecubital or popliteal fossa and administered for a longer period of time, with a median time of 24 hours. The results of the study showed that more investigation should be done regarding peripheral administration of pressors to determine whether peripheral administration is a safe practice. After discussion, our conclusions were that while a central line is still preferred for pressor use, it may be acceptable to give pressors through a more proximal peripheral line for a short period of time, such as <6 hours, until central access can be obtained.
The Diagnostic Accuracy of Bedside Ocular Ultrasonography for the Diagnosis of Retinal Detachment: A Systematic Review and Meta-analysis
This review article of 3 small prospective observational studies evaluated the diagnostic accuracy of ED bedside ultrasound in identifying retinal detachment. In all three trials, the examiner was at the very least given a lecture on how to perform the ultrasound examination of the posterior chamber to identify retinal detachment. Exams were performed by residents, fellows, and attendings. Sensitivity ranged from 97-100% and specificity was 83-100% in the three trials. Our discussion concluded that this is an exam worth doing on a patient with an ocular complaint that is concerning for retinal detachment or other posterior chamber abnormality.
Thrombectomy within 8 Hours after Symptom Onset in Ischemic Stroke
This article outlines a Randomized Controlled Trial that aimed to compare ischemic stroke patients treated within 8 hours of symptom onset with medical therapy (alteplase) alone versus medical therapy plus thrombectomy. Only individuals who had persistent proximal large-vessel occlusion 30 minutes after alteplase administration were included in the randomized groups. The study was concluded prior to reaching its goal of participants due to clear data from this trial and others published at the time that thrombectomy improves outcomes, so it was unethical to randomize patients to not receive the thrombectomy. Despite the incomplete set of data, there was a significant difference in disability between the group that received medical therapy (lower disability) plus thrombectomy compared to medical therapy alone (more disability). Based on this study, patients that can be treated within 8 hours of symptom onset should be treated with medical therapy (if the patient qualifies for such treatment) plus thrombectomy for proximal large-vessel occlusion ischemic strokes.
This review article evaluated adverse events associated with giving vasopressors through peripheral IV catheters versus central lines, as it is standard practice not to give vasopressors through peripheral lines. The majority of the 85 articles examined were case reports. 318/325 adverse events were events that occurred with peripheral administration of pressors, most of which were at sites distal to the antecubital or popliteal fossa and administered for a longer period of time, with a median time of 24 hours. The results of the study showed that more investigation should be done regarding peripheral administration of pressors to determine whether peripheral administration is a safe practice. After discussion, our conclusions were that while a central line is still preferred for pressor use, it may be acceptable to give pressors through a more proximal peripheral line for a short period of time, such as <6 hours, until central access can be obtained.
The Diagnostic Accuracy of Bedside Ocular Ultrasonography for the Diagnosis of Retinal Detachment: A Systematic Review and Meta-analysis
This review article of 3 small prospective observational studies evaluated the diagnostic accuracy of ED bedside ultrasound in identifying retinal detachment. In all three trials, the examiner was at the very least given a lecture on how to perform the ultrasound examination of the posterior chamber to identify retinal detachment. Exams were performed by residents, fellows, and attendings. Sensitivity ranged from 97-100% and specificity was 83-100% in the three trials. Our discussion concluded that this is an exam worth doing on a patient with an ocular complaint that is concerning for retinal detachment or other posterior chamber abnormality.
Thrombectomy within 8 Hours after Symptom Onset in Ischemic Stroke
This article outlines a Randomized Controlled Trial that aimed to compare ischemic stroke patients treated within 8 hours of symptom onset with medical therapy (alteplase) alone versus medical therapy plus thrombectomy. Only individuals who had persistent proximal large-vessel occlusion 30 minutes after alteplase administration were included in the randomized groups. The study was concluded prior to reaching its goal of participants due to clear data from this trial and others published at the time that thrombectomy improves outcomes, so it was unethical to randomize patients to not receive the thrombectomy. Despite the incomplete set of data, there was a significant difference in disability between the group that received medical therapy (lower disability) plus thrombectomy compared to medical therapy alone (more disability). Based on this study, patients that can be treated within 8 hours of symptom onset should be treated with medical therapy (if the patient qualifies for such treatment) plus thrombectomy for proximal large-vessel occlusion ischemic strokes.
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