European Guidelines: Management of Bleeding, Coagulopathy Following Trauma According to the Global Burden of Diseases, Injuries, and Risk Factors Study, trauma accounted for 8% of total deaths annually. Among adolescents aged 10-24 years, road injuries, self-harm, and interpersonal violence are the top causes of disability-adjusted life-years, and road injuries are ranked first in the 25-49 year age group. Post-traumatic bleeding and associated traumatic coagulopat...

Prehospital Physician Presence During Paediatric OHCA A study was conducted to investigate whether the presence of prehospital physicians affected the neurological outcomes of paediatric patients who experienced an out-of-hospital cardiac arrest (OHCA). The study included paediatric patients who were 17 years old or younger and were registered in a database between June 2014 and December 2019.  The researchers used logistic regression models and stabil...

Early Tracheostomy vs Late Tracheostomy in Traumatic Brain Injury, Stroke A recent review aimed to determine whether early tracheostomy benefits patients with severe traumatic brain injury (TBI) and stroke and whether these benefits persist across different underlying conditions. The included studies in the review were those written in English, French, Spanish, or Portuguese and with a formulated question that compared outcomes between early and late tracheostom...

Determining Brain Death The Uniform Law Commission (ULC) created the Uniform Determination of Death Act (UDDA) in the United States in 1980, which was adopted by all 50 states. The UDDA defines death as either the irreversible cessation of circulatory and respiratory functions or the irreversible cessation of all functions of the entire brain, including the brainstem. While the loss of cardiorespiratory function has always been recognised as death, some view the de...

Drones Delivering Automated External Defibrillators Out-of-Hospital Cardiac Arrest (OHCA) is a dangerous condition with high mortality and poor health outcomes. According to the International Liaison Committee for Resuscitation (ILCOR), the global incidence of OHCA treated by emergency medical services (EMS) is 30.0-97.1 per 100,000 population, with discharge/30-day survival rates of 3.1-20.4% and good neurological outcomes of 2.8±18.2%. OHCA incidence in Europe is...

Medical News & Perspectives  April 5, 2023 It Takes an Average of 17 Years for Evidence to Change Practice—the Burgeoning Field of Implementation Science Seeks to Speed Things Up Rita Rubin JAMA. Published online April 5, 2023. doi:10.1001/jama.2023.4387 Colorectal cancer screening with an at-home stool test is more convenient than with a colonoscopy, but an abnormal result on the former still requires a follow-up with the latter. ...

Remote Ischaemic Conditioning in Septic Shock Septic shock is one of the most severe complications of any infection. It affects millions of people each year. Studies show that in the U.S. and Europe, nearly 10% of patients admitted to the ICU have septic shock. Significant efforts have been made to recognise and treat septic shock early. Still, over 50% of patients die of septic shock within days or weeks after diagnosis. Thus, there is a need for new therapeutic a...

Editorial  April 11, 2023 Lack of Benefit of Renin-Angiotensin System Inhibitors in COVID-19 Matthew M. Y. Lee, John J. V. McMurray JAMA. 2023;329(14):1155-1156. doi:10.1001/jama.2023.4405 There has been considerable interest in the potential role of renin-angiotensin system (RAS) inhibitors in patients with COVID-19 given that angiotensin-converting enzyme 2 (ACE2) is the functional receptor for SARS-CoV-2.1 Because ACE inhibitors and angiot...

ECMO for COVID-19 ARDS There is increasing evidence supporting the use of extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS) in patients that do not respond to maximal medical therapy. ARDS can occur in some COVID-19 patients who are hospitalised, and ECMO can be utilised as a treatment option in some cases. Using ECMO can help avoid ventilator-induced lung injury and give the lungs time to rest while waiting for recove...

Prone Positioning for Acute Hypoxaemic Respiratory Failure Prone positioning is a medical intervention that was initially proposed over 50 years ago as a way to improve gas exchange. Multiple clinical trials have been conducted on its effectiveness, with the Proning Severe ARDS Patients landmark trial demonstrating a mortality benefit in patients with severe ARDS. As a result, expert consensus and societal guidelines now recommend using prone positioning for severe...