Effect of Fluid Bolus Administration on Cardiovascular Collapse Among Critically Ill Patients Undergoing Tracheal Intubation: A Randomized Clinical Trial.

Importance: Hypotension is common during tracheal intubation of critically ill adults and increases the risk of cardiac arrest and death. Whether administering an intravenous fluid bolus to critically ill adults undergoing tracheal intubation prevents severe hypotension, cardiac arrest, or death remains uncertain.

Objective: To determine the effect of fluid bolus administration on the incidence of severe hypotension, cardiac arrest, and death.

Protocol and statistical analysis plan for the PREventing cardiovascular collaPse with Administration of fluid REsuscitation during Induction and Intubation (PREPARE II) randomised clinical trial.

Introduction: Cardiovascular collapse is a common complication during tracheal intubation of critically ill adults. Whether administration of an intravenous fluid bolus prevents cardiovascular collapse during tracheal intubation remains uncertain. A prior randomised trial found fluid bolus administration to be ineffective overall but suggested potential benefit for patients receiving positive pressure ventilation during tracheal intubation.

Emulating a Novel Clinical Trial Using Existing Observational Data. Predicting Results of the PreVent Study.

"Target trial emulation" has been proposed as an observational method to answer comparative effectiveness questions, but it has rarely been attempted concurrently with a randomized clinical trial (RCT). We tested the hypothesis that blinded analysts applying target trial emulation to existing observational data could predict the results of an RCT. PreVent (Preventing Hypoxemia with Manual Ventilation during Endotracheal Intubation) was a multicenter RCT examining the effects of positive-pressure ventilation during tracheal intubation on oxygen saturation and severe hypoxemia.

Utility and diagnostic accuracy of bedside lung ultrasonography during medical emergency team (MET) activations for respiratory deterioration.

Purpose: We investigated the feasibility and diagnostic accuracy of lung ultrasonography during medical emergency team (MET) activations for respiratory deterioration.

Material And Methods: We performed a prospective study of inpatients requiring MET evaluation for respiratory decompensation. A blinded investigator recorded videos of lung and lower extremity ultrasonography.

Independent lung ventilation in the management of ARDS and bronchopleural fistula.

Independent lung ventilation is a decades-old, but infrequently used technique for physiological separation in critically-ill patients with asymmetric lung disease. Here we present a case report of bilateral necrotizing pneumonia complicated by acute respiratory distress syndrome and bronchopleural fistula, which was successfully managed with independent lung ventilation. The use of independent lung ventilation allowed for adequate oxygenation with use of high positive end expiratory pressure in the "good lung" while simultaneously allowing for closure of the bronchopulmonary fistula in the contralateral lung by maintaining relatively low airway pressures.

Can We Trust Observational Studies Using Propensity Scores in the Critical Care Literature? A Systematic Comparison With Randomized Clinical Trials.

Objective: To assess the degree of agreement between propensity score studies and randomized clinical trials in critical care research.

Data Sources: Propensity score studies published in highly cited critical care or general medicine journals or included in a previous systematic review; corresponding randomized clinical trials included in Cochrane Systematic Reviews or published in PubMed.

Study Selection: We identified propensity score studies of the effects of therapeutic interventions on short- or long-term mortality.

Left-sided superior vena cava and venous hyperoxia masquerading as inadvertent carotid artery catheterization.

Background: A persistent left-sided superior vena cava (PLSVC) is a rare, often asymptomatic, venous anomaly that may be first diagnosed during central venous catheterization. During chest radiograph interpretation, a PLSVC can be confused with inadvertent arterial catheterization.

Case Report: We describe the presentation of a 45-year-old man with end-stage liver disease who required central venous catheterization for treatment of septic shock.

Resource utilization and end-of-life care in a US hospital following medical emergency team-implemented do not resuscitate orders.

Background: Medical emergency teams frequently implement do not resuscitate orders, but little is known about end-of-life care in this population.

Objective: To examine resource utilization and end-of-life care following medical emergency team-implemented do not resuscitate orders.

Design: Retrospective review.

The effect of body mass index on intubation success rates and complications during emergency airway management.

We evaluated the effect of body mass index (BMI) on intubation success rates and complications during emergency airway management. We retrospectively analyzed an airway registry at an academic medical center. The primary outcomes were the incidence of difficult intubation and complication rates, stratified by BMI.

Ultrasonography-guided peripheral intravenous catheter survival in ED patients with difficult access.

Objectives: We determined the survival and complications of ultrasonography-guided peripheral intravenous (IV) catheters in emergency department (ED) patients with difficult peripheral access.

Methods: This was a prospective, observational study conducted in an academic hospital from April to July of 2007. We included consecutive adult ED patients with difficult access who had ultrasonography-guided peripheral IVs placed.

Ruptured abdominal aortic aneurysm presenting as painless testicular ecchymosis: the scrotal sign of Bryant revisited.

The diagnosis of ruptured abdominal aortic aneurysm (AAA) is often missed as a result of an atypical presentation, resulting in increased mortality. Here we present an unusual case of painless scrotal ecchymosis as a presentation of ruptured AAA. We review the origin of the scrotal sign of Bryant and emphasize the importance of this uncommon finding as a diagnostic aid in atypical cases of ruptured AAA.

The painful eye.

Emergency physicians are required to diagnose and treat patients who have a painful eye on a regular basis. This article focuses on ophthalmologic emergencies that range in presentation from mild to severe symptomatology and include vision and eye-threatening ailments. The etiology, pathophysiology, physical examination, and treatment of the following conditions are discussed: acute angle closure glaucoma, scleritis, anterior uveitis, optic neuritis, keratitis, and corneal abrasion.