Date: September 21, 2016
Host: Dr. Goulding
- Irazuzta JE, Paredes F, Pavlicich V, Domínguez SL. High-Dose Magnesium Sulfate Infusion for Severe Asthma in the Emergency Department: Efficacy Study. Pediatric Critical Care Medicine. 2016 Feb 1;17(2):e29-33.
Junior: Donovan MacDonald
Senior: Tristan Jones
Staff: Dr. Wong
Bottom Line: Most of the attending physicians present would try a high-dose Mg infusion if all other therapies were already in progress, and only in kids that would need IV access for other reasons. There was a trend in the discussion towards trying a 1 hour infusion (a.k.a. single bolus dose) and then discussing with the admitting paediatrician to see whether they would like to continue it.
- Ortiz M, Martín A, Arribas F, Coll-Vinent B, del Arco C, Peinado R, Almendral J. Randomized comparison of intravenous procainamide vs. intravenous amiodarone for the acute treatment of tolerated wide QRS tachycardia: the PROCAMIO study. European Heart Journal. 2016 Jun 28:ehw230.
Junior: Chris Applewhaite
Senior: Adam Thomas
Staff: Dr. Ricketson
Bottom Line: Concern about the low enrolment numbers and open-label nature of the trial. Procainamide is not a bad drug, but if there is any doubt about the appropriateness of chemical cardioversion, electrical cardioversion is probably safer and as or more effective. Amiodarone is a non-specific cardiac poison and may be unnecessary in some of these patients. Already a significant amount of Procainamide use in our local practice pattern.
- Weingart SD, Trueger NS, Wong N, Scofi J, Singh N, Rudolph SS. Delayed sequence intubation: a prospective observational study. Annals of emergency medicine. 2015 Apr 30;65(4):349-55.
Junior: Leigh Sadler
Senior: Tristan Jones
Staff: Dr. MacPherson
Bottom Line: This is really just a case series, and a comparison, randomized trial would be useful. It isn’t clear how this balances out against RSI without adequate preoxygenation. That being said, the consensus was that this is probably quite reasonable to do, and in fact is already fairly common practice in our local group.
** The bottom lines recorded here are a synthesis of the discussion at our local journal club and are not intended to be construed as clinical advice.