One-Liners, Part Two

Digging out of the archives of the past few weeks.

Futile and Harmful Reperfusion and the Balance Between Treatment Effect and Overall Outcomes in Stroke

You don’t see many articles like this coming out of the stroke literature – the vast majority are: damn the torpedoes, everyone’s a candidate for therapy! The authors sum it up nicely, right there in the abstract: “[I]n an individual patient, reperfusion does not necessarily or uniformly translate into meaningful improvement and favorable outcomes. The concept of futile reperfusion is real.” And “[I]n a small subset of patients, reperfusion may actively worsen outcome; this is harmful reperfusion. While additional harm may seem negligible in such a high-risk population, this rationale is flawed as it encourages therapeutic actionism and violates the foundational medical ethical principle of primum non nocere.” These authors have nailed it.

Single Dose Epinephrine Protocol Is Associated With Improved Survival of Older Adults With Out-Of-Hospital Cardiac Arrest

Not sure what to make of this concept that “single dose epinephrine is superior”. It seems irrevocably confounded by indication to say patients who only receive a single dose fare better than those who required additional doses. That said, yes, epinephrine Isn’t Good For You.

Emergency Physician Versus Telemedicine Psychiatrist Impression of Patient Need for Inpatient Psychiatric Care

Again, not sure what to make of “emergency physicians and psychiatrists don’t consistently agree”. What’s the gold standard? This study would benefit greatly from an in-person psychiatric assessment as another comparator arm.

Pickleball-Related Ocular Injuries Among Patients Presenting to Emergency Departments

Injuries associated with popular sport have increased in tandem with said sport’s popularity. Real talk.

Arterial Doppler Ultrasound Blood Flow Waveforms During Chest Compressions to Detect Arterial Line Pulsatility

Just a pilot article, but I suspect these sorts of non-invasive applications are going to rapidly increase as technology advances. Why put in an arterial line solely for hemodynamic evaluation if ultrasound can give you equivalent information without the time-cost of line insertion? The Future.

Early Warning Score Performance at Time of Admission in the Prediction of Future Organ Support Needs

Sick people look sick, and have NEWS2 scores reflective of looking sick. A lot of work being put into machine learning models and “AI” prediction of future ICU admission, but NEWS2 still gives an AUROC of ~0.8 for various serious outcomes. Unfortunately, the balance between sensitivity and specificity likely strays into that “clinically unusable” area, as do many in this realm.