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"The Point of Care’’ — IS the PATIENT

29/4/2016

In the April edition of the Journal of The American Society of Echocardiography, Dr Susan E. Wiegers, a cardiologist and the president of the society, published the attached (short) statement - strongly supporting Point Of Care Ultrasound (POCUS). A few quotes say it all:

"There is no denying that if I were to suffer a sudden hemodynamic collapse and would wind up in an emergency department, I would want it to be one in which the emergency physicians were fully trained in POCUS (point of care ultrasound) and knew how to apply it to patient care”.
"I see POCUS as part of the continuum of care”.
"If our goal is to ensure ‘‘the right test at the right time’’ then we can all agree that ‘‘The Point of Care’’—IS the PATIENT".

Point Of Care US is no longer the future. It is the present, and is a core component of Emergency Medicine mastery. It is exciting to see such a formal endorsement in an echocardiography journal.

Click here to download (open access): http://www.onlinejase.com/article/S0894-7317(16)00090-0/pdf

Danny

Dr Danny Ben-Eli, BSc, MD, FACEM

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Myocarditis review

21/4/2016

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Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest

11/4/2016

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Multiple studies questioned use of adrenaline during out of hospital cardiac arrest, showing increased likelihood ROSC, at the expense of worse neurological outcomes (see here and here).

This week sees the publication of another study, questioning utility (or possibly futility) of Amiodarone or Lignocaine for out-of-hospital cardiac arrest for shock-refractory ventricular fibrillation or pulseless ventricular tachycardia (open access here)

In this randomised, double-blind trial, researchers compared parenteral amiodarone, lidocaine, and saline placebo, along with standard care, in adults who had non-traumatic out-of-hospital cardiac arrest, shock-refractory ventricular fibrillation or pulseless ventricular tachycardia after at least one shock, and vascular access. Paramedics enrolled patients at 10 North American sites.

The primary outcome was survival to hospital discharge; the secondary outcome was favourable neurologic function at discharge.

3026 patients were randomly assigned to amiodarone (974), lidocaine (993), or placebo (1059). 24.4%, 23.7%, and 21.0%, respectively, survived to hospital discharge. Neurologic outcome at discharge was similar in the three groups.

There was some indication that giving drugs early was associated with improved outcomes (not statistically significant).

The authors conclude that overall, neither amiodarone nor lidocaine resulted in a significantly higher rate of survival or favourable neurologic outcome than the rate with placebo among patients with out-of-hospital cardiac arrest due to initial shock-refractory ventricular fibrillation or pulseless ventricular tachycardia.

However they did add the following comment - "Nonetheless, the suggestion that survival was improved by drug treatment in patients with witnessed out-of-hospital cardiac arrest, without evidence of harm in those with unwitnessed arrest, merits thoughtful consideration."

Food for thought for your next VF case.

Danny

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﻿"The Point of Care’’ — IS the PATIENT

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Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest

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"The Point of Care’’ — IS the PATIENT