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Journal Feed Weekly Wrap-Up

We always work hard, but we may not have time to read through a bunch of journals. It’s time to learn smarter.
Originally published at JournalFeed, a site that provides daily or weekly literature updates.
Follow Dr. Clay Smith at @spoonfedEM, and sign up for email updates here.

#1: When to Start Norepinephrine for Septic Shock?

Spoon Feed
In a meta-analysis of patients with septic shock, starting norepinephrine earlier had no mortality benefit, though heterogeneity and bias limit clinically relevant conclusions.

Source
Comparison of Early and Late Norepinephrine Administration in Patients With Septic Shock: A Systematic Review and Meta-Analysis. Chest. 2024 Dec;166(6):1417-1430. doi: 10.1016/j.chest.2024.05.042. Epub 2024 Jul 5. PMID: 38972348

#2: Ketamine vs. Etomidate – 7 RCTs Combined

Spoon Feed
Ketamine has no difference in mortality, organ dysfunction, or first-pass success when compared to etomidate but may be associated with higher peri-intubation hemodynamic instability and need for vasopressors just after intubation.

Source
Ketamine Versus Etomidate for Rapid Sequence Intubation: A Systematic Review and Meta-Analysis of Randomized Trials. Crit Care Med. 2024 Nov 21. doi: 10.1097/CCM.0000000000006515. Epub ahead of print. PMID: 39570063

#3: “I Can’t Breathe” Means EMERGENCY – Avoiding Restraint Deaths

Spoon Feed
Restraint in the prone position is commonly used by law enforcement officers, but this technique impairs effective ventilation and increases the risk of death for restrained individuals. Take “I can’t breathe” statements seriously in this population.

Source
Handcuffs and Unexpected Deaths – “I Can’t Breathe” as a Medical Emergency. N Engl J Med. 2024 Nov 30. doi: 10.1056/NEJMp2407162. Epub ahead of print. PMID: 39620456

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