Funtabulously Frivolous Friday Five 361

Endotracheal intubation

Although first pass intubation is ideal and the gold standard, has this been for our ego or for best patient outcomes?

I think in our hearts we always knew it was both, as stress increases with every attempt, not only in our minds and hearts but in the patients’ physiology (or pathopshysiology). This study gives depth to the patient centred reasons of why first pass success is so important.

The most common major complication was hypoxaemia

Reference:

• April MD, Schauer SG, Nikolla DA, Casey JD, Semler MW, Ginde AA, Carlson JN, Long BJ, Brown CA 3rd. Association between multiple intubation attempts and complications during emergency department airway management: A national emergency airway registry study. Am J Emerg Med. 2024 Nov;85:202-207.

Screen time.

A 2021 JAMA study by Macnow, et al, divided a cohort of concussed American teenagers into standard care (home and bye) or screen abstinence for 48 hours. The screen time permitted group had a significantly longer median concussion recovery time of 8.0 days compared with 3.5 days in the screen time abstinent group.

Interestingly, the screen time permitted group reported a median screen time of 630 minutes in 48 hours, compared with 130 minutes in the screen time abstinent group. That’s a lot of screen time.

Traumatic brain injuries account for an estimated 2.5 million ED visits annually in the United States. Concussions are the most common form of traumatic brain injury, with adolescents contributing to the highest incidence of concussions. An estimated 1.6 to 3.8 million people experience a sports-related concussion annually in the US. If your patient can limit their screen time to less than one hour a day, given that complete abstinence seems a bit of a lofty goal in the current day and age, they will benefit.

Reference:

• Macnow T, Curran T, Tolliday C, Martin K, McCarthy M, Ayturk D, Babu KM, Mannix R. Effect of Screen Time on Recovery From Concussion: A Randomized Clinical Trial. JAMA Pediatr. 2021 Nov 1;175(11):1124-1131
• Rabaza C, Piggott C, Lyon C. Put down the electronics after a concussion? J Fam Pract. 2023 Jan;72(1):E10-E12.

Respiratory syncytial virus (RSV)

Nirsevimab is a monoclonal antibody with an extended half-life, and is approved for the prevention of RSV–associated lower respiratory tract illness in neonates and infants during their first RSV season.

In March, 2023, Galicia, a region in northwest Spain with approximately 2.7 million inhabitants and 14,495 annual births as of 2022, became one of the first places in the world to introduce nirsevimab into its immunisation calendar as a prophylactic measure against RSV.

0·3% of 9408 infants who received nirsevimab versus 1·9% of 851 who did not receive nirsevimab were hospitalised for RSV-related LRTI, corresponding to an effectiveness of 82%. Effectiveness was

• 86·9% against severe RSV requiring oxygen support,
• 69·2% against all-cause LRTI hospitalisations,
• 66·2% (56·0–73·7) against all-cause hospitalisations.

In Australia 2006-2015, there were 63,814 hospitalisations with an RSV principal diagnosis; 94.9% were of children under 5 years of age. Where the hospitalisation rate for children under 5 years was 418 / 100 000, for children under 6 months of age it was 2224 / 100 000. The highest rate is for infants up to 2 months old, 2778 / 100 000. RSV hospitalisation rates were higher for adults aged 65, and were also higher for Indigenous Australians than other Australians.Reference:

• Saravanos GL, Sheel M, Homaira N, Dey A, Brown E, Wang H, Macartney K, Wood NJ. Respiratory syncytial virus-associated hospitalisations in Australia, 2006-2015. Med J Aust. 2019 Jun;210(10):447-453.
• Ares-Gómez S et al. Effectiveness and impact of universal prophylaxis with nirsevimab in infants against hospitalisation for respiratory syncytial virus in Galicia, Spain: initial results of a population-based longitudinal study. Lancet Infect Dis. 2024 Aug;24(8):817-828
  

Dupuytren contracture

Given I have recently acquired said contracture in my right (dominant) hand, I was interested to read the Oct 9, 2024 NEJM an article directly comparing limited fasciectomy to collagenase injection.

I had to read the ‘plain language summary’ to make sense of the confusing double negative conclusion the authors arrived at: “Collagenase injection was not noninferior to limited fasciectomy”.

Reference:

• Dias J et al. Collagenase Injection versus Limited Fasciectomy for Dupuytren’s Contracture. N Engl J Med. 2024 Oct 24;391(16):1499-1510
• Baron Guillaume Dupuytren (1777-1835)
• Dupuytren contracture. Eponymictionary