Explore the vast range of titles available.

Documented symptomatic hypoglycemia is defined as “event during which typical symptoms of hypoglycemia are accompanied by measured blood glucose of ≤70 mg/dL. Most of the studies and recommendations for the unconscious hypoglycemic adult advocate the use of 25 g of glucose as 50 mL of 50% dextrose solution intravenous or 1 mg of intramuscular glucagon. To compare the efficacy and safety of 5 g boluses of 10%, 25% and 50% dextrose in the treatment of hypoglycemic patients presenting to our emergency department. This was a randomized controlled single blinded study. Hypoglycemic patients in altered mental status were randomized into three treatment arms to be administered 10%, 25% or 50% dextrose. 5 g aliquots of intravenous 10%,25% or 50% dextrose were administered over 1 min. Time taken to achieve a Glasgow Coma Scale (GCS) of 15 and median total doses (g) were the primary outcomes. Data of 204 patients were analysed in the study. There was no difference in the median time to achieve a GCS of 15 in all three treatment arms (6 min). Total median dose administered in the 10% and 25% groups was lower than 50% (10 g vs 15 g). Proportion of patients who received the maximum dose of 25 g was higher in the 50% group as compared to 10% and 25% groups (12%, 3%, 4%). There was no difference in 10% dextrose and 25% dextrose as compared to 50% dextrose in achieving the baseline mental status (or GCS 15) in the treatment of hypoglycemia in the ED.

Acute coronary syndromes (ACS) are the most common presentation of atherosclerotic cardiovascular diseases in the emergency department. Numerous risk factors such as smoking, low High Density Lipoprotein (HDL) levels, metabolic syndrome, high triglycerides, diabetes, etc. have been implicated in the development of coronary artery disease and ACS. The management tools instead of focusing on the reversal of the above risk factors relies on lipid lowering drugs. Our series of patients suffering from ACS shows a possible association with low serum vitamin B12, high homocysteine, high Triglyceride, low HDL, low cholesterol and low LDL levels. There needs to be a paradigm shift in managing patients of ACS and the advice prescribed to them at the time of discharge. It would be prudent for emergency physicians to test for vitamin B12 and homocysteine levels in ACS patients.

In modern times, the emergency physician (EP) has access to a host of video laryngoscopes (VL). There are different makes, models, angulations in the blades provided by different VLs. The blades may be channeled or non-channeled. In busy emergency departments (ED), ease and speed of intubations in managing the emergent airways may impact the outcome for the patient. The primary objective of our study was to compare the rates of first pass success using the channeled versus the non-channeled blades of the KingVision VL (KVVL). This was a randomized controlled single blinded study. All patients requiring emergent definitive airway management were included in the study. They were randomized into 2 groups – channeled and non-channeled KVVL. Intubations were carried out accordingly. First pass success, time taken to intubate and crossover between the blades were recorded. A total of 130 patients were enrolled in the study. First pass success for the channeled and non-channeled KVVL was 55.4 % and 81.6 % (p = 0.005) respectively. The mean time to intubate using the channeled and non-channeled KVVL were 24.69 s [95 % CI 20.25–29.13] and 28.95 s [95 % CI 23.64–34.26] (p = 0.207) respectively. A total of 33.07 % patients had crossovers between the blades. We found the non-channeled blades to have a significantly higher percentage of first pass success. Performance with respect to time to intubate was similar between the two. We recommend using the non-channeled KVVL for intubations in the EDs.