In this retrospective cohort of pre-hospital patients with suspected opiate overdose, the patients in the intranasal group and the intravenous group had about the same mean time to clinical response (20 vs 21 minutes). In patients with no IV access, intranasal naloxone is an effective alternative (abstract)

In this retrospective cohort of US patients, researchers found that the number of cardiac implanted electronic devices increased 12% (from 2004 to 2006), and the number of device infections increased 57% in that same time period. Hospitalists should expect to see an increasing number of device infections, as the number of implantations increase in patients with more co-morbidities (abstract).

The anti-viral medication Zanamivir (Relenza), should be administered via a diskhaler device, is not supposed to be suspended and dispensed via nebulizer or mechanical ventilation. The FDA has released a report of a pregnant woman with influenza, who died in relation to the use of zanamivir, which was suspended and administered through a mechanical ventilator, and caused a malfunction in the ventilator equipment (FDA site). The FDA has approved the use of IV peramivir for critically ill patients with influenza.

In this large retrospective study of out-of-hospital cardiac arrests, researchers evaluated survival before and after the 2005 update to the American Heart Association (AHA) CPR guide. They found a 1.8 greater adjusted odds of survival after 2005. In a convenience sample of EKG strips, they also found improvements in CPR quality, including higher chest compression rates, higher proportion of time spent in chest compressions, and shorter chest compression pause times. Since the revision of the AHA guidelines, CPR quality and mortality have improved (abstract)

The FDA has issued an emergency use authorization (EUA) for the IV drug Peramivir in children and adults hospitalized with (suspected or confirmed) H1N1. This drug should be used in patients who have not responded (or are not expected to respond) to oral or inhaled anti-viral therapy, or for which the provider determines that IV therapy is appropriate and warranted. Clinicians considering it’s use should read this (Fact Sheet)

The FOUR score (Full Outline of UnResponsiveness),  is a new coma scale (range 0-16) with 4 components (eye response, motor response, brainstem reflex, and respiration pattern) which was validated against the Glascow coma scale (GCS) in 100 medical ICU patients. The FOUR score and GCS were almost identical in their ability to predict poor neurologic outcome, and the FOUR score was able to be performed reliably (with excellent interrater reliability). It is also able to be performed in intubated patients. The FOUR score may become a popular coma scale in critically ill medical patients (abstract).

In this trial of 197 obese patients randomized to either gastric bypass or gastric banding, bypass was more effective (higher percentage of excessive weight, and lower percentage of failures), but bypass was associated with more complications (both short and long term). The risk of complications (primarily bowel obstructions and strictures) should be weighed against the risk of lower efficacy, in deciding type of obesity surgery to perform (abstract). Although these findings seem intuitive, this is the largest randomized trial to date quantifying the risks and benefits of these 2 surgical approaches.

In this analysis of a large cardiovascular registry, of the patients with moderate to severe systolic CHF who were eligible for aldosterone antagonist therapy, only 1/3 received it at discharge. Many patients eligible for aldosterone antagonist therapy do not receive it (abstract)

This cohort study determined the risk of major peri-operative adverse cardiac events (death, MI, repeat revascularization) in patients undergoing non-cardiac surgery after the placement of a bare metal or drug eluting stent. They found the risks of major adverse events after bare metal stenting were 50%, 14%, and 4% (<1month, 1month-3months, and >3months, respectively). Risks after drug eluting stenting were 35%, 13%, 15%, 6%, and 9% (<1month, 1-3months, 3-6months, 6-12months, and >12months). Of the patients that experienced an adverse cardiac event, all were on anti-platelet therapy (45% on single agent, 55% on dual agent). Risks of cardiac events after non-cardiac surgery are substantial in the time after a stent, even in patients on dual anti-platelet therapy (abstract). Non-cardiac surgery should be deferred as long as feasible in patients post-stent (at least 1.5 months for bare metal stents, and at least 1 year for drug eluting stents), which is in line with current practice guidelines.

In this large cohort of 94,917 patients who received gadolinium-based contrast over an 8 year period, the risk of developing NSF was 1% among hemodialysis patients and 0.8% among renal transplant patients (abstract). Although retrospective, the large cohort study helps to quantify the risk of NSF among patients with significant renal insufficiency.