High-Impact Studies Review — June 2025 (1/4)

Stay updated with breakthrough research in emergency medicine, critical care, and advanced therapeutics.

Featured Educational Video

In this episode of PACUPod, we explore three fresh studies with immediate implications for acute care practice. First, we unpack a prospective trial comparing oxymetazoline, tranexamic acid, and an epinephrine–lidocaine mix for treating nosebleeds. Oxymetazoline emerges as the clear winner, demonstrating rapid, effective bleeding control—crucial for emergency settings. Next, we delve into a phase II trial investigating whether IV salbutamol can alleviate renal colic pain. Despite its theoretical promise, the study found no significant benefit, adding nuance to the debate over non-traditional analgesics. Finally, we tackle the perennial challenge of IV insertion pain. A head-to-head comparison of vapocoolant spray and lidocaine–prilocaine cream reveals comparable pain relief, but the spray’s immediacy and fewer side effects may give it the upper hand. Tune in for these evidence-based updates, each ready to reshape your practice at the bedside.

1. Comparison of the Efficacy of Oxymetazoline, Tranexamic Acid, and Epinephrine-Lidocaine Combination in the Treatment of Epistaxis

American Journal of Emergency Medicine | 2025

This prospective ED study compared three topical agents—oxymetazoline, tranexamic acid, and an epinephrine-lidocaine mix—to determine which achieves the fastest and most durable hemostasis for non-traumatic epistaxis.

Key Findings

Highest Hemostasis Success: Oxymetazoline controlled bleeding in 71% of cases, outperforming tranexamic acid (55%) and epinephrine-lidocaine (49%).
Statistically Significant Advantage: Oxymetazoline’s superiority reached significance (p=0.007).
Practical Implications: Rapid action and easy availability make oxymetazoline a pragmatic first-line choice in EDs.

Clinical Pharmacist's Perspective

Stock oxymetazoline and integrate it into epistaxis protocols; provide team education on correct dosing to optimize bleeding control and reduce returns.

Full Article

2. Salbutamol for Analgesia in Renal Colic: A Prospective, Randomised, Placebo-Controlled Phase II Trial

Emergency Medicine Journal | 2025

Investigated whether a single 250 µg IV dose of salbutamol, given alongside standard therapy, provides superior pain relief for ED patients with confirmed renal colic.

Key Findings

No Additional Analgesic Benefit: Median pain-score reduction at 30 min was similar between salbutamol (-18 mm) and placebo (-13 mm); difference 5 mm, p=0.575.
Higher Adverse-Event Burden: 65 AEs in the salbutamol arm vs 42 with placebo (p=0.02).
Clinical Implication: Routine IV salbutamol is not justified for renal-colic pain control.

Clinical Pharmacist's Perspective

Focus on established multimodal analgesia (NSAIDs ± opioids); reserve salbutamol for bronchospasm rather than ureteric spasm until larger efficacy data emerge.

Full Article

3. Vapocoolant Spray vs Lidocaine-Prilocaine Cream for Reducing Pain of Intravenous Cannulation: A Randomised Controlled Trial

Emergency Medicine Journal | 2025

Compared a rapid-acting vapocoolant spray (applied 30 s pre-cannulation) with lidocaine-prilocaine cream (45 min pre-cannulation) in adult ED patients requiring peripheral IV access.

Key Findings

Comparable Pain Scores: Median NRS pain 2 with spray vs 3 with cream (p=0.09).
Fewer Adverse Effects: Transient paleness occurred in 31% overall—predominantly in the cream group (p=0.03).
Greater Patient Preference: 43% opted to reuse the spray vs 27% for the cream (p=0.02).

Clinical Pharmacist's Perspective

Vapocoolant offers a fast, low-cost option when time constraints preclude topical-cream dwell times; monitor skin reactions and document patient preferences for future procedures.

Full Article

🔎 Final Takeaways:

Oxymetazoline for Epistaxis: Achieves the highest and fastest hemostasis success, supporting its adoption as first-line topical therapy in the ED.
IV Salbutamol in Renal Colic: Fails to improve pain relief and increases adverse events—avoid routine use for ureteric pain control.
Vapocoolant Spray for IV Access: Offers comparable analgesia to lidocaine-prilocaine cream with near-instant application, ideal when rapid cannulation is required.