In this post, we review an approach to antibiotics, bronchodilators, and corticosteroids in the outpatient management for acute exacerbations of COPD. COPD – The Basics What is it? An incompletely reversible obstructive lung disease due to airway and/or alveolar abnormalities leading to airflow limitation and persistent respiratory symptoms Caused byRead More →
Journal Club Summary Methodology: 4/5 Usefulness: 2.5/5 Meltzer AC, et al. JAMA Intern Med. 2018 Aug 1;178(8):1051-1057. Editorial: Medical Expulsive Therapy for Ureteral Stones – Stone Age Medicine. Methods: This multi-center RCT of emergency department patients presenting with symptomatic renal colic compared Tamsulosin vs placebo in the rate of stone passage at 28Read More →
Care of the Elderly is an ever-growing, important, and prevalent part of an Emergency Physician’s repertoire of skills. With increasing numbers of elderly patients presenting to EDs across Canada, we look to discuss the issue of polypharmacy, prescribing, and deprescribing for this high risk population in the ED. After readingRead More →
Journal Club Summary Methodology Score: 3/5 Usefulness Score: 2/5 Atkinson PR, et al. Ann Emerg Med. 2018 Oct;72(4):478-489 Question and Methods: This was the first multicenter, prospective, RCT examining the effect of POCUS on 30-day survival of undifferentiated hypotensive patients presenting to ED. Findings: There was no important survival benefit with theRead More →
Methodology Score: 2.5/5 Usefulness Score: 2.5/5 Little P, et al. BMJ. 2017 May 22;357:j2148. Editorial: Controlling antibiotic prescribing for lower respiratory tract infections Scott AM et al. BMJ. 2017 May 22;357:j2398. doi: 10.1136/bmj.j2398. Question and Methods: This is a large, prospective, observational study of ambulatory patients with acute cough treated with no, immediateRead More →
Spinal epidural abscess (SEA) is a challenging diagnosis to make in the Emergency Department (ED), with a diagnostic delay occurring in about 75% of patients.[1] To ultimately make a diagnosis of SEA, patients typically require an MRI, and so physicians may often have diagnostic hesitancy, as MRI’s are such aRead More →
Journal Club Summary Methodology: 4/5 Usefulness: 4/5 Kent AP, et al. J Am Coll Cardiol. 2018 Jul 17;72(3):255-267 Question and Methods: This was a post hoc analysis of the RE-LY trial examining the risk of NSAID use in patients receiving oral anticoagulation (OAC) for atrial fibrillation. Findings: NSAID use wasRead More →
For other ultrasound cases see our POCUS archives Case Vignette 63-year-old male presents with a two-day history of groin pain and swelling. He has a history of hypertension and smoking. He takes an anti-hypertensive medication and an atypical antipsychotic for sleeping. The patient denies abdominal pain, nausea/vomiting, back pain, fevers, trauma.Read More →
I’ve recently spent some time thinking about what it means to be a mentor. We’re often thrust into this role – with very little training on how to actually do this. I’ve been fortunate enough to be surrounded by a plethora of excellent mentors and residents, and have noted some clear observationsRead More →
Journal Club Summary Methodology Score: 4/5 Usefulness Score: 5/5 Nogueira RG, et al. N Engl J Med. 2018 Jan 4;378(1):11-21 Editorial: A New DAWN for Imaging-Based Selection in the Treatment of Acute Stroke. Questions and Methods: DAWN was an open-label multi-centre RCT assessing functional outcomes of embolectomy compared with standardRead More →