Video Laryngoscopy Compared to Augmented Direct Laryngoscopy in Adult Emergency Department Tracheal Intubations: A National Emergency Airway Registry (NEAR) Study

Methodology: 2/5 Usefulness: 4/5 Brown CA 3rd, et al. Acad Emerg Med. 2020 Feb;27(2):100-108. Question and Methods: This was one the largest prospective, observational, ED-only airway studies to date comparing first-pass success (FPS) rates in “augmented” DL (A-DL) intubations with unaided VL intubations. Findings: FPS for unaided VL: 90.9% (95%CI 88.7-93.1%) vs. A-DL: 81.1%(78.7-83.5%). Multivariable AOR was 2.8 (2.4-3.3) in favour of […]

Trust the Process

“Trust the process” – a promise that our assistant Program Director (PD), Jen Leppard, makes on our first day of the EM year. I am new here, and I am nervous. But, as I walk into the ED, this feeling quickly vanishes, as I am reminded of what drew me to Ottawa in the first place – the teaching. Throughout […]

Does N-Terminal Pro-B-Type Natriuretic Peptide Improve the Risk Stratification of Emergency Department Patients With Syncope?

Methodology: 4/5 Usefulness: 3/5 Thiruganasambandamoorthy V, et al. Ann Intern Med. 2020 May 19;172(10):648-655. Methods: Prospective cohort study to evaluate whether adding NT-proBNP to the CSRS improves prediction of 30-day SAEs. Findings: Adding NT-proBNP provided no additional benefit to the model and would result in 10% of patients being correctly reclassified and 8.7% of patients being incorrectly reclassified in terms […]

Multicenter Emergency Department Validation of the Canadian Syncope Risk Score

Methodology: 4.5/5 Usefulness: 4.5/5 Thiruganasambandamoorthy V, et al. JAMA Intern Med. 2020 Mar 23;180(5):1-8.  Question and Methods: Prospective cohort validation to predict 30-day serious outcomes among ED patients with syncope Findings: 3819 patients had an overall 3.6% serious event rate at 30-days. At a score of -1, the CSRS had a Sn/Sp/NPV of 97.8%/44.3%/100% Limitations: Overlap in recruitment sites and […]

Diagnosis and Outpatient Management of Chronic Obstructive Pulmonary Disease: A Review

Methodology: 1/5 Usefulness: 2/5 Riley CM, et al. JAMA. 2019 Feb 26;321(8):786-797. Question: Aimed to review and provide practical information regarding the diagnosis and long-term management of patients with COPD in the outpatient setting. Methods: This was a systematic assessment where authors searched multiple sources and simply reviewed articles. Findings: They suggested the treatment of COPD should be done on a step-wise […]

The Status on Status: Management of Status Epilepticus

Status epilepticus (SE) is considered one of the most common neurological emergencies with an estimated incidence of 20 cases/100,000 people worldwide. Just the facts The distribution is bimodal, peaking in patients <1 and >60 years old.  In children, the cause is predominantly from febrile illnesses, with or without infection, and in adults it is largely secondary to acute damage from […]

Electrical versus pharmacological cardioversion for emergency department patients with acute atrial fibrillation (RAFF2): a partial factorial randomised trial.

Methodology: 4.5/5 Usefulness: 4/5 Stiell IG, et al. Lancet. 2020 Feb 1;395(10221):339-349 Editorial: Atrial fibrillation cardioversion in the emergency department.  Question and Methods: This partial factorial randomized trial aimed to determine which rhythm control strategy was superior; procainamide followed by electrical cardioversion if needed compared with electrical cardioversion alone. It also sought to determine whether anterolateral or antero-posterior pad placement […]

What a headache: Updates on Migraine Management

Migraine headaches are not a benign disease – they have a significant impact on quality of life, ability to function, and pose a considerable economic and societal burden. Prevalence tends to peak during peoples’ period of highest productivity.  According to the World Health Organization’s (WHO) update on Global Burden of Disease (2004), a severe migraine is considered to be as disabling […]