Methodology Score: 4/5 Usefulness Score: 4.5/5 Kearon C, et al. N Engl J Med. 2019 Nov 28;381(22):2125-2134 Question and Methods: the authors sought to demonstrate safety using a d-dimer cut-off of 1000ng/mL for low pre-test probability patients & a cut-off of 500ng/mL for moderate pre-test probability patients. Findings: Of 1325Read More →
A healthy patient presents to the Emergency Department (ED) where you are working one night. He complains of a four-day history of progressively worsening fatigue, constant and diffuse headache, neck stiffness, fever, chills and night sweats. There was no associated photophobia or phonophobia. He denies any infective symptoms, sick contactsRead More →
Methodology: 4/5 Usefulness: 2/5 Sims CA, et al. JAMA Surg. 2019 Aug 28. Question and Methods: Single-centre, double-blind, randomized control trial to determine whether low-dose vasopressin decreases the need for blood product transfusion in trauma patients with hemorrhagic shock. Findings: A total of 100 adult trauma patients were enrolled. VasopressinRead More →
RAFF2 Ian Stiell and colleagues are back at it with atrial fibrillation; The RAFF2 trial (Electrical versus Chemical cardioversion for Emergency Department patients with Atrial Fibrillation (RAFF2); A partial factorial randomized trial) was published in The Lancet this week. Acute atrial fibrillation is an irregular dysrhythmia that should be treatedRead More →
In September 2018, Dr. Bram Rochwerg and I wrote a blog post on the treatment of patients with sepsis and septic shock. Much of this was based on the 2016 Surviving Sepsis Campaign (SSc) Clinical Practice Guidelines [1]. However, in a little over a year, significant new research has alreadyRead More →
Methodology: 4/5 Usefulness: 4/5 Lyttle MD, et al. Lancet. 2019 May 25;393(10186):2125-2134. Question and Methods: Eclipse was an open label RCT that evaluated time to seizure cessation in pediatric SE between Keppra and Dilantin Findings: They found that Keppra was not superior (HR 1.2, 95%CI 0.91-1.60, p= 0.20) to DilantinRead More →
And on the 6th day Graham bellowed; “let thee environment be considered among thy seven dimensions of wellness.” And so, the environment was added to the wheel of physical, social, spiritual, occupational, intellectual, financial and emotional wellness. Although I have to confess, compared to the authors of this week’s blogs;Read More →
On a sweltering night in July, I’m called to see a patient with difficulty breathing. I work in Toronto, where past estimates have placed the number of heat-related deaths at about 120 each year. With Canada heating twice as fast as the world average, that number is likely rising. InRead More →
Increasing awareness of the urgency of climate change, led by the youth climate movement, and growing felt impacts of the health effects of climate change, including the devastating bushfires in Australia, are fuelling a global increase in interest in the concepts of “eco-anxiety” and “ecological grief.” How to cope withRead More →
As a species, we’re making bad choices – polluting the planet and making life difficult now, and perhaps impossible in the future. As physicians, it is time to do what you do best: heal the planet. Ok sure, that sounds corny, but take a listen and let me explain howRead More →