The Unwritten Rules of Mentorship

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 observations on what seems to work well, beyond the evidence. This […]

Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct

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 standard medical therapy for patients presenting after 6 hours or awakening […]

EMS Bootcamp – An introduction to pre-hospital medicine

As dedicated in-hospital emergency providers, few of us truly understand or get to experience the difficulties and unique challenges facing our pre-hospital colleagues. Beyond the EMS handover and transfer of patient care, we seldom interact with this large and extremely important facet of our medical system. It is easy to forget that the pre-hospital environment is even more chaotic, uncontrolled, […]

Clopidogrel and Aspirin in Acute Ischemic Stroke and High-Risk TIA

Journal Club Summary Methodology Score: 3.5/5 Usefulness Score: 4/5 Johnston SC, et al. N Engl J Med. 2018 Jul 19;379(3):215-225 Editorial:  Antiplatelet Therapy after Ischemic Stroke or TIA. Question and Methods: This randomized, double-blind trial evaluated ASA + Clopidogrel (DAPT) against ASA alone for preventing ischemic events after a minor stroke/high-risk TIA. Findings: Although there was a significant reduction in DAPT group ischemic […]

Health Journalism: Does it matter?

Why Should You Care About Health Journalism? Patients receive health information from many sources—and it’s often not from you, their doctor. The accuracy of the health information available varies widely. Critical health journalism can help set records straight, as was the case with the now-debunked measles-mumps-rubella (MMR) vaccine safety controversy. What’s out there in the media has important consequences on […]

Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis

Journal Club Summary Methodology: 4/5 Usefulness: 4/5 Kuppermann N, et al. N Engl J Med. 2018 Jun 14;378(24):2275-2287. Editorial: Fluid Composition, Infusion Rate, and Brain Injury in Diabetic Ketoacidosis. Question and Methods: 13 centre RCT with four arms to determine the impact of fluid resuscitation rate and type on development of cerebral injury in children with DKA. Findings: In regard to […]

Focus on POCUS: Ultrasound in Delirium

For other POCUS focused cases please see our ultrasound archives Case The next chart you pick up is for an 87 year-old female brought in by EMS from her nursing home for agitation and vomiting. She is afebrile and her vital signs are normal. She has a past medical history of advanced dementia and a remote oophorectomy for ovarian cancer. […]

Atraumatic versus conventional lumbar puncture needles: a systematic review and meta-analysis

Journal Club Summary Methodology Score: 4/5 Usefulness Score: 5/5 Nath S, et al. Lancet. 2018 Mar 24;391(10126):1197-1204 Question and Methods: This meta-analysis sought to determine, in lumbar punctures, whether atraumatic or conventional (traumatic) spinal needles were superior in terms of their complication rates. Findings: Atraumatic spinal needles were superior to conventional needles in every outcome assessed, including decreased postdural-puncture headache (RR 0.4) […]

Procedural Sedation in the ED: Agents

In this two part series, we are delving into a few of the many controversies regarding procedural sedation and explore how to reduce resource utilization and ED length of stay. In PART 1, we discussed preprocedural fasting and concluded that adherence to fasting guidelines is unnecessary in healthy patients undergoing procedural sedation in the ED. A review of existing literature showed […]