Prehospital Plasma during Air Medical Transport in Trauma Patients at Risk for Hemorrhagic Shock

Journal Club Summary Methodology Score: 3.5/5 Usefulness Score: 2.5 /5 Sperry JL, et al. N Engl J Med. 2018 Jul 26;379(4):315-326.  Question and Methods: Determine the efficacy of prehospital plasma compared with standard-care resuscitation in injured patients at risk for hemorrhagic shock during air medical transport to level 1 trauma centre Findings: Mortality at 30 days was 23.2% in the […]

Sodium Bicarbonate: Supply Shortages and Medical Shortcomings

We’re familiar with sodium bicarbonate as a simple buffer solution, which has been utilized for a myriad of medical indications backed up by physiologic rationale and occasional moderate-quality evidence. It comes in two forms; vials (typically for infusions) and pre-filled syringes (pushed in cardiac arrest). There have been on-an-off shortages of these formulations over the past several years, sparking a […]

Effect of a Strategy of Initial Laryngeal Tube Insertion vs Endotracheal Intubation on 72-Hour Survival in Adults With Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial

Journal Club Summary Methodology: 4/5 Usefulness: 3.5/5 Wang HE, et al. JAMA. 2018 Aug 28;320(8):769-778. Editorial: Pragmatic Airway Management in Out-of-Hospital Cardiac Arrest. Question and Methods: This multicenter pragmatic cluster-crossover randomized trial compared initial advanced airway strategy effectiveness between laryngeal tube (LT) and endotracheal intubation (ETI) in adults with OHCA. Findings: The LT group had higher 72-hour survival (18.3%) compared to ETI (15.4%; P=.04), […]

Identifying stroke mimics in the ED

In this post, we will aim to review the literature looking at identifying clinical and historical features that can help differentiate stroke mimics from strokes. We will also discuss the safety of the administration of IV tPA to misdiagnosed stroke mimics. This post will not focus on the recent developments in endovascular therapy for stroke and the implications of this. […]

Effect of Bag-Mask Ventilation vs Endotracheal Intubation During Cardiopulmonary Resuscitation on Neurological Outcome After Out-of-Hospital Cardiorespiratory Arrest: A Randomized Clinical Trial

Journal Club Summary Methodology Score: 3.5/5 Usefulness Score: 2.5/5 Jabre P, et al. JAMA. 2018 Feb 27;319(8):779-787. Question and Methods: This was a multicenter randomized trial comparing bag valve mask ventilation with endotracheal intubation performed by emergency physicians in 2043 patients with out-of-hospital cardiac arrest in France and Belgium Findings: Their primary outcome of favorable neurologic function at 28 days was 4.3% in the […]

Factors associated with treatment failure in non-purulent skin and soft tissue infections

Non-purulent skin and soft tissue infections (SSTIs; i.e. cellulitis or erysipelas) account for up to 3% of all emergency department (ED) visits. Once the diagnosis of a non-purulent SSTI is made, the emergency physician must select the appropriate antibiotic agent, dose, duration and route (oral or intravenous (IV)). Current guidelines regarding the optimal route of therapy are based on expert […]

Canadian Syncope Risk Score – Duration of Cardiac Monitoring

Syncope constitutes 1% of Emergency Department (ED) visits, and approximately 10% of these patients will have serious underlying conditions causing syncope (arrhythmia, MI, serious structural heart disease, pulmonary embolism, subarachnoid or severe hemorrhage). Alarmingly, half to one-third of these serious conditions will not be identified during ED evaluation. We previously derived the Canadian Syncope Risk Score to predict the probability of serious […]

A Systematic Review and Meta-analysis of Ketamine as an Alternative to Opioids for Acute Pain in the Emergency Department

Journal Club Summary Methodology Score: 4/5 Usefulness Score: 2/5 Karlow N, et al. Acad Emerg Med. 2018 Oct;25(10):1086-1097. Question and Methods: This was a systematic review and meta-analysis of low dose ketamine (LDK 0.3 – 0.5mg/kg) vs opioids for acute pain management in the ED. Findings: 3 studies were included suggesting LDK IV push was non-inferior to IV opioids for acute pain. The […]

Wellness Week – closing thoughts

In 2018, CAEP endorsed the creation of a Wellness Committee, led by Drs. Roderick Lim (chair), Sara Gray (vice-chair), Louise Rang (communications), Lisa Fischer (secretary), Jada Fitzpatrick (resident representative). To conclude the Canadian EM Wellness Week, the executive of the committee has put together some reflections on the importance of addressing Wellness in Emergency Medicine on a national level, as […]