Pneumonia: Getting In-Sync with the Guidelines

Community-acquired pneumonia is the leading infectious cause of death in Canada, and combined with influenza is the 7th most common cause of death overall. Diagnosis The 3 main pillars leading to the diagnosis of pneumonia are as follow: Evidence of infection (fever, chills, leukocytosis) Signs and symptoms localized to the respiratory system (cough, SOB, sputum, chest pain, crackles on auscultation, elevated RR, low […]

Subdissociative‐dose Ketamine Is Effective for Treating Acute Exacerbations of Chronic Pain

Methodology: 2/5 Usefulness: 2.5 /5 Lumanauw DD, et al. Acad Emerg Med. 2019 Sep;26(9):1044-1051. doi: 10.1111/acem.13755. Epub 2019 Apr 29. Question and Methods: A randomized placebo-controlled trial to determine if sub-dissociative dose Ketamine (SDDK) is effective for treating acute exacerbations of chronic Pain in the emergency department. Findings: Ketamine infusions at both 0.5 and 0.25 mg/kg over 20 minutes were effective […]

Community Paramedicine: Behind the Scenes

What is Community Paramedicine? The international round table on community paramedicine provides the following definition: “…a model of care whereby paramedics apply their training and skills in non-traditional community-based environments outside of the usual emergency response/transport model. The community paramedic practices in an expanded role; working in non-traditional roles using existing skills.”(1) Models of Care in Community Paramedicine The CSA group describes 3 models […]

Oral Lefamulin vs Moxifloxacin for Early Clinical Response Among Adults With Community-Acquired Bacterial Pneumonia: The LEAP 2 Randomized Clinical Trial

Methodology: 4/5 Usefulness: 2/5 Alexander E., et al. JAMA. 2019 Sep 27. doi: 10.1001/jama.2019.15468. Editorial: Lefamulin-A New Antibiotic for Community-Acquired Pneumonia. Question and Methods: LEAP-2 was a phase 3, double-blinded RCT to determine non-inferiority of early clinical response of an oral lefamulin to oral moxifloxacin in Community Acquired Bacterial Pneumonia (CABP). Findings: Early clinical response rates were 90.8% with lefamulin and 90.8% with moxifloxacin (0.1%, -4.4% to infinity). […]

Diagnosis of Pulmonary Embolism with d-Dimer Adjusted to Clinical Probability

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 1325 patients with low or moderate pre-test probability and negative corresponding […]

Point-of-Care Ultrasound diagnosis of Endocarditis

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 contacts or recent travel. He denies any past medical or surgical […]

Effect of Low-Dose Supplementation of Arginine Vasopressin on Need for Blood Product Transfusions in Patients With Trauma and Hemorrhagic Shock: A Randomized Clinical Trial

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. Vasopressin significantly decreased the volume of blood products given in the […]