Guidelines for Emergency Airway Management of COVID-19

Guiding Principles Suspected SARS-COV-2 patients showing signs of hypoxemic respiratory failure should be intubated proactively, as early as possible. Signs may include FiO2 requirement > 50%, clinical signs of respiratory fatigue despite supplemental oxygen, or hemodynamic instability. Do not wait for rapid deterioration to act! Such unstable respiratory failure patients in the ED – whether under the care of Emergency […]

Ticagrelor or Prasugrel in Patients with Acute Coronary Syndromes

Methodology Score: 4/5 Usefulness Score: 4/5 Schüpke S, et al N Engl J Med. 2019 Oct 17;381(16):1524-1534. Editorial: Ticagrelor or Prasugrel in Acute Coronary Syndromes – The Winner Takes It All? Question and Methods: This open-label multicenter trial was the first head-to-head trial examining Ticagrelor vs Prasugrel as part of DAPT in ACS requiring angiography. Findings: The authors found that […]

Bupropion – Picking our Poisons

What is Bupropion? Bupropion is an anti-depressant commonly prescribed for seasonal affective disorder, as a smoking cessation aid, and off-label in the management of major depressive disorder. You may know it by the trade names Wellbutrin, Zyban or Champix. While frequently compared to SSRIs, it has a unique mechanism of action – it is a norepinephrine-dopamine reuptake inhibitor, with barely […]

Effect of Vitamin C, Hydrocortisone, and Thiamine vs Hydrocortisone Alone on Time Alive and Free of Vasopressor Support Among Patients With Septic Shock: The VITAMINS Randomized Clinical Trial

Methodology: 4/5 Usefulness: 3/5 Fujii T, et al. JAMA. 2020 Jan 17. doi: 10.1001/jama.2019.22176. [Epub ahead of print] Editorial: Lack of Benefit of High-Dose Vitamin C, Thiamine, and Hydrocortisone Combination for Patients With Sepsis. Question and Methods: International, multicenter, open-label RCT to determine whether HAT (hydrocortisone, ascorbate, thiamine) compared with hydrocortisone alone, improves the duration of time alive and free […]

Managing Stress and Anxiety related to COVID-19

As Bob Dylan once said; “Times, they are a-changin’”. With respect to the novel coronavirus-19 (COVID-19), the situation in Canada and around the globe is changing rapidly and aggressively. As part of the first responder network, Emergency Departments (ED) and it’s health care teams are in a powerful position to mobilize and act fast to respond to the pandemic. First-line […]

Hypothermia Part 2: Prognostication and Protocols

Here we present part two on our series on hypothermia. For more on the assessment, resuscitation, and management of the hypothermic patient, see part one. Prognostication of cardiac arrest in hypothermia Indicators of cardiac arrest before cooling (Brown 2012) Major trauma Witnessed normothermic arrest Avalanche burial <35 min Patients with primary hypothermia and cardiac stability who have been treated with […]

Alcohol Abstinence in Drinkers with Atrial Fibrillation

Methodology: 5/5 Usefulness: 3.5/5 Voskoboinik A, et al. N Engl J Med. 2020 Jan 2;382(1):20-28.  Editorial: A Sober Reality? Alcohol, Abstinence, and Atrial Fibrillation. Question/Methods: Among adults who consume ≥10 drinks/week with symptomatic paroxysmal or persistent atrial fibrillation successfully converted to sinus rhythm, investigators conducted a multicentre RCT of control versus alcohol abstinence. Two blinded cardiologists reviewed tracings from intensive […]

Hypothermia: Keeping your cool when it gets cold

Hypothermia results in slightly over one hundred deaths per year in Canada; typically as a result of primary hypothermia, frostbite and other cold exposure injuries (Toronto Public Health, 2014). In the United States, this is estimated at 1500 deaths annually (Baumgartner 2008). Both are likely underestimates of the scope of illness, as it only represents patients brought to a hospital, […]