2014 Canadian Guidelines for AF Management: Part 3: Unstable Patients with AF

We continue to discuss the latest recommendations for ED management of atrial fibrillation (AF) as presented in the newly published 2014 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation. The Guidelines PDF can be downloaded from the CCS website at 2014 Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation   Beware of Unstable […]

2014 Canadian Guidelines for AF Management: Part 2: ED Algorithm and Risk Stratification for Stroke

We continue to discuss the latest recommendations for ED management of atrial fibrillation (AF) as presented in the newly published 2014 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation. The Guidelines PDF can be downloaded from the CCS website at 2014 Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation   Clinical experience and […]

Electrical vs Chemical Cardioversion in ED patients with Atrial Fibrillation (RAFF2)

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 treated within 48 hours to avoid significant complications such as stroke […]

Pregnancy-Adapted YEARS Algorithm for Diagnosis of Suspected Pulmonary Embolism

Journal Club Summary Methodology Score: 4.5/5 Usefulness Score: 4.5 /5 van der Pol LM, et al. N Engl J Med. 2019 Mar 21;380(12):1139-1149 Question and Methods: Using a prospective cohort study of 510 pregnant women, the authors were trying to see whether an algorithm could safely diagnose PEs and avoid unnecessary imaging. Findings: YEARS algorithm can safely rule out PE […]

CRP-guided antibiotic treatment in acute exacerbations of COPD in hospital admissions

Journal Club Summary Methodology Score: 2.5/5 Usefulness Score: 3/5 Prins HJ, et al. Eur Respir J. 2019 May 23;53(5).  Question and Methods: The CATCH Study was a multicentre, randomised, controlled open intervention clinical trial comparing CRP guided antibiotics for COPDE vs the Gold Strategy Findings: The study had a 14.5% AAR in antibiotic use within 24 hours with a NNT […]

Thrombolysis Guided by Perfusion Imaging up to 9 Hours after Onset of Stroke

Journal Club Summary Methodology: 3.5/5 Usefulness: 2.5/5 Ma H, et al N Engl J Med. 2019 May 9;380(19):1795-1803 Editorial: Image-Guided Intravenous Alteplase for Stroke – Shattering a Time Window.  Question and Methods: This was an international, multicenter, randomized, placebo-controlled trial of intravenous tPA in patients with stroke who presented 4.5-9 hours after symptom onset and who had salvageable penumbra tissue on perfusion […]

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 […]

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 […]

Effect of Tamsulosin on Passage of Symptomatic Ureteral Stones: A Randomized Clinical Trial

Journal Club Summary Methodology: 4/5 Usefulness: 2.5/5 Meltzer AC, et al. JAMA Intern Med. 2018 Aug 1;178(8):1051-1057.  Editorial: Medical Expulsive Therapy for Ureteral Stones – Stone Age Medicine. Methods: This multi-center RCT of emergency department patients presenting with symptomatic renal colic compared Tamsulosin vs placebo in the rate of stone passage at 28 days based on patient report. Findings: It showed a very […]

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) […]