Methodology Score: 4/5 Usefulness Score: 3/5 Venkatesh B, et al. N Engl J Med. 2018 Jan 19. Journal Club Bottom Line Question/Methods: This was a international, pragmatic, double-blind, randomized, controlled trial comparing hydrocortisone as continuous infusion to placebo in patients with septic shock on mechanical ventilation and at least 4-hoursRead More →
In this post, we will review the anatomy, essential history, and common presentations of tracheostomy patients in the ED, including obstruction, decannulation, bleeding, tracheal stenosis, and infection. Anatomy of a tracheostomy tube Outer cannula Sits directly in the tracheal stoma Proximal end designed to allow tube to be easily securedRead More →
The management of traumatic cardiac arrest differs significantly from the management of medical cardiac arrest, however the management is often lumped together. In this weeks Grand Rounds summary Dr. Nicholas Costain takes us through some controversies in the management of these difficult cases. Objectives: Review updated literature regarding indications toRead More →
There are a few specific arrhythmias that we encounter often in the ED that deserve a little bit more thought. Dr. Matthew Lipinski takes us through a few updates in the area beyond the routine basics. For other Grand Rounds Summaries please see our archives. Chronic Bundle Branch Block andRead More →
Unstable pelvic fractures have high mortality rates, particularly with patients who are hemodynamically unstable, due to difficulty in achieving hemostasis and other associated injuries. At present, there is no standard guideline that has been published and universally accepted in the management of pelvic trauma. These patients should have integrated management betweenRead More →
Journal Club Summary Khanna A, et al. N Engl J Med. 2017 Aug 3;377(5):419-430. Abstract Link EDITORIAL: Angiotensin II for the Treatment of Vasodilatory Shock – Promise and Caution. Dellinger RP, et al. N Engl J Med. 2017 Aug 3;377(5):486-487. Methodology Score: 4/5 Usefulness Score: 3.5/5 Question and Methods: International multicenter placebo-controlled RCTRead More →
The demographics in Canada are changing, with individuals becoming increasingly more obese. In 2014 over 40% of Canadians self-identified as being overweight or obese and this number is rising. Dr. Brittany Ellis brings us through a review of the differences in anatomy and physiology of the bariatric patient and howRead More →
Journal Club Summary Reference: Kirkegaard H, et al. JAMA. 2017 Jul 25;318(4):341-350 EDITORIAL: Targeted Temperature Management After Cardiac Arrest: Finding the Right Dose for Critical Care Interventions. Callaway CW. JAMA. 2017 Jul 25;318(4):334-336. Methodology Score: 3.5/5 Usefulness Score: 2/5 Question and Methods: This pragmatic, multicenter, randomized superiority trial examined whether TTM at 33CRead More →
Many aspects of cardiac arrest care are likely to change in the not-so-distant future. Let’s take a system-level view of cardiac arrest care and see what we can do to conservatively start to move in the direction of more regionalized care. We’ll also take a further evidence based look atRead More →
The global vitamin and supplement industry is expected to be worth $278 billion by 2024. “Wellness” as a concept and industry, which often includes vitamin and supplement use, is heavily promoted by celebrities, athletes, and social media stars. IV therapy lounges are all the rage and have popped up inRead More →