Hot off the press from CJEM; End-of-life care in the Emergency Department for the patient imminently dying of a highly transmissible acute respiratory infection (such as COVID-19).Read More →
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 patientsRead More →
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 ofRead More →
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 withRead More →
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 withRead More →
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 controlRead More →
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 ofRead More →
Methodology Score: 4/5 Usefulness Score: 3.5/5 Kapur J et al. N Engl J Med. 2019 Nov 28;381(22):2103-2113. Question and Methods: A multicenter, randomized, blinded, comparative-effectiveness trial to determine the efficacy and safety of fosphenytoin, valproic acid and levetiracetam, for treatment of benzodiazepine-refractory generalized convulsive status epilepticus. Findings: No significant difference between treatmentRead More →
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 ofRead More →
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%Read More →