Mechanical CPR: Past, Current, and Future

Mechanical CPR is a technology whereby a machine performs chest compressions in place of a human provider. These devices are becoming increasingly prevalent in the prehospital and in-hospital arenas, and it is inevitable that healthcare providers will interact with them in some capacity. Given the variable evidence in the literature, the indications for when to apply these devices is not […]

Damage Control Resuscitation (DCR) – A Summary of the Joint Trauma System Clinical Practice Guideline

Hemorrhage is the leading cause of preventable death on the battlefield. Damage Control Resuscitation (DCR) works synergistically with Damage Control Surgery (DCS) and prioritizes non-surgical interventions that reduce morbidity and mortality due to trauma and hemorrhage. DCR aims to restore homeostasis and prevent or mitigate tissue hypoxia and coagulopathy. This is accomplished through aggressive hemorrhage control and blood transfusion with […]

Effect of a Strategy of Initial Laryngeal Tube Insertion vs Endotracheal Intubation on 72-Hour Survival in Adults With Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial

Journal Club Summary Methodology: 4/5 Usefulness: 3.5/5 Wang HE, et al. JAMA. 2018 Aug 28;320(8):769-778. Editorial: Pragmatic Airway Management in Out-of-Hospital Cardiac Arrest. Question and Methods: This multicenter pragmatic cluster-crossover randomized trial compared initial advanced airway strategy effectiveness between laryngeal tube (LT) and endotracheal intubation (ETI) in adults with OHCA. Findings: The LT group had higher 72-hour survival (18.3%) compared to ETI (15.4%; P=.04), […]

Does Point-of-Care Ultrasonography Improve Clinical Outcomes in Emergency Department Patients With Undifferentiated Hypotension? An International Randomized Controlled Trial From the SHoC-ED Investigators

Journal Club Summary Methodology Score: 3/5 Usefulness Score: 2/5 Atkinson PR, et al. Ann Emerg Med. 2018 Oct;72(4):478-489 Question and Methods: This was the first multicenter, prospective, RCT examining the effect of POCUS on 30-day survival of undifferentiated hypotensive patients presenting to ED. Findings: There was no important survival benefit with the use of POCUS, including no important differences in IV fluids, […]

A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest.

Journal Club Summary: A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest Methodology Score: 4/5 Usefulness Score: 3.5/5 Perkins GD, et al N Engl J Med. 2018 Jul 18. Editorial:  Testing Epinephrine for Out-of-Hospital Cardiac Arrest. Callaway CW, et al. N Engl J Med. 2018 Jul 18. Question and Methods: Multicenter, randomized, double-blind, placebo-controlled trial sought to determine the safety and effectiveness […]

Plasma-first resuscitation to treat haemorrhagic shock during emergency ground transportation in an urban area: a randomised trial

Journal Club Summary Methodology: 3.5/5           Usefulness: 3.5/5 Moore HB, et al. Lancet. 2018 Jul 28;392(10144):283-291.  Editorial: No gains with plasma-first resuscitation in urban settings? Question and Methods: Use of prehospital plasma in patients with hemorrhagic shock before arrival at an urban level 1 trauma center. Findings: 28-day mortality was 15% in the plasma group vs. […]

The Anatomy and Physiology of a Resuscitation

Emergency medicine is a diverse specialty. We’ve all had the shift where you go from suturing an elderly woman’s scalp, to managing an anxious patient with chest pain, to running a cardiac arrest as EMS patches in with a trauma. We wear many hats throughout a single shift and it’s the greatest part of our chosen specialty. Perhaps the area […]

Burn Management in the ED

The vast majority of burns that present to the ED can be managed as outpatients1,2, usually by the patient’s family doctor, but many emergency physicians do not feel comfortable with burn management. Burn management often follows the preferences and experiences of plastic surgeons, so the overarching caveat for everything below is that you should check with your local plastic surgery […]

Adjunctive Glucocorticoid Therapy in Patients with Septic Shock

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-hours of vasopressor support in ICU. Findings: There were no significant […]