An Analysis of Paralysis: Neuromuscular blocking agents in the Emergency Department

In this post, we will discuss the use of neuromuscular blocking agents (NMBAs) for intubation in the Emergency Department; we will focus on considerations in predicted difficult airways (RSI vs. awake intubation), Rocuronium vs. Succinylcholine, and the indications for Sugammadex. This post will not cover laryngoscopy; although this was previously well covered by Dr. Peter Reardon’s previous Grand Rounds Summary […]

A Multicenter, Randomized Trial of Ramped Position vs Sniffing Position During Endotracheal Intubation of Critically Ill Adults

Methodology Score: 3.5/5                Usefulness Score: 3/5 Semler MW, et al. Chest. 2017 Oct;152(4):712-722. Editorial: Should the Ramped Position Be “Sniffed at” in the ICU? Scott JA, et al. Chest. 2017 Oct;152(4):693-694. Question and Methods: Multicenter, randomized, unblinded, trial of 260 ICU patients comparing the ramped vs sniffing position for intubations performed by critical care fellows. Findings: There were no differences in the primary outcome of lowest […]

Prehospital Advanced Cardiac Life Support for Out-of-hospital Cardiac Arrest: A Cohort Study.

Journal Club Summary Methodology Score: 3.5/5 Usefulness Score: 3.5/5 Cournoyer A, et al. Acad Emerg Med. 2017 Sep;24(9):1100-1109. Question and Methods: Retrospective observational cohort study to evaluate if the addition ACLS to BLS during EMS management for Out-of-Hospital cardiac arrest – OHCA (and for a predefined subgroup of potential ECMO candidates) improve rates of ROSC, survival to hospital discharge and delay from call […]

Opening the Book: Pelvic Trauma in the ED

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 between ED physicians, trauma surgeons, orthopedic surgeons and interventional radiologists. In […]

Angiotensin II for the Treatment of Vasodilatory Shock

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 RCT evaluating the effectiveness of angiotensin II for the treatment of […]

Resuscitation of the Bariatric Trauma Patient

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 how we can more effectively resuscitate the trauma patient on our […]

Targeted Temperature Management for 48 vs 24 Hours and Neurologic Outcome After Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial

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 33C for 48 hours vs 24 hours results in better neurologic […]

Emergency Department use of Apneic Oxygenation versus usual care during rapid sequence intubation: A randomized controlled trial (The ENDAO Trial)

Journal Club Summary Reference: Caputo N, et al. Acad Emerg Med. 2017 Aug 9. doi: 10.1111/acem.13274.  Methodology Score: 3.5/5 Usefulness Score: 3/5 Question and Methods: This single centre, un-blinded RCT compared oxygen saturation levels for apneic oxygenation versus usual car in ED patients undergoing RSI intubation. Findings: No difference between the two groups in the lowest mean desaturation, or in any secondary […]

Video versus Direct Laryngoscopy: Calling for Truce in the Arms Race

    Airway management in the Emergency Department (ED) is challenging. Given the critically ill and physiologically unstable patients, complicated by c-spine collars, distorted anatomy, and airway contamination – the stakes are high. Recent evidence draws attention to an adverse event rate of approximately 8-12% in the ED.1–3 Even more daunting is that with successive attempts, the complication rate rises […]