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 previouslyRead More →
In this post, we will discuss updates and controversies surrounding rate control in Afib, specifically we will: Review the new 2017 CAEP Afib best practices guidelines Review Tachycardia Induced Cardiomyopathy Review Afib and Type 2 ACS Discuss the identification and management of secondary Afib 2017 CAEP AAF Best Practices GuidelineRead More →
Necrotising soft tissue infections are an significant cause of morbidity and mortality, so an timely diagnosis is critical for the Emergency Physician. Here we discuss the publication of a new systematic review and meta-analysis on this challenging diagnostic entity, and include an helpful infographic to help interpret the findings [1]. Background NecrotizingRead More →
Meningitis is defined as the inflammation of the membranes of the brain and/or spinal cord. The incidence of bacterial meningitis is in the range of 5-10 cases per 100,000 patients per year1. Despite modern medical therapy, it is associated with a case fatality rate of 10-20% and results in unfavourableRead More →
Journal Club Summary Alam N, et al. Lancet Respir Med. 2018 Jan;6(1):40-50. Question and Methods: The authors of this nation-wide open-label RCT studied the mortality effect of pre-hospital antibiotics on febrile patients with one other non-laboratory SIRS criteria by comparing pre-hospital usual care with IV fluids and oxygen to theRead 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 →
Journal Club Summary Methodology: 3.5/5 Usefulness: 3/5 Peacock WF, et al. JAMA Cardiol. 2017 Dec 13 EDITORIAL: The Wait for High-Sensitivity Troponin Is Over-Proceed Cautiously Korley FK. JAMA Cardiol. 2017 Dec 13 Question and Methods: This prospective, observational, multicenter study evaluated if a negative hsTnt assay at 0h and 3h post EDRead More →
In this post, we take a deep dive into the ever-present issue of ED crowding, going beyond the basic input-throughput-output model and focusing on institutional and provincial strategies for managing patient flow and overcrowding. We will cover the following objectives: Going beyond input – throughput – output: Understanding ED crowdingRead More →
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 criticalRead More →
