In this post, we will review several recent updates related to pre-hospital medicine. Specifically, we will: Review the role of tranexamic acid (TXA) in pre-hospital trauma Discuss the use of ketamine in Excited Delirium Examine the new Ottawa ROSC bypass protocol and new modifications to the Trauma bypass protocol forRead More →
Methodology: 3.5/5 Usefulness: 2.5/5 Heidari K. et al. J Shoulder Elbow Surg. 2014 Jun;23(6):759-66. Journal Club Bottom Line Question & Methods: Can abduction and external rotation (AbER) immobilization after primary anterior shoulder dislocation reduce rates of recurrence compared to conventional immobilization in adduction and internal rotation (AdIR). A randomized trial. Findings: AfterRead More →
Patients who receive solid organ or stem cell transplants are complex, but we see them frequently in the Emergency Department! This review summarizes the physiology of transplant and a few of the key issues to be aware of in these patients. Transplant by the numbers Locally, in Ottawa, there areRead More →
Methodology Score: 3/5 Usefulness Score: 3/5 Nazerian P, et al. Circulation. 2018 Jan 16;137(3):250-258. Editorial – Biomarker-Assisted Diagnosis of Acute Aortic Dissection. Question: The ADvISED trial was an International Multicenter prospective observational study of a novel diagnostic strategy that integrated the Aortic Dissection Detection Risk Score (ADD-RS) and D-Dimer in an ED population to rule outRead More →
There is no denying that the evolution of technology will continue to alter our practice of Emergency Medicine; a prime example of this has come with the transition to electronic health information within our clinical environments. In seeking to better understand the effect of such a shift, this post aimsRead More →
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 →
Methodology: 3.5/5 Usefulness: 4/5 Albers GW, et al. N Engl J Med. 2018 Jan 24. Journal Club Bottom Line Question/Methods: This was a multicentre, prospective, randomized, open label, blinded outcome trial comparing thrombectomy + medical therapy vs medical therapy alone in patients with delayed presentation (6-16 hours) of proximal MCARead More →
Urgent care presents a specific set of challenging clinical questions for the emergency physician. Often, seemingly mundane presentations will leave us questioning whether or not we have managed a case appropriately. Our decision-making can be highly influenced by the long lasting effects of dogma, clinical anecdotes, or historical studies ofRead More →
Sickle Cell Disease (SCD) is a complex medical entity, associated with significant morbidity and mortality. Patients with SCD suffer from acute and chronic pain, along with a seemingly endless list of additional complications (from hemolysis and sequestration, to aplastic crises and acute chest syndrome). The associated morbidity of SCD isRead More →