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 →
Community-acquired pneumonia is the leading infectious cause of death in Canada, and combined with influenza is the 7th most common cause of death overall. Diagnosis The 3 main pillars leading to the diagnosis of pneumonia are as follow: Evidence of infection (fever, chills, leukocytosis) Signs and symptoms localized to the respiratory system (cough,Read More →
Methodology: 2/5 Usefulness: 2.5 /5 Lumanauw DD, et al. Acad Emerg Med. 2019 Sep;26(9):1044-1051. doi: 10.1111/acem.13755. Epub 2019 Apr 29. Question and Methods: A randomized placebo-controlled trial to determine if sub-dissociative dose Ketamine (SDDK) is effective for treating acute exacerbations of chronic Pain in the emergency department. Findings: Ketamine infusions atRead 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 →
Methodology Score: 4/5 Usefulness Score: 4.5/5 Kearon C, et al. N Engl J Med. 2019 Nov 28;381(22):2125-2134 Question and Methods: the authors sought to demonstrate safety using a d-dimer cut-off of 1000ng/mL for low pre-test probability patients & a cut-off of 500ng/mL for moderate pre-test probability patients. Findings: Of 1325Read More →
A healthy patient presents to the Emergency Department (ED) where you are working one night. He complains of a four-day history of progressively worsening fatigue, constant and diffuse headache, neck stiffness, fever, chills and night sweats. There was no associated photophobia or phonophobia. He denies any infective symptoms, sick contactsRead More →
Methodology: 4/5 Usefulness: 2/5 Sims CA, et al. JAMA Surg. 2019 Aug 28. Question and Methods: Single-centre, double-blind, randomized control trial to determine whether low-dose vasopressin decreases the need for blood product transfusion in trauma patients with hemorrhagic shock. Findings: A total of 100 adult trauma patients were enrolled. VasopressinRead More →
RAFF2 Ian Stiell and colleagues are back at it with atrial fibrillation; The RAFF2 trial (Electrical versus Chemical cardioversion for Emergency Department patients with Atrial Fibrillation (RAFF2); A partial factorial randomized trial) was published in The Lancet this week. Acute atrial fibrillation is an irregular dysrhythmia that should be treatedRead More →