We are excited to introduce the Fifth edition of The Ottawa Handbook of Emergency Medicine. Your bedside guide for approaches to various Emergency Medicine presentations.
Highlights of the Fifth edition include the addition of: general surgery emergencies, pediatric orthopedic presentations, and updates in pediatric fever + more!
Pneumonia: Getting In-Sync with the Guidelines
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,...
Subdissociative‐dose Ketamine Is Effective for Treating Acute Exacerbations of Chronic Pain
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...
Community Paramedicine: Behind the Scenes
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...
Oral Lefamulin vs Moxifloxacin for Early Clinical Response Among Adults With Community-Acquired Bacterial Pneumonia: The LEAP 2 Randomized Clinical Trial
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...
Diagnosis of Pulmonary Embolism with d-Dimer Adjusted to Clinical Probability
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...
Point-of-Care Ultrasound diagnosis of Endocarditis
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...
Effect of Low-Dose Supplementation of Arginine Vasopressin on Need for Blood Product Transfusions in Patients With Trauma and Hemorrhagic Shock: A Randomized Clinical Trial
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...
Electrical vs Chemical Cardioversion in ED patients with Atrial Fibrillation (RAFF2)
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...
Emerging Updates in Septic Shock
In September 2018, Dr. Bram Rochwerg and I wrote a blog post on the treatment of patients with sepsis and septic shock. Much of this was based on the 2016 Surviving Sepsis Campaign (SSc) Clinical Practice Guidelines [1]. However, in a little over a year, significant...
Levetiracetam versus phenytoin for second-line treatment of paediatric convulsive status epilepticus (EcLiPSE): a multicentre, open-label, randomised trial
Methodology: 4/5 Usefulness: 4/5 Lyttle MD, et al. Lancet. 2019 May 25;393(10186):2125-2134. Question and Methods: Eclipse was an open label RCT that evaluated time to seizure cessation in pediatric SE between Keppra and Dilantin Findings: They found that Keppra was...