We are excited to introduce the Sixth edition of The Ottawa Handbook of Emergency Medicine. Your bedside guide for approaches to various Emergency Medicine presentations.
Highlights of the Sixth edition include the addition of: Oncologic emergencies, approach to the pregnant patient, geriatrics and more!
Focus on POCUS: Palpitations and Dyspnea Post-AVR
A female in her 20's presents to the emergency department 15 days after major cardiac surgery to repair a congenital aortic valve defect. Her chief complaint is palpitations and shortness of breath, which have been constant and ongoing for the last 4 days. She has no...
Propofol or Ketofol for Procedural Sedation and Analgesia in Emergency Medicine – The POKER Study: A Randomized Double-Blind Clinical Trial
Journal Club Summary Methodology Score: 4/5 Usefulness Score: 3.5/5 Ferguson I, et al. Ann Emerg Med. 2016 Nov;68(5):574-582. Abstract Link This was a large multicenter double-blind RCT to compare ketafol in a 1:1 ratio to propofol failed to find a 10% absolute...
SIRS? No SIRS? Understanding Sepsis in the Emergency Department after Sepsis-3.
Use of the term “sepsis” continues to be controversial. We understand that patients with infection can manifest an immune-mediated systemic response, and are at risk of deterioration, organ dysfunction, and death. At what point in that cascade the patient is termed...
Effect of Hydrocortisone on Development of Shock Among Patients With Severe Sepsis: The HYPRESS Randomized Clinical Trial
Journal Club Summary Methodology Score: 3/5 Usefulness Score: 2.5/5 Keh D, et al. JAMA. 2016 Nov 1;316(17):1775-1785 Abstract Link In this multicenter placebo-controlled double-blind RCT, the authors concluded that in adults with severe sepsis,...
REBOA: Resuscitative Endovascular Balloon Occlusion of the Aorta
The use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has become a topic of considerable interest as of late, primarily to treat non-compressible truncal hemorrhage (NCTH). However, it is beginning to expand into other causes...
Focus on POCUS: Pleuritic Chest Pain with Tachycardia – Pericarditis or PE?
A young, previously healthy male in his 30s presents to the ED from his family physicians office with chest pain and an abnormal ECG. He has a 3-4 day history of non-radiating upper back pain and sensation of chest tightness that is pleuritic in nature and worse when...
The Top 10 Most Important Articles of 2016 (and some from 2015)
This is a summary of a talk given by Drs. Krishan Yadav and Maggie Kisilewicz at the National Capital Conference in Emergency Medicine. Below are brief summaries and a bottom line, but of course you'll have to read the literature yourself to make your own decisions!...
Comparison of Intravenous Ketorolac at Three Single-Dose Regimens for Treating Acute Pain in the Emergency Department: A Randomized Controlled Trial
Journal Club Summary Methodology Score: 2.5/5 Usefulness Score: 3/5 Motov S, et al. Ann Emerg Med. 2016 Dec 14. pii: S0196-0644(16)31244-6. Abstract Link This randomized, double-blind study of the analgesic efficacy of ketorolac at three...
Restrictive versus liberal blood transfusion for acute upper gastrointestinal bleeding (TRIGGER): a pragmatic, open-label, cluster randomized feasibility trial
Journal Club Summary Methodology Score: 3/5 Usefulness Score: 2/5 Jairath V, et al. Lancet. 2015 Jul 11;386(9989):137-44 Abstract Link This open label, cluster randomized feasibility trial based in six university hospitals in the United Kingdom...
Bedside Diagnosis of the ‘Red Eye’: A Systematic Review
Summary Methodology Score: 2/5 Usefulness Score: 2/5 Narayana S, et al. Am J Med. 2015 Nov;128(11):1220-1224.e1. Abstract Link This review study looked at the diagnostic accuracy of physical exam findings for serious causes of red eye and...