MILD THERAPEUTIC HYPOTHERMIA TO IMPROVE THE NEUROLOGIC OUTCOME AFTER CARDIAC ARREST

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The Article: Hypothermia after Cardiac Arrest Study Group. “Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest.” N Engl J Med2002.346 (2002): 549-556.

The Idea: Several animal studies prior to this randomized controlled trial had shown that moderate systemic hypothermia or mild hypothermia markedly mitigated brain damage after cardiac arrest in dogs. Prior to hypothermic therapy, there was no therapy with documented efficacy in preventing brain damage after cardiac arrest.

The Study: In this multicenter trial with blinded assessment of the ...

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HEART Score

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The Article:

Backus BE, Six AJ, Kelder JC et al. “A prospective validation of the HEART score for chest pain patients at the emergency department” International Journal of Cardiology 168(2013): 2153-2158

 

The Idea:

Chest pain is a common presenting complaint in the Emergency Department and risk stratification is important for determining which patients are safe to discharge and which require admission for observation or further workup. The authors of this study state their intent was to create a simple scoring system that would ...

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The ProCESS Trial

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Article Title:

“A Randomized Trial of Protocol-Based Care for Early Septic Shock” (The ProCESS Trial)

 

Background:

The Rivers paper in 2001 was the landmark paper on management of sepsis, establishing a protocol called “Early Goal Directed Therapy” that relied on Central Venous Pressure, Central Venous Oxygen Saturation, and MAP to guide the administration of fluid, pressors, inotropes, and blood transfusions. The Rivers paper found that this protocol reduced mortality from sepsis fro 46.5% to 30.5%, and became widely regarded ...

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Computed Tomography of the Head Before Lumbar Puncture in Adults with Suspected Meningitis

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Hasbun R, Abrahams J, Jekel J, Quagliarello V. “Computed Tomography of the Head Before Lumbar Puncture in Adults with Suspected Meningitis.” NEJM 345 (2001):1727-1733

 

Background:

This study was done to determine if CT of the head is necessary prior to lumbar puncture, as has become common practice in the ED, with the intent to minimize unnecessary imaging and patient radiation exposure.

 

The Study:

This was a single center prospective cohort study in which 301 patients with a median age of 40 years and clinically ...

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Oral Dexamethasone for Sore Throat in Adults

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The Article: Hayward, Gail Nicola, et al. “Effect of Oral Dexamethasone Without Immediate Antibiotics vs Placebo on Acute Sore Throat in Adults: A Randomized Clinical Trial.” Jama 317.15 (2017): 1535-1543.

The Idea: Compare oral dexamethasone versus placebo to determine if one-time dose of 10mg dexamethasone in the primary care setting can result in total resolution of symptoms at 24 or 48 hours.  Key metric was complete resolution at 24 hours with complete resolution at 48 hours as a secondary outcome.

The Study: Adult primary ...

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Suprascapular Nerve Block Vs. Procedural Sedation in Shoulder Reduction

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The Article:

Tezel et al (2014). A Comparison of Suprascapular Nerve Block and Procedural Sedation Analgesia in Shoulder Dislocation Reduction. American Journal of Emergency Medicine; 32 (2014) 549-552.

Background:

Shoulder joints are the most frequently dislocated joints seen in the Emergency Department. Reduction of shoulder joint is a necessary but painful procedure that patients must endure. Procedural sedation has become common in order to aid with analgesia during shoulder reduction. Although advantageous, procedural sedation can be time consuming and have side effects depending ...

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Ottawa Subarachnoid Hemorrhage Rule

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The article: Perry JJ, Stiell IG, Sivilotti ML, et al. Clinical decision rules to rule out subarachnoid hemorrhage for acute headache. JAMA. 2013;310:1248-1255.

The bottom line: Use of the Ottawa subarachnoid hemorrhage rule in the ED to help determine which patients need workup for possible SAH decreases the rate of missed SAH and allows clinicians to safely classify patients meeting none of the criteria as low risk. However, the rule does not decrease the investigation rate of SAH and still need ...

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ED EEGs for Uncomplicated First-Time Seizure

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The Article:

The First-Time Seizure Emergency Department Electroencephalogram Study. Wyman et al. (2017) Annals of Emergency Medicine. 69(2):184-191.

The Idea:

To determine whether obtaining an EEG in the ED after first time uncomplicated seizure could identify patients with epilepsy as candidates for immediate initiation of an antiepileptic drug (AED) on discharge.

The Study:

A prospective trial of a convenience sample of patients presenting with an uncomplicated first time seizure at a single tertiary care center in North Carolina. Inclusion criteria included all patients over age ...

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Ketamine for agitation

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The Article: 

Ketamine as a first-line treatment for severely agitated emergency department patients. J Riddell et al. American Journal of Emergency. 2017 Feb 13. pii: S0735-6757(17)30114-6.

 

The Idea:

Rapid control of the severely agitated person in the ED is important for both patient and staff safety. Benzodiazepines and haloperidol are commonly used first line agents that have draw backs. Ketamine may be a faster, more reliable option, and has been shown to be effective in the prehospital setting.

The Study: 

A single-center, prospective, observational study ...

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Suicide Assessment in the ED

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The Article:

Literature based recommendations for suicide assessment in the Emergency Department: A review. The Journal of Emergency Medicine, Vol. 43, No. 5, pp. 836–842, 2012

Linda Ronquillo, MA, Arpi Minassian, PHD, Gary M. Vilke, MD, and Michael P. Wilson, MD, PHD.

 

The Background:

Suicidal ideation and suicide attempts are frequent complaints in the ED. The Joint Commission established a National Patient Safety Goal that requires practitioners who are taking care of patients ...

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