This is part 1 of our 3 part series recapping our most recent journal club.  In this podcast, Dr Jeff Hill leads a discussion of a paper by Calver et al which was a multicenter prospective trial looking at the safety and efficacy of droperidol for acutely agitated patients in the ED

Droperidol for Agitation - Part 1

This is our second in a 3 part series looking at the evidence for the safety and efficacy of droperidol for acute agitation in the ED.  In this episode, Dr. Shawn Hassani leads us in a discussion of an article by Taylor et al which was a randomized trial of droperidol vs droperidol + midazolam vs olanzapine.

Droperidol for Agitation in the ED - Part 2

This is part 3 of 3 recapping our most recent journal club where we looked at the evidence for the safety and efficacy of droperidol for treating acute agitation in the ED.  In this final episode, Dr. Christa Pulvino will share her summary of the DORM trial done by Isbister et al which looked at IM droperidol vs midazolam for violence and acute behavioral disturbance in the ED.

Droperidol for Agitation - Part 3

One of the first tests ordered for a patient with ROSC following cardiac arrest is an EKG. Many of these EKGs are profoundly abnormal. Current practice is to evaluate for STEMI and to activate the cardiac cath lab if one is found. But, the test characteristics (sensitivity and specificity) of post-ROSC EKGs are likely different than the test characteristics for patients presenting to the ED with complaints of chest pain/symptoms concerning for ACS. This meta-analysis looked to pull together the existing literature and determine those test characteristics for this critically ill patient population. Read the summary after the link and listen to the podcast to hear a breakdown of this study.

How Good is a Post-ROSC EKG?

Time is myocardium, and minimizing door-to-activation time improves outcomes in patients with acute coronary occlusion. There are a number of existing quality metrics used to help drive improvements in the time-based care of STEMI patients. Could a new quality metric help the decision making time of Emergency Physicians?

ECG to Activation

In this Journal Club podcast, PGY-3 Tony Fabiano breaks down a paper from the Journal of Trauma comparing the effectiveness and patient perception of pigtail catheters versus standard chest tubes for hemothorax in the setting of trauma.  Is a tiny tube effective at all in draining blood from the chest?

Tube Thoracostomy - Tiny Tubes for Bloody Effusions

In this Journal Club paper breakdown, Dr Bailee Stark recaps the findings of a recently published study by Driver et al looking at the effect of bougie aided intubation vs standard stylet intubation.

Bougie so Bougie

In this podcast, Dr. Courtney Kein breaks down a recently published article examining the effects of a bolus of IVF at the time of intubation.  Does a push of fluid prevent peri-intubation hemodynamic collapse?

A Life Saving Bolus? Fluids at the Time of Intubation

Palpating a pulse during a resuscitation can be more challenging than it seems. Digital palpation of femoral pulses may lack sensitivity and specificity needed to accurately detect the presence of a pulse.  In this Journal Club recap, Dr Martina Diaz summarizes a recently published paper looking at the use of Doppler ultrasound for pulse checks.

Doppler US For Pulse Checks

Cardiac arrests are an inevitable reality for emergency medicine providers. There is often a debate on whether family members presence during CPR will lead to more emotional burdens on the family members who witnessed these resuscitations. Dr Melanie Yates summarizes this recent study that aimed to determine if there are increased rates of PTSD-related symptoms of close relatives who witnessed CPR of a family member.

Family Presence During Cardiac Arrest Resuscitations

During a cardiac arrest resuscitation, finally palpating a pulsatile flow beneath your gloved fingertips brings a sense of satisfaction like no other. But just as you go to finally breathe a sigh of relief and wipe the beading sweat off your brow, your now widening pupils focus on the patient’s steadily plummeting blood pressure. As you begin to sense your own heart palpitating, you think about medications to utilize in hopes of staving off another round of chest compressions. Since you’ve already given four doses of code-dose epinephrine, maybe an epinephrine infusion is best? You also recall that norepinephrine seems to be a popular choice in patients with shock, so maybe you should start that instead?

What Drip After the Drop - Post Cardiac Arrest Hypotension

In this podcast, Dr. Justin Milligan covers a recently published retrospective review that could inform our future practice.  We all rely on a negative CT within 6 hours for diagnosing SAH, but what if we could through the time limits out the window?

CTs in SAH - Does Time Even Matter

Early recognition and resuscitation of patients in septic shock are critical skills for an emergency medicine physician. Many clinical decision-making tools have been developed and validated in their use to identify and define those who are in sepsis or septic shock, as well as predict a patient’s overall risk of morbidity and mortality, including tools like the SIRS criteria and SOFA score. The diastolic blood pressure is determined by vascular tone, and thus it can be assumed that a decrease in the diastolic blood pressure should correlate with the pathologic vasodilation in septic shock. As a result, the authors of this study hypothesized that the relationship between heart rate and the diastolic blood pressure (i.e. the diastolic shock index) could provide providers a tool to quickly identify patients that are at risk for unfavorable outcomes.

Diastolic Shock Index

The management of atrial fibrillation with rapid ventricular response is often complicated by the presence of heart failure with reduced ejection fraction.  The presence of HFrEF limits pharmacologic options for rate control.  This podcast will cover a retrospective study looking at the use of metoprolol vs diltiazem in patients with A fib with RVR and concomitant heart failure

IV Metoprolol vs Diltiazem for A fib with Concomitant Heart Failure

Dr Gillespie breaks down the recently published CLOVERS trial that looked into the early administration of vasopressors in sepsis

Clovers

Boarding of admitted patients in the ED and subsequent overcrowding of ED’s continues to plague hospitals in the United States and Internationally.  The Covid-19 pandemic exacerbated an already growing problem regarding capacity management and patient flow. In this current climate, the Emergency Physician’s responsibilities continue to shift toward the front-end of the process, mainly patients waiting to be seen in the lobby.  As such, identifying sick patients in a timely manner and utilizing additional resources to predict patients at risk of clinical deterioration will be paramount moving forward.  This recap covers a paper that looks to see if EtCO2 can play a bigger and better role in the triage process

Sick or Not Sick through a Sniff - EtCO2 at Triage

Dr Marlena Wosiski-Kuhn recaps a recent journal club covering the paper by Mahajan and colleagues: Serious Bacterial Infections in Young Febrile Infants with Positive Urinalysis Results.

Hunting for Invasive Bacterial Illness in Infants with a Positive UA

Drs. Wilson and Arnold discuss the latest research that went into their development of a protocol for managing Acute Liver Failure

Qi/KT - Acute Liver Failure

In this journal club podcast we break down 2 articles.  Do we need to reduce doses of ketamine or etomidate in RSI to avoid post-intubation hypotension?  Should video laryngoscopy fully and finally replace direct laryngoscopy in the ED?

Induction Reduction and Had Video Finally Killed the DL?

Dr Casey Glenn walks through a study analyzing the 'lever test' for the diagnosis of ACL tears in the acute setting.  Given significant swelling and pain the acute diagnosis of ligamentous injury can be both challenging and painful to patients. The lever test is a promising physical exam maneuver that may be more accurate and better tolerated that traditional exam maneuvers.

Lever Test

Ultrasound is an increasingly ubiquitous tool to augment the physical exam in the Emergency Department.  Dr Jazmyn Shaw walks us through a paper that looks at whether or not US is a useful adjunct to physical exam for the diagnosis of shoulder dislocation in the Emergency Department

US For Shoulder Dislocation

Pain from rib fractures can be severely limiting in the acute setting.  In this recap from our most recent Journal Club, Dr Olivia Gobble leads us through a paper looking at the effectiveness of Serratus Anterior Plane Blocks for treating pain from rib fractures in the Emergency Department.

Serratus Anterior Plane Blocks

In this podcast, Dr Charlie Brower PGY-3 at the University of Cincinnati leads a discussion of a recent journal club article looking at the impact of a subcutaneous insulin treatment pathway for mild and moderate DKA.  We explore the financial and operational impacts of this pathway as compared to traditional treatment with IV insulin

SQUID Protocol

Can the addition of high-dose methylprednisolone to the treatment of out-of-hospital cardiac arrest make a meaningful difference? In this post-hoc analysis of a placebo-controlled randomized control trial comparing high-dose methylprednisolone versus placebo in out-of-hospital cardiac arrest (OHCA), the authors aimed to assess the hemodynamic effects of prehospital high-dose glucocorticoid treatment in resuscitated comatose OHCA patients.

STEROCHA Trial: 'Roids to the Rescue?

In this journal club breakdown, we analyze an article examining the relationship between invasive arterial line blood pressure measurements and non-invasive cuff measurements.

Is the Cuff Enough?

In this most recent Journal Club recap podcast, Dr. Cole Davis covers a paper investigating the use of sterile vs clean gloves for laceration repair in the ED.

Sterile v NonSterile

We recap 3 recently published articles that look at various aspects of caring for pediatric cardiac arrest patients.  Is Epi helpful? Therapeutic hypothermia or normothermia - which is better? Is old school lidocaine better than amiodarone?

Updates in Pediatric Cardiac Arrest

A dive into 3 articles looking at the use of ketamine in the Emergency Department.

01:23 - Slow vs rapid infusion of ketamine for pain control in the ED
13:42 - Hemodynamic effects of ketamine vs etomidate for RSI
21:59 - Effect of versed or haldol vs placebo for emergence agitation in ketamine procedural sedation

A Trio of Ketamine

We cover a trio of papers related to the care of the trauma patient - should we be adding some vasopressin in patients needing >6 units of blood? Is VL really superior to DL in trauma patients? Should we stop wasting time of IVs and just grab the IO drill?

Trio of Trauma - Journal Club Recap

This is the final of 3 podcasts recapping our most recent journal club.  In this podcast Dr. Olivia Urbanowicz walks us through a meta-analysis by Wu et al published in the Journal of Emergency Medicine in 2020.  We tackle the question as to whether or not there is evidence that supports the routine use of sodium bicarbonate in patients with cardiac arrest.

Hold the Bicarb?

www.tamingthesru.com - Free. Open-Access. Focused on Emergency Medicine, critical care and prehospital medicine, as well as practice algorithms and decreasing knowledge translation in Med Ed.

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