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Journal Club Archive

Starting with January, 2007 each Journal Club will have a summary.

These comments were arrived upon by the JC group as a summary of our discussion.  The authors of the study and you may not

agree and we encourage you to read the papers and form your own conclusions. 

 

January 2008 -  Take a Deep Breath (Low Risk PE & CHF)

 

1)  Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism.  Kline, et al.  J Thromb Haemost,  2004.

 

---Summary:  The PERC Rule can be very helpful in low risk patients

 

2) Validation of the Acute Heart Failure Index.  Hsieh, et al.  J. EM, 2008. 

 

 ---Summary:  Even low risk CHF patients have a fairly high mortality

 

 

November 2007 -  The Agitated Patient in the ED

 

1)  A Prospective, Double-blind, Randomized Trial of Midazolam versus Haloperidol versus Lorazepam in the Chemical Restraint of Violent and Severely Agitated Patients.  Nobay, et al.  Acad. EM, 2004.

   ---Summary:  Ativan & Haldol still the way to go

 

2)  An Unusual Case of Subterfuge in the Emergency Department:  Covert Administration of Antipsychotic and Anxiolytic Medications to Control an Agitated Patient.  Lewin, et al.  Ann. EM, 2006.

   ---  Summary:  What do you think???

 

October 2007 -  ENT in the ED

 

1)  Early Treatment with Prednisolone or Acyclovir in Bell’s Palsy.  Sullivan, et al. NEJM.  2007

 

  ---Summary:  Prednisone helpful, acyclovir not. 

 

2)  Intravenous Lorazepam Versus Dimenhydrinate for Treatment of Vertigo in the Emergency Department: A Randomized Clinical Trial.  Marill, et al.  Ann. EM, 2000. 

 

 

September 2007 -  Glucose & Electrolytes

 

1)  The Ability of Physicians to Predict Hyperkalemia from the EKG.  Wrenn, et al.  1991.

  ---Summary:  EKG's aren't very good at ruling in or out hyperkalemia

 

2)  Comparison of Octreotide and Standard Therapy Versus Standard Therapy Alone for the Treatment of Sulfonylurea-Induced Hypoglycemia.  Fasano, et al.  2007

    ---Summary:  Octreotide seems to keep glucose levels higher in patients who have sulfonylurea induced hypoglycemia 

 

 

 

August 2007 -  Other Factors Influencing Patient Care

 

1)  The Effect of Low Complexity Patients on ED Waiting Times - Schull, et al.  Ann EM, 2007.

   ---Summary:  They don't significantly add to the wait times of higher complexity patients. 

 

2)  The Impact of Trauma Activations on the Care of ED Patients with Potential ACS - Fishman, et al.  Ann EM. 2006.

   ---Summary:  Trauma activations negatively impact the care of potential ACS patients 

 

July 2007 -  Seizures

 

 

1)  Lorazepam for the Prevention of the Recurrent Seizures Related to Alcohol.  NEJM.  G. D'Onorfrio, et al, 1999.

     ---Summary - Lorazepam significantly reduces the recurrence of alcohol related seizures 

 

2)  A Comparison of Phenytoin-Loading Techniques in the Emergency Department.  Acad Emerg Med.  S. Swadron, et al.  2004.

       ---Summary:  IV is the fastest if time to 'therapeutic' is important

 

Additional Info:

Dilantin is not useful for preventing alcohol withdrawal seizures...see this paper

 

June 2007 - Appendicitis

 

1)  Clinical Value of Total WBC and Temperature in the Evaluation of Patients with Suspected Appendicitis.  Cardall, et al.

 

---Summary-WBC & Temp not helpful

 

2)  Prospective comparison of helical CT of the abdomen and pelvis without and with oral contrast in assessing acute abdominal pain in adult Emergency Department patients.  Lee, et al.

 

---Summary-Oral Contrast not very helpful, however it's more complicated than that...

 

 

May 2007 - Headache

 

• Randomized, Placebo-Controlled Evaluation of Prochlorperazine [Compazine] Versus Metoclopramide [Reglan] for Emergency Department Treatment of Migraine Headache.  Copploa, et al.  Ann EM.  Nov, 1995.

----Summary:  Compzine vs Reglan for benign headache.

• Intravenous dexamethasone to prevent the recurrence of benign headache after discharge from the emergency department: a randomized, double-blind, placebo-controlled clinical trial.  Baden, et al.  CJEM.  Nov, 2006.

----Summary:  Dexamethasone to prevent the return of migraine headache.

 

• Additional Info:

Diagnostic Criteria for Migraine

A good Review of Migraine Headaches

 

April 2007 - DVT & PE

• Evaluation of d-dimer in the Diagnosis of Suspected Deep-Vein Thrombosis.  Philip S. Wells, et al.  NEJM  349; 13.  Sept 25, 2003.

----Summary:  So can we use d-dimer in the evaluation of DVT?

 

• Multidetector Computed Tomography for Acute Pulmonary Embolism.  Paul D. Stein, et al.  NEJM  354; 22.  June 1, 2006.

----Summary:  How good is CTPA for the diagnosis of PE?

 

• Additional Info:

-----Well's Score for Determining the Clinical Probability of Pulmonary Embolism

 

March 2007 - Meningitis

 

• Clinical Features and Prognostic Factors in Adults with Bacterial Meningitis - van de Beek, et al, 2004

  ---Summary:  Can you rule out meningitis by using the classic symptoms & signs?

   

• Dexamethasone in Adults with Bacterial Meningitis - de Gans, et al, 2002

  ---Summary:  Is Dexamethasone useful in the treatment of bacterial meningitis?

 

 

February 2007 -  Essays & Ideas about the Emergency Department

•  Is There Evidence to Support the Need for Routine Surgeon Presence on Trauma Patient Arrival?  SM Green.  May, 2006

An essay discussion of the need for a surgeon to be in the ED upon the arrival of a trauma patient - by an EM Physician.

 

• Frequent Emergency Department Visitors:  The End of Inappropriateness.  SL Bernstein.  July, 2006

An essay discussion of the common belief that ED overcrowding is to a large part due to the large number of 'inappropriate ED patients'.

 

 

January 2007 - Chest Pain and MI

• Early intravenous then oral metoprolol in 45,852 patients with acute myocardial infarction: randomised placebo controlled
          trial.  COMMIT (ClOpidogrel and Metoprolol in Myocardial Infarction Trial) collaborative group* 

---Summary:  Beta-blockers and MI: What's Known at This Point??? What Does COMMIT Tell Us???

 

•  Changes in the Numeric Descriptive Scale for Pain After Sublingual Nitroglycerin Do Not Predict Cardiac Etiology of Chest Pain. Diercks, et al.

---Summary:  Summary of Chest Pain and Nitroglycerin…What Does the Effect of NTG on CP Tell Us???

 

December 2006 -  COPD

•  Outpatient Oral Prednisone after Emergency Treatment of Chronic Obstructive Pulmonary Disease - Aaron, et al.

 

• Antibiotic Therapy in Exacerbations of Chronic Obstructive Pulmonary Disease - Anthonisen, et al.

 

November 2006 - Toxicology

• Aminotransferase Elevations in Healthy Adults
  Receiving 4 Grams of Acetaminophen Daily - Watkins, et al.

 

• Elevated Blood Cyanide Concentrations in Victims of Smoke Inhalation - Baud, et al.

 

October 2006 - Psych & Neurology

• Comparison of the Canadian CT Head Rule
  and the New Orleans Criteria
  in Patients With Minor Head Injury -Stiell, et al.

 

• San Francisco Synope Rules  - Quinn, et al.

 

September 2006  Dermatology

• High Prevalence of Methicillin-Resistant Staphylococcus aureus in
  Emergency Department Skin and Soft Tissue Infections - Frazee, et al.

 

• Sterile Versus Nonsterile Gloves for Repair of
  Uncomplicated Lacerations in the Emergency
  Department: A Randomized Controlled Trial - Perelman

 

August 2006  EMS & Geriatrics

• Inappropriate Medication Administration to the Acutely Ill Elderly - Caterino, et al.

 

• Out of Hospital Endotracheal Intubation:  Where Are We? - Wang, et al.

 

July 2006 IOM Reports

• The Future of Emergency Care:  Key Findings and Recommendations

 

• The Future of Emergency Care in the US Health System

 

June 2006  Airway

• Laryngeal View During Laryngoscopy: A Randomized Trial
  Comparing Cricoid Pressure, Backward-Upward-Rightward
  Pressure, and Bimanual Laryngoscopy- Levitan, et al

 

• Transtracheal Open Ventilation in Acute Respiratory
  Failure Secondary to Severe Chronic Obstructive
  Pulmonary Disease Exacerbation - Gregoretti, et al