First10EM Journal Club: March 2017

Hello EBM listeners

After a month of radio silence we are back with the March episode of the Justin & Casey Journal club.

This month we have 11 papers in 3-quarters of an hour. We cover the good, bad and ugly of migraine sprays.  How Facebook stats can determine your longevity, Marik’s Magic Sepsis Sauce and how to “toughen up” in the face of rudeness mid-Resus!

As always – the papers discussed are available on the links below in full-text, PDF glory.  So don’t rely on our simple minds – have a read and make up your own mind!  You can read Justin’s in depth, written analysis over at First10EM (great blog!)

Most misunderstood and misinterpreted paper of the month
Barnett ML, Olenski AR, Jena AB. Opioid-Prescribing Patterns of Emergency Physicians and Risk of Long-Term Use.   The New England journal of medicine. 376(7):663-673. 2017. PMID: 28199807

Bottom line: Opioids are a problem. Prescribe responsibly. Don’t use combination pills. Avoid euphorics like percocet and stick to plain oral morphine. Prescribe only short courses for acute pain. But ignore this paper – it doesn’t tell you anything.

Why we need resuscitation sequenced Intubation
Perbet S, De Jong A, Delmas J. Incidence of and risk factors for severe cardiovascular collapse after endotracheal intubation in the ICU: a multicenter observational study.   Critical care (London, England). 19:257. 2015. PMID: 26084896

Bottom line: In critically ill patients, post-intubation cardiovascular collapse is common. We need to resuscitate these patients prior to intubation, and be prepare for deterioration.

Intranasal Ketorolac?
Rao AS et al. A Randomized Trial of Ketorolac vs. Sumatripan vs. Placebo Nasal Spray (KSPN) for Acute Migraine. Headache.   Headache 56(2):331-40. 2016. PMID: 26840902

Bottom line: I don’t use any of these options in the emergency department for migrain right now. This paper won’t change my practice.

Intranasal lidocaine? Adding insult to injury?

Avcu N, Doğan NÖ, Pekdemir M. Intranasal Lidocaine in Acute Treatment of Migraine: A Randomized Controlled Trial.    Annals of emergency medicine. 2016. PMID: 27889366

Bottom line: Just in case you were wondering, intranasal lidocaine is unlikely to help your migraine patients.

Forget the sepsis bundles, these patients just need vitamins
Marik PE, Khangoora V, Rivera R, Hooper MH, Catravas J. Hydrocortisone, Vitamin C and Thiamine for the Treatment of Severe Sepsis and Septic Shock: A Retrospective Before-After Study.   Chest. 2016. PMID: 27940189

Bottom line: Definitely not a game changer, but I think it is interesting, and you will here about it, whether in a medical venue or on NPR.

A couple papers on rudeness…
Riskin A, Erez A, Foulk TA. The Impact of Rudeness on Medical Team Performance: A Randomized Trial.      Pediatrics. 136(3):487-95. 2015. PMID: 26260718

Riskin A, Erez A, Foulk TA. Rudeness and Medical Team Performance. Pediatrics. 139(2):. 2017. PMID: 28073958
Bottom Line: Our performance is not directly influenced by outside stimuli – it is our interpretation of those stimuli that matters. That is good news, because you can train yourself to alter your interpretations and therefore maintain the excellent performance you are accustom to. (JM: You can read more about this in my recent post Performance Under Pressure.)

The easy IJ…
Moayedi S, Witting M, Pirotte M. Safety and Efficacy of the “Easy Internal Jugular (IJ)”: An Approach to Difficult Intravenous Access.   The Journal of emergency medicine. 51(6):636-642. 2016. PMID: 27658558

Bottom line: I will definitely keep this procedure in mind in patients with difficult vascular access

Treatment for first time seizures?
Leone MA et al. Immediate antiepileptic drug treatment, versus placebo, deferred, or no treatment for first unprovoked seizure. The Cochrane database of systematic reviews. 2016. PMID: 27150433

Bottom line: This is all about shared decision making to me. There isn’t a clear answer, so I will probably still leave this decision to the neurologists in follow up.

They might bend, but they won’t break
Jiang N, Cao ZH, Ma YF, Lin Z, Yu B. Management of Pediatric Forearm Torus Fractures: A Systematic Review and Meta-Analysis.    Pediatric emergency care. 32(11):773-778. 2016. PMID: 26555307

Bottom line: There is no reason to be casting torus fractures. We should probably stock velcro splints in the ED instead.

Could facebook extend your life?
Hobbs WR, Burke M, Christakis NA, Fowler JH. Online social integration is associated with reduced mortality risk. Proceedings of the National Academy of Sciences of the United States of America. 113(46):12980-12984. 2016. PMID: 27799553
Bottom line: I wish I had more friends

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