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First10EM Journal Club: July 2018

Good day listeners and readers alike.  Another episode of the Journal Club with Justin Morgenstern is out now.  The papers are all free and linked below.  You can also go over tot he First10EM blog and read the in-depth analysis from my favourite EBM nerd…

This month we cover bougies, brain-bleeds and the best Paeds DKA paper ever.  We also degenerate into the recent and remote evolutionary history of hiccoughs… fun times are to be had!

Have a listen on the podcast – link below or via your preferred podcast player.


TXA is not magical?

Sprigg N, Flaherty K, Appleton JP, et al. Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage (TICH-2): an international randomised, placebo-controlled, phase 3 superiority trial. Lancet (London, England). 2018; 391(10135):2107-2115. PMID: 29778325 [free full text]

The full write up can be found here. 


Bougie is better

Driver BE, Prekker ME, Klein LR, et al. Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients With Difficult Airways Undergoing Emergency Intubation: A Randomized Clinical Trial. JAMA. 2018; 319(21):2179-2189. PMID: 29800096

The full write up can be found here.


Interesting airway hack

Waldron S, Dobson A. A novel positioning technique to assist laryngoscopy in patients with a potentially difficult airway. European journal of anaesthesiology. 2010; 27(10):921. PMID: 20498607

 


Medical management of peritonsillar abscess?

Souza DL, Cabrera D, Gilani WI, et al. Comparison of medical versus surgical management of peritonsillar abscess: A retrospective observational study. The Laryngoscope. 2016; 126(7):1529-34. PMID: 27010228

Bottom line: Although probably not appropriate for all comers, some select patients with peritonsillar abscess might be managed non-surgically.

 


Does ED physician speed affect patient experience?

Lenz K, McRae A, Wang D, et al. Slow or swift, your patients’ experience won’t drift: absence of correlation between physician productivity and the patient experience. CJEM. 2017; 19(5):372-380. PMID: 27819217


Once again: tamsulosin doesn’t help with kidney stones

Meltzer AC, Burrows PK, Wolfson AB, et al. Effect of Tamsulosin on Passage of Symptomatic Ureteral Stones: A Randomized Clinical Trial. JAMA internal medicine. 2018. PMID: 29913020

The full write up can be found here.

 


IV fluids DO NOT cause cerebral edema in pediatric DKA

Kuppermann N, Ghetti S, Schunk JE, et al. Clinical Trial of Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis. The New England journal of medicine. 2018; 378(24):2275-2287. 

The full write up can be found here.


Best medical care in the world

Reilly BM. The Best Medical Care in the World. The New England journal of medicine. 2018; 37(18):1741-1743.

Justins full written response here  or  [free full text]

 


Best ever cure for hiccups

Peleg R, Peleg A. Case report: sexual intercourse as potential treatment for intractable hiccups. Canadian family physician. 2000; 46:1631-2. [free full text]

 Possibly a case of non-heroic self-experimentation that turned out just fine….


A disturbing historical case report about hiccoughs and “Medicine” in 1845

Dexter G. Singular Case of Hiccough Caused by Masturbation The Boston Medical and Surgical Journal. 1845; 32(10):195-197.


So why do we hiccough anyway?

The answer is all about tadpoles and suckling…  or at least the best one I could find.  Nerdy zoological paper below:

C. Straus  A phylogenetic hypothesis for the origin of hiccough.   BioEssays 25:182–188, 2003.


 

Comments

  1. tom fiero says:

    excellent collection of journal articles, lads.
    i have used TXA in my head bleeds, but the tele-neurologists often say “i don’t know”, when i ask them about it. i figure the upside may be very valuable, the risk low. cost 200.00. US dollars.

    the Reilly article is terribly tragic.
    someday, certainly not today, we shall learn how to treat mental disorders, and to discern a cervical spine injury from “depression”.

    i have stopped using flomax on nearly all my renal colics. orthostatic hypotension, syncope and head bleeds are real. the benefit in renal colic might not be, and seems unproven.

    thank you so very much to my australian friends in Broome.

    tom fiero, merced, california

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