First10EM Journal Club: November 2017

Welcome back to the Journal Club with Dr Justin Morgenstern.  It has been 2 months since we last dusted off the papers on Justin’s bedside table… but like a mythical (nerdy) Sisyphus Justin must push another load of evidence out into the ether in order to go back and start the whole process again.

This episode is on steroids.  I mean it is largely about steroids, not actually “on steroids” but there is a sprinkling of other stuff and a bit of philosophical banter about machine learning at the end.

So sit back, grab a beverage and tune in for another hour of evidence and education from our corners of the world. You can read Justin’s written thoughts over at First10EM now

Here are the papers:

Braude D, Soliz T, Crandall C, Hendey G, Andrews J, Weichenthal L. Antiemetics in the ED: a randomized controlled trial comparing 3 common agents. The American journal of emergency medicine. 2006; 24(2):177-82. PMID: 16490647

Bottom line: We really need to get our acts together and get droperidol back in our emergency departments.

Roldan CJ, Chambers KA, Paniagua L, Patel S, Cardenas-Turanzas M, Chathampally Y. Randomized Controlled Double-blind Trial Comparing Haloperidol Combined With Conventional Therapy to Conventional Therapy Alone in Patients With Symptomatic Gastroparesis. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2017. PMID: 28646590

Bottom line: Until someone brings droperidol back to Canada, haloperidol will remain a key component of my cyclic vomiting management strategy.

Sadeghirad B, Siemieniuk RAC, Brignardello-Petersen R. Corticosteroids for treatment of sore throat: systematic review and meta-analysis of randomised trials. BMJ (Clinical research ed.). 2017; 358:j3887. PMID: 28931508 [free full text]

Bottom line: Steroids will decrease pain from pharyngitis, although the exact balance of harms and benefits is probably not known.

Waljee AK, Rogers MA, Lin P. Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study. BMJ (Clinical research ed.). 2017; 357:j1415. PMID: 28404617 [free full text]

Bottom line: We know there are adverse events from steroid prescriptions, but this study really doesn’t give us much information.

Qaseem A, Harris RP, Forciea MA. Management of Acute and Recurrent Gout: A Clinical Practice Guideline From the American College of Physicians. Annals of internal medicine. 2017; 166(1):58-68. PMID: 27802508

This is a well done clinical practice guideline (meaning transparently based in evidence) with a few decent take homes about gout for emergency practitioners.

Callaham ML. The Prudent Layperson’s Complicated and Uncertain Road to Urgent Care. Annals of emergency medicine. 2017. PMID: 28935282

Bottom line: Stop blaming patients for using the emergency department. We have system issues and societal education issues that we need to address, but for now I am happy to look after any patient who is scared about their health.

Daum RS, Miller LG, Immergluck L. A Placebo-Controlled Trial of Antibiotics for Smaller Skin Abscesses. The New England journal of medicine. 2017; 376(26):2545-2555. PMID: 28657870

Bottom line: Some patients will benefit from antibiotics after I+D of their abscess.

Gottlieb M, Russell FM. How Safe Is the Ultrasonographically-Guided Peripheral Internal Jugular Line? Annals of emergency medicine. 2017. PMID: 28969927

Bottom line: The ability to rapidly (and safely) place a peripheral IV into the internal jugular could be lifesaving in the correct patient, but shouldn’t be used routinely.

Cabitza F, Rasoini R, Gensini GF. Unintended Consequences of Machine Learning in Medicine. JAMA. 2017; 318(6):517-518. PMID: 28727867


Ziad Obermeyer, Thomas H. Lee.   Lost in Thought — The Limits of the Human Mind and the Future of Medicine
N Engl J Med 2017; 377:1209-1211  September 28, 2017

Bottom Line:  Machines may help us make better decisions in the future. But we still need to know what the data input looks like and what goes on inside the black box!

OK Here is the podcast, thanks for joining us once again.  Comments are always welcomed.


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