First10EM Journal Club: March 2018

Welcome back – another episode of the sporadic journal club this month.  In this month’s episode, Justin and I cover chest pain, LPs, nebulised furosemide, the Lazarus phenomenon and of course, the sport of Quidditch.  Spoiler alert: Quidditch players suffer wrist sprains and insightless injuries to their own pride…

You can check out the written version and some choice videos of hipsters playing Quidditch over at the First10EM blog.

Here are the papers we cover this month:

Syed S, Gatien M, Perry JJ. Prospective validation of a clinical decision rule to identify patients presenting to the emergency department with chest pain who can safely be removed from cardiac monitoring. CMAJ. 2017; 189(4):E139-E145. PMID: 28246315 [free full text]

Bottom line: The rule is probably not ready for prime-time, but the data here does remind us that not every chest pain patient requires a cardiac monitor.

Gongora CA, Bavishi C, Uretsky S, Argulian E. Acute chest pain evaluation using coronary computed tomography angiography compared with standard of care: a meta-analysis of randomised clinical trials. Heart. 2018; 104(3):215-221. PMID: 28855273

Bottom line: In the RCTs we have to date, CCTA demonstrate no benefit, but leads to an increase in unnecessary invasive procedures.

Owens D. Nebulized Furosemide for the Treatment of Dyspnea. Journal of Hospice & Palliative Nursing. 2009; 11(4):200-201. DOI: 10.1097/NJH.0b013e3181b06227

Bottom line: This won’t be first-line for me, but it is nice to know about.

Driver B, Dodd K, Klein LR. The Bougie and First-Pass Success in the Emergency Department. Annals of emergency medicine. 2017; 70(4):473-478.e1. PMID: 28601269

Bottom line: The bougie is a great device

Nath S, Koziarz A, Badhiwala JH. Atraumatic versus conventional lumbar puncture needles: a systematic review and meta-analysis. Lancet. 2017. PMID: 29223694

Bottom line: This one is done. It is time to stop doing studies and just use the atraumatic needles.

April MD, Long B, Koyfman A. Emergency Medicine Myths: Computed Tomography of the Head Prior to Lumbar Puncture in Adults with Suspected Bacterial Meningitis – Due Diligence or Antiquated Practice? The Journal of emergency medicine. 2017; 53(3):313-321. PMID: 28666562

Bottom line: There is no clear evidence-based answer here. Just be sure that no matter what you do those antibiotics are given as soon as possible if you are considering bacterial meningitis.

Aboltins CA, Hutchinson AF, Sinnappu RN. Oral versus parenteral antimicrobials for the treatment of cellulitis: a randomized non-inferiority trial. The Journal of antimicrobial chemotherapy. 2015; 70(2):581-6. PMID: 25336165

Bottom line: For the most part, stick with oral antibiotics for cellulitis.

Kuisma M, Salo A, Puolakka J. Delayed return of spontaneous circulation (the Lazarus phenomenon) after cessation of out-of-hospital cardiopulmonary resuscitation. Resuscitation. 2017; 118:107-111. PMID: 28750883

Bottom line: Although The Princess Bride provides us with much wisdom, I am not sure “there is a big difference between mostly dead and all dead”

Princess bride:

Monty Python “Not Dead Yet”

Patricia Gerritson’s SMACC DUB Talk on the Lazarus phenomenon...

Ilgen JS, Eva KW, Regehr G. What’s in a Label? Is Diagnosis the Start or the End of Clinical Reasoning? Journal of general internal medicine. 2016; 31(4):435-7. PMID: 26813111

 Pennington R, Cooper A, Edmond E, Faulkner A, Reidy MJ, Davies PSE. Injuries in quidditch: a descriptive epidemiological study. International journal of sports physical therapy. 2017; 12(5):833-839. PMID: 29181260 [free full text]

Bottom line: This is just ridiculous. If I catch anyone running around with a broom between your legs, I will mock you endlessly. Seriously – just look at the kids in this video.


Yes, that is seriously a thing….

The podcast is below, or download it on your favourite podcast app /thingy.




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