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First10EM Journal Club: December 2018

The year is drawing to a close and we have just one more chance to learn from my very wise, ex-Canadian friend Dr Justin Morgenstern.  In this month’s episode, Justin and I discuss a bunch of papers.  Topics include:

  • Paediatric plastic poop
  • OOHCA Airway options
  • Weingart’s suction failure
  • Cricoid pressure is not-non-inferior to nothing
  • a new nasal spray for SVT
  • How much insulin is sweet?
  • Parachutes: are they really worth the extra luggage fees?

As always the full text PDFs of these papers are included – just click on the title to get access and do the reading before you change your practice!


Tagg A, Roland D, Leo GS, Knight K, Goldstein H, Davis T. Everything is awesome: Don’t forget the Lego. J Paediatr Child Health. 2018. 

Now.. let’s rip our good friends’ excellent paper to shreds in the name of science education. If you follow the approach outlined in the post “evidence based medicine is easy”, the first question you should ask is:

The actual bottom line:
“If an experienced clinician with a PhD is unable to adequately find objects in their own stool, it seems clear that we should not be expecting parents to do so – the authors feel that national guidance could include this advice.“


Benger JR, Kirby K, Black S, et al. Effect of a Strategy of a Supraglottic Airway Device vs Tracheal Intubation During Out-of-Hospital Cardiac Arrest on Functional Outcome: The AIRWAYS-2 Randomized Clinical Trial. JAMA. 2018; 320(8):779-791. PMID: 30167701

The full write up can be found here.


Jabre P, Penaloza A, Pinero D, et al. Effect of Bag-Mask Ventilation vs Endotracheal Intubation During Cardiopulmonary Resuscitation on Neurological Outcome After Out-of-Hospital Cardiorespiratory Arrest: A Randomized Clinical Trial. JAMA. 2018; 319(8):779-787.

The full write up can be found here.


Wang HE, Schmicker RH, Daya MR, et al. Effect of a Strategy of Initial Laryngeal Tube Insertion vs Endotracheal Intubation on 72-Hour Survival in Adults With Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA. 2018; 320(8):769-778.

The full write up can be found here.


Shah K, Weingart S. Suction tubing reversal as a dormant failure during airway management. The American Journal of Emergency Medicine. 2018; 36(12):2336.e3-2336.e4.


Birenbaum A, Hajage D, Roche S, et al. Effect of Cricoid Pressure Compared With a Sham Procedure in the Rapid Sequence Induction of Anesthesia: The IRIS Randomized Clinical Trial. JAMA surgery. 2018;

Justin – please explain this non-inferiority design and tell me… was this the right way to answer this question?


Stambler BS, Dorian P, Sager PT, et al. Etripamil Nasal Spray for Rapid Conversion of Supraventricular Tachycardia to Sinus Rhythm. Journal of the American College of Cardiology. 2018; 72(5):489-497.


LaRue HA, Peksa GD, Shah SC. A Comparison of Insulin Doses for the Treatment of Hyperkalemia in Patients with Renal Insufficiency. Pharmacotherapy. 2017; 37(12):1516-1522.

Bottom line: 5 units of IV push insulin might be as effective as 10 units in the management of hyperkalemia, with fewer side effects, but I want to see more data.


FINALLY! An RCT of parachutes!

Yeh RW, Valsdottir LR, Yeh MW, et al. Parachute use to prevent death and major trauma when jumping from aircraft: randomized controlled trial. BMJ (Clinical research ed.). 2018; 363:k5094. 



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Comments

  1. Casey,

    Your statement about cricoid pressure is wrong way around I think; sham cricoid is not provably non-inferior to cricoid.

    (although cricoid is also not superior to sham)

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