First10EM Journal Club: August 2020

Welcome back for another month of nerdy Nirvana with Dr Justin Morgenstern. This month on the journal club we cover TXA for GI, Dex for COVID, pinky ladies (again) and haloperidol for headaches… plus a bunch of other goodies that just might make your job easier.

As always there are free PDF copies of the papers we discuss linked below. As my friend Ken says – be skeptical, even if you hear it here… actually especially of you hear it here.


 

HALT-IT Trial Collaborators. Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial. Lancet. 2020;395(10241):1927-1936. doi:10.1016/S0140-6736(20)30848-5 PMID: 32563378


RECOVERY Collaborative Group, Horby P, Lim WS, et al. Dexamethasone in Hospitalized Patients with Covid-19 – Preliminary Report. N Engl J Med. 2020;10.1056/NEJMoa2021436. doi:10.1056/NEJMoa2021436 PMID: 32678530

 

You can read more here. and HERE too


Carley S, Horner D, Body R, Mackway-Jones K. Evidence-based medicine and COVID-19: what to believe and when to change. Emerg Med J. 2020;emermed-2020-210098. doi:10.1136/emermed-2020-210098 PMID: 32651176

 


Warren J, Cooper B, Jermakoff A, Knott JC. Antacid monotherapy is more effective in relieving epigastric pain than in combination with lidocaine. A randomized double-blind clinical trial. Acad Emerg Med. 2020;10.1111/acem.14069. doi:10.1111/acem.14069 PMID: 32602148

 

There are prior RCTs saying the same thing.


Lindblad AJ, McCormack J, Korownyk CS, et al. PEER simplified decision aid: osteoarthritis treatment options in primary care. Can Fam Physician. 2020 Mar; 66(3):191-193. Available at: https://www.cfp.ca/content/66/3/191

 


McCoy JJ, Aldy K, Arnall E, Petersen J. Treatment of Headache in the Emergency Department: Haloperidol in the Acute Setting (THE-HA Study): A Randomized Clinical Trial. J Emerg Med. 2020;S0736-4679(20)30349-8. doi:10.1016/j.jemermed.2020.04.018 PMID: 32402480 NCT02747511

 


Zulman DM, Haverfield MC, Shaw JG, et al. Practices to Foster Physician Presence and Connection With Patients in the Clinical Encounter [published correction appears in JAMA. 2020 Mar 17;323(11):1098]. JAMA. 2020;323(1):70–81. doi:10.1001/jama.2019.19003 PMID: 31910284 [article]

 

My talk from SMACC GOLD entitled: The History of Empathy is worth a listen if you are interested in the science behind empathy and patient connection. There is some good data that we can improve our care with simple empathy.

 

McQuivey KS, Christopher ZK, Chung AS, Makovicka J, Guettler J, Levasseur K. Implementing the Lever Sign in the Emergency Department: Does it Assist in Acute Anterior Cruciate Ligament Rupture Diagnosis? A Pilot Study. J Emerg Med. 2019;57(6):805-811. doi:10.1016/j.jemermed.2019.09.003 PMID: 31708315

 


 

Tran QK, Rehan MA, Haase DJ, Matta A, Pourmand A. Prophylactic antibiotics for anterior nasal packing in emergency department: A systematic review and meta-analysis of clinically-significant infections. Am J Emerg Med. 2020;38(5):983-989. doi:10.1016/j.ajem.2019.11.037 PMID: 31839514


 

Turner JS, Bucca AW, Propst SL, et al. Association of Checklist Use in Endotracheal Intubation With Clinically Important Outcomes: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3(7):e209278. Published 2020 Jul 1. doi:10.1001/jamanetworkopen.2020.9278 PMID: 32614424

For a great talk on airway checklists, check out My Checklists Manifesto by Michael Lauria: https://www.youtube.com/watch?v=36vgGdxKkPQ&feature=youtu.be

The SMACC Airway Checklist debate is still going… but you can catch the first 20 minutes here:


 

Catchpole K, Russ S. The problem with checklists. BMJ Quality & Safety 2015;24:545-549. DOI: 10.1136/bmjqs-2015-004431

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