First10EM Journal Club: Jan 2021

Welcome back for another Journal Jam with Justin.  Another month and another 10 or so papers to keep you pondering what we do in the ED…. or outer space…

This month we are covering another Dexamethasone trial, magnesium vs. morphine in the renal colic showdown  and exactly how to do CPR in zero gravity… Justin even rants about stuff as banal as burn blisters!

Sit back, grab a cup and enjoy!  PDFs linked below as always.


The ARREST trial: Yannopoulos D, Bartos J, Raveendran G, Walser E, et al. Advanced reperfusion strategies for patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation (ARREST): a phase 2, single centre, open-label, randomised controlled trial. Lancet. 2020 Nov 12:S0140-6736(20)32338-2. PMID: 33197396 

Bottom line: The first ever RCT of ECMO in OOHCA demonstrates a massive benefit, but there are lots of sources of bias that should temper our optimism.  You can read more here.

Morgenstern J, Gottlieb M. Burn-Related Blisters Should Not Be Removed in the Emergency Department. Annals of Emergency Medicine. 2020; 76(6):770-771. [article]

April MD, Koyfman A, Long B. Select Burn Blisters Should not be Left Intact. Annals of Emergency Medicine. 2020; 76(6):771-773. [article]

Bottom line: There is no evidence that debriding burn blisters helps, but it definitely hurts.

Villar J, Ferrando C, Martínez D, et al. Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomised controlled trial. Lancet Respir Med. 2020 Mar;8(3):267-276. doi: 10.1016/S2213-2600(19)30417-5. Epub 2020 Feb 7. PMID: 32043986 NCT01731795

Bottom line: Probably not a decision for me in the ED, and at least for the next little while all these patients will be getting steroids because of COVID, but I think this remains an open question with the needle leaning somewhat towards treatment. 

Ranji SR, Shojania KG, Trowbridge RL, Auerbach AD. Impact of reliance on CT pulmonary angiography on diagnosis of pulmonary embolism: a Bayesian analysis. J Hosp Med. 2006 Mar;1(2):81-7. doi: 10.1002/jhm.71. PMID: 17219477

Bottom line: This study is an excellent reminder that tests are not objective. They don’t give us perfect answers. You can’t just read the report. As I have discussed before, in order to interpret any test, you must know the pretest probability

Zolfaghari Sadrabad A, Azimi Abarghouei S, Farahmand Rad R, Salimi Y. Intravenous magnesium sulfate vs. morphine sulfate in relieving renal colic: A randomized clinical trial. Am J Emerg Med. 2020 Jul 21:S0735-6757(20)30629-X. doi: 10.1016/j.ajem.2020.07.035. PMID: 33071088 ACTRN12615001372572

Bottom line: In this small RCT, both intravenous magnesium and a small dose of morphine decreased pain due to renal colic.

Sjoding MW, Dickson RP, Iwashyna TJ, Gay SE, Valley TS. Racial Bias in Pulse Oximetry Measurement. N Engl J Med. 2020 Dec 17;383(25):2477-2478. doi: 10.1056/NEJMc2029240. PMID: 33326721

You can hear more from Lauren Westafer on the FOAMcast podcast. PulmCrit also wrote about this, and apparently we have known about this issue for more than a decade.

Bottom line: Medical research needs to be far more inclusive, and for the meantime we need to be cautious in our interpretation of pulse oximetry. 

Petrosoniak A, Fan M, Hicks CM, White K, McGowan M, Campbell D, Trbovich P. Trauma Resuscitation Using in situ Simulation Team Training (TRUST) study: latent safety threat evaluation using framework analysis and video review. BMJ Qual Saf. 2020 Oct 23:bmjqs-2020-011363. doi: 10.1136/bmjqs-2020-011363 PMID: 33097610

Wallace PJ, Haber JJ. Top 10 evidence-based countermeasures for night shift workers. Emerg Med J. 2020 Sep;37(9):562-564. doi: 10.1136/emermed-2019-209134. PMID: 32332056

You can read more here, or just take the time to read the paper, because this is information we all need.

Gaudart P, Cazes N, Simon K, Larger D, Deharo JC. The reverse vagal manoeuvre: A new tool for treatment of supraventricular tachycardia? Am J Emerg Med. 2020 Dec 26;41:66-69. doi: 10.1016/j.ajem.2020.12.061. PMID: 33387931

Hinkelbein J, Kerkhoff S, Adler C, et al. Cardiopulmonary resuscitation (CPR) during spaceflight – a guideline for CPR in microgravity from the German Society of Aerospace Medicine (DGLRM) and the European Society of Aerospace Medicine Space Medicine Group (ESAM-SMG). Scand J Trauma Resusc Emerg Med. 2020 Nov 2;28(1):108. doi: 10.1186/s13049-020-00793-y. PMID: 33138865



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