First10EM Journal Club January 2022
Our first Journal Club for 2022 is out now. You can listen on your favourite podcast player or use the link below. Links to the studies are in the written summary and you can read Justin’s deep and critical thoughts over at First10EM blog. Here is a list of the papers and the bottom lines.
If epinephrine doesn’t work, what makes you think calcium would be any better?
Vallentin MF, Granfeldt A, Meilandt C, et al. Effect of Intravenous or Intraosseous Calcium vs Saline on Return of Spontaneous Circulation in Adults With Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA. 2021 Nov 30. doi: 10.1001/jama.2021.20929. PMID: 34847226
Bottom line: We should not be using calcium empirically for out of hospital cardiac arrest, but be mindful of specific indications.
2022 and we still got nose danglers
Pettit N, Zaidi A, O’Neill B, Doehring M. Use of Adhesive Tape to Facilitate Optimal Mask Positioning and Use in the Emergency Department: A Randomized Controlled Trial. Ann Emerg Med. 2021 Aug 2:S0196-0644(21)00479-0. doi: 10.1016/j.annemergmed.2021.06.004. PMID: 34353646
Bottom line: A simple intervention using tape on the nose may dramatically increase proper mask use among patients.
Longer is not always better in urology
Drekonja DM, Trautner B, Amundson C, Kuskowski M, Johnson JR. Effect of 7 vs 14 Days of Antibiotic Therapy on Resolution of Symptoms Among Afebrile Men With Urinary Tract Infection: A Randomized Clinical Trial. JAMA. 2021 Jul 27;326(4):324-331. doi: 10.1001/jama.2021.9899. PMID: 34313686
Bottom line: This non-inferiority RCT demonstrates that a 7 day course of antibiotics is probably just as good as a 14 day course in afebrile male patients with UTIs.
We are probably not using enough buprenorphine
Herring AA, Vosooghi AA, Luftig J, Anderson ES, Zhao X, Dziura J, Hawk KF, McCormack RP, Saxon A, D’Onofrio G. High-Dose Buprenorphine Induction in the Emergency Department for Treatment of Opioid Use Disorder. JAMA Netw Open. 2021 Jul 1;4(7):e2117128. doi: 10.1001/jamanetworkopen.2021.17128. PMID: 3426432
Bottom line: It appears to be safe to use higher doses of buprenorphine in the emergency department when managing opioid use disorder.
CBT for IBS
Buffone A, Goldman RD. Cognitive-behavioural therapy for children with irritable bowel syndrome. Can Fam Physician. 2021 Dec;67(12):905-907. doi: 10.46747/cfp.6712905. PMID: 34906937 [free full text].
Bottom line: Consider a referral for CBT in children meeting the diagnostic criteria for IBS.
RAPTOR shears for ring removal is fast and fun!
Walter J, DeBoer M, Koops J, Hamel LL, Rupp PE, Westgard BC. Quick cuts: A comparative study of two tools for ring tourniquet removal. Am J Emerg Med. 2021 Aug;46:238-240. doi: 10.1016/j.ajem.2020.07.039. Epub 2020 Jul 25. PMID: 33046320
Bottom line: I don’t know whether the price will be worth it to you, but I believe that the Leatherman Raptor trauma shears make a pretty good ring cutter.
Elevated blood pressure: NOT an abnormal vital sign
McAlister FA, Youngson E, Rowe BH. Elevated Blood Pressures Are Common in the Emergency Department but Are They Important? A Retrospective Cohort Study of 30,278 Adults. Ann Emerg Med. 2021 Apr;77(4):425-432. doi: 10.1016/j.annemergmed.2020.11.005. Epub 2021 Feb 10. PMID: 33579586
Bottom line: High blood pressure is incredibly common in emergency department patients and not associated with adverse cardiovascular events over the next 2 years. There is no need for high blood pressure to be assessed or managed in the ED, and absolutely no role for referring patients with asymptomatic high blood pressure into the emergency department.
It is very important to be able to speak to your doctor
Portillo EN, Stack AM, Monuteaux MC, Curt A, Perron C, Lee LK. Association of limited English proficiency and increased pediatric emergency department revisits. Acad Emerg Med. 2021 Sep;28(9):1001-1011. doi: 10.1111/acem.14359. Epub 2021 Aug 25. PMID: 34431157
Bottom line: This study is far from perfect, but it is likely that patients who don’t speak English are more likely to have 72 hour bounceback visits to the emergency department.
Do you bougie?
Driver BE, Semler MW, Self WH, et al. Effect of Use of a Bougie vs Endotracheal Tube With Stylet on Successful Intubation on the First Attempt Among Critically Ill Patients Undergoing Tracheal Intubation: A Randomized Clinical Trial. JAMA. 2021 Dec 8. doi: 10.1001/jama.2021.22002 PMID: 34879143
Bottom line: This large multicentre RCT showed no benefit of routinely using a bougie for the first intubation attempts, but the result probably don’t apply to airway experts. Personally, I want to consider myself an airway expert.
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Just beware the tape rippers – inadvertent shave biopsy.
I find taking some tack off by sticking it to my shirt, peeling then to my mask and nose works just as good and doesn’t exfoliate so aggressively.
re: the ED BP study, this Swedish study showed a risk for adverse consequence when patient were followed for 6 yrs.