First10EM Journal Club: March 2022

The latest episode of the Journal Club with Dr J Morgenstern is now out. Lots of evidence to reassure you that it’s all a bit unclear! Some great philosophical articles and a super scary Tox plant I never knew to worry about.. Enjoy.

Links to article are clickable to access free PDFs and audio is available on the podcast feed, or at the bottom of this post..

Normal saline vs. Plasmalyte… meh!

Finfer S, Micallef S, Hammond N, Navarra L, Bellomo R, Billot L, Delaney A, Gallagher M, Gattas D, Li Q, Mackle D, Mysore J, Saxena M, Taylor C, Young P, Myburgh J; PLUS Study Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group. Balanced Multielectrolyte Solution versus Saline in Critically Ill Adults. N Engl J Med. 2022 Jan 18. doi: 10.1056/NEJMoa2114464. Epub ahead of print. PMID: 35041780

Hammond NE, Zampieri FG, Di Tanna GL, et al. Balanced Crystalloids versus Saline in Critically Ill Adults — A Systematic Review with Meta-Analysis. NEJM Evidence. 2022; 1(2).

Swallow a rosary pea and you ain’t got a prayer!

Jang DH, Hoffman RS, Nelson LS. Attempted suicide, by mail order: Abrus precatorius. J Med Toxicol. 2010 Dec;6(4):427-30. doi: 10.1007/s13181-010-0099-1. PMID: 20563676

No, pain is not a ‘vital sign’

Davis S, Ju C, Marchandise P, Diagne M, Grant L. Impact of Pain Assessment on Canadian Triage and Acuity Scale Prediction of Patient Outcomes. Ann Emerg Med. 2022 Feb 17:S0196-0644(22)00014-2. doi: 10.1016/j.annemergmed.2022.01.014. Epub ahead of print. PMID: 35184870

Bottom line: The pain score does not seem to add any predictive value to the Canadian triage score. 

A non-fatal MI is not gonna kill you

O’Fee K, Deych E, Ciani O, Brown DL. Assessment of Nonfatal Myocardial Infarction as a Surrogate for All-Cause and Cardiovascular Mortality in Treatment or Prevention of Coronary Artery Disease: A Meta-analysis of Randomized Clinical Trials. JAMA Intern Med. 2021 Dec 1;181(12):1575-1587. doi: 10.1001/jamainternmed.2021.5726. PMID: 34694318

When cancer is the cure.

Trueger NS. The Best Bad News. JAMA Neurol. 2022; doi:10.1001/jamaneurol.2021.5113

Thank you to my friend Dr Seth Trueger for sharing his personal journey through a horrible year in which he bested much more than Covid.

Don’t prescribe tramadol. Seriously.

Xie J, Strauss VY, Martinez-Laguna D, Carbonell-Abella C, Diez-Perez A, Nogues X, Collins GS, Khalid S, Delmestri A, Turkiewicz A, Englund M, Tadrous M, Reyes C, Prieto-Alhambra D. Association of Tramadol vs Codeine Prescription Dispensation With Mortality and Other Adverse Clinical Outcomes. JAMA. 2021 Oct 19;326(15):1504-1515. doi: 10.1001/jama.2021.15255. PMID: 34665205

Bottom line: Don’t prescribe tramadol.

Emergency medicine: is less more?

Atkinson P, McGeorge K, Innes G. Saving emergency medicine: is less more? CJEM. 2022 Jan;24(1):9-11. doi: 10.1007/s43678-021-00237-1. Epub 2022 Jan 17. PMID: 35038157

An important read about the “big picture of Emergency medicine”. Maybe we should stick to caring for sick humans and spend less time on paperwork, low-value care and administration!

This article reminds me a lot of the arguments Scott Weingart made at SMACC in Dublin, in his debate with Simon Carley entitled “EM is a failed paradigm”.

AF: Metoprolol vs. diltiazem… and the winner is… a few minutes

Jafri SH, Xu J, Warsi I, Cerecedo-Lopez CD. Diltiazem versus metoprolol for the management of atrial fibrillation: A systematic review and meta-analysis. Am J Emerg Med. 2021 Oct;48:323-327. doi: 10.1016/j.ajem.2021.06.053. Epub 2021 Jun 30. PMID: 34274577

Misinformation in the Time of Covid... we are drowning in dross!

Parker L, Byrne JA, Goldwater M, Enfield N. Misinformation: an empirical study with scientists and communicators during the COVID-19 pandemic. BMJ Open Sci. 2021 Nov 25;5(1):e100188. doi: 10.1136/bmjos-2021-100188. PMID: 35047703

Masks are in and should not be out anytime soon!

Andrejko KL, Pry JM, Myers JF, et al. Effectiveness of Face Mask or Respirator Use in Indoor Public Settings for Prevention of SARS-CoV-2 Infection — California, February–December 2021. MMWR Morb Mortal Wkly Rep. ePub: 4 February 2022. DOI:

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