First10EM Journal Club: May 2022

The nerdy goodness of #FOAMed #EBM is back with Dr Justin Morgenstern and I discussing a lot of papers – PE, COvID, flaming fingers, diverticulitis, over-diagnosis, more PEs, vitamin C, fraud and some myth busting, more PEs…. As always the free PDFs are linked to the titles below so you can read and ponder your own thoughts… seriously, you should not believe anything we say!

WARNING: This is a seriously long episode at nearly 2 hours, you might want to do it in a few sessions to avoid the inevitable silliness that creeps into our discussions!

Was the original Marik Vitamin C trial based on fraudulent data?

Sheldrick, K. Evidence of Fabricated Data in a Vitamin C trial by Paul E Marik et al in CHEST. Available at:

Can you place an IV line in the arm of a woman after axillary clearance for breast cancer?

Naranjo J, Portner ER, Jakub JW, Cheville AL, Nuttall GA. Ipsilateral Intravenous Catheter Placement in Breast Cancer Surgery Patients. Anesth Analg. 2021 Sep 1;133(3):707-712. doi: 10.1213/ANE.0000000000005597. PMID: 34043309

The RePHILL trial – should ambulances carry plasma and blood?

Crombie N, Doughty HA, Bishop JRB, Desai A, Dixon EF, Hancox JM, Herbert MJ, Leech C, Lewis SJ, Nash MR, Naumann DN, Slinn G, Smith H, Smith IM, Wale RK, Wilson A, Ives N, Perkins GD; RePHILL collaborative group. Resuscitation with blood products in patients with trauma-related haemorrhagic shock receiving prehospital care (RePHILL): a multicentre, open-label, randomised, controlled, phase 3 trial. Lancet Haematol. 2022 Apr;9(4):e250-e261. doi: 10.1016/S2352-3026(22)00040-0. PMID: 35271808

The optimal pad placement for defibrillation of AF is….

Schmidt AS, Lauridsen KG, Møller DS, Christensen PD, Dodt KK, Rickers H, Løfgren B, Albertsen AE. Anterior-Lateral Versus Anterior-Posterior Electrode Position for Cardioverting Atrial Fibrillation. Circulation. 2021 Dec 21;144(25):1995-2003. doi: 10.1161/CIRCULATIONAHA.121.056301. Epub 2021 Nov 24. PMID: 34814700

Who is afraid of the next PE? You are… and the data proves it.

Ly DP. The Influence of the Availability Heuristic on Physicians in the Emergency Department. Ann Emerg Med. 2021 Nov;78(5):650-657. doi: 10.1016/j.annemergmed.2021.06.012. Epub 2021 Aug 6. PMID: 34373141

Being awake and paralysed in ED is unpleasant – don’t do this to people!

Pappal RD, Roberts BW, Mohr NM, Ablordeppey E, Wessman BT, Drewry AM, Winkler W, Yan Y, Kollef MH, Avidan MS, Fuller BM. The ED-AWARENESS Study: A Prospective, Observational Cohort Study of Awareness With Paralysis in Mechanically Ventilated Patients Admitted From the Emergency Department. Ann Emerg Med. 2021 May;77(5):532-544. doi: 10.1016/j.annemergmed.2020.10.012 PMID: 33485698

New Strategy to unstuff the D-dimer turkey.

Freund Y, Chauvin A, Jimenez S, Philippon AL, Curac S, Fémy F, Gorlicki J, Chouihed T, Goulet H, Montassier E, Dumont M, Lozano Polo L, Le Borgne P, Khellaf M, Bouzid D, Raynal PA, Abdessaied N, Laribi S, Guenezan J, Ganansia O, Bloom B, Miró O, Cachanado M, Simon T. Effect of a Diagnostic Strategy Using an Elevated and Age-Adjusted D-Dimer Threshold on Thromboembolic Events in Emergency Department Patients With Suspected Pulmonary Embolism: A Randomized Clinical Trial. JAMA. 2021 Dec 7;326(21):2141-2149. doi: 10.1001/jama.2021.20750. PMID: 34874418

If you look for PE you will find it… but should we?

Jiménez D, Agustí A, Tabernero E, Jara-Palomares L, Hernando A, Ruiz-Artacho P, Pérez-Peñate G, Rivas-Guerrero A, Rodríguez-Nieto MJ, Ballaz A, Agüero R, Jiménez S, Calle-Rubio M, López-Reyes R, Marcos-Rodríguez P, Barrios D, Rodríguez C, Muriel A, Bertoletti L, Couturaud F, Huisman M, Lobo JL, Yusen RD, Bikdeli B, Monreal M, Otero R; SLICE Trial Group. Effect of a Pulmonary Embolism Diagnostic Strategy on Clinical Outcomes in Patients Hospitalized for COPD Exacerbation: A Randomized Clinical Trial. JAMA. 2021 Oct 5;326(13):1277-1285. doi: 10.1001/jama.2021.14846. PMID: 34609451

ED overdiagnosis – time to rethink the labels we apply

Vigna M, Vigna C, Lang ES. Overdiagnosis in the emergency department: a sharper focus. Intern Emerg Med. 2022 Mar 5. doi: 10.1007/s11739-022-02952-8. Epub ahead of print. PMID: 35249191

Diverticulitis: antibiotics are out.

Mora-López L, Ruiz-Edo N, Estrada-Ferrer O, Piñana-Campón ML, Labró-Ciurans M, Escuder-Perez J, Sales-Mallafré R, Rebasa-Cladera P, Navarro-Soto S, Serra-Aracil X; DINAMO-study Group. Efficacy and Safety of Nonantibiotic Outpatient Treatment in Mild Acute Diverticulitis (DINAMO-study): A Multicentre, Randomised, Open-label, Noninferiority Trial. Ann Surg. 2021 Nov 1;274(5):e435-e442. doi: 10.1097/SLA.0000000000005031. PMID: 34183510

Long COVID… what you need to know … sort of.

Xie Y, Xu E, Bowe B, Al-Aly Z. Long-term cardiovascular outcomes of COVID-19. Nat Med. 2022 Mar;28(3):583-590. doi: 10.1038/s41591-022-01689-3. Epub 2022 Feb 7. PMID: 35132265

Try and avoid imolliating patients with subungal haematomas

Blereau C, Radloff S, Grisham J. Up in Flames: The Safety of Electrocautery Trephination of Subungual Hematomas with Acrylic Nails. West J Emerg Med. 2022 Feb 23;23(2):183-185. doi: 10.5811/westjem.2021.10.53567. PMID: 35302451

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