First10EM Journal Club: April 2023

We are back with the long-windiest and borderline funny Emergency Medicine journal club to date.

Justin and I are covering some big new trials, some old and unusual papers and a few that just might change your practice. As always the links to the papers are in the write up below and you definitely should read them rather than believe a couple of nerds amusing themselves upon the internet.

Enjoy. Casey

The CLOVERS trial: National Heart, Lung, and Blood Institute Prevention and Early Treatment of Acute Lung Injury Clinical Trials Network; Shapiro NI, Douglas IS, Brower RG, et al. Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. N Engl J Med. 2023 Jan 21. doi: 10.1056/NEJMoa2212663. Epub ahead of print. PMID: 36688507

You can read Justin’s Full write up here. 

Lukosiute-Urboniene A, Nekrosius D, Dekeryte I, Kilda A, Malcius D. Clinical risk factors for testicular torsion and a warning against falsely reassuring ultrasound scans: a 10-year single-centre experience. Emerg Med J. 2022 Dec 16:emermed-2021-211946. doi: 10.1136/emermed-2021-211946. Epub ahead of print. PMID: 36526335

Yarter JT, Racht J, Michels KS. Retrobulbar hemorrhage decompression with paracanthal “one-snip” method: Time to retire lateral canthotomy? Am J Emerg Med. 2023 Feb;64:206.e1-206.e3. doi: 10.1016/j.ajem.2022.11.027. Epub 2022 Nov 21. PMID: 36564334

Ehmann MR, Mitchell J, Levin S, Smith A, Menez S, Hinson JS, Klein EY. Renal outcomes following intravenous contrast administration in patients with acute kidney injury: a multi-site retrospective propensity-adjusted analysis. Intensive Care Med. 2023 Jan 30. doi: 10.1007/s00134-022-06966-w. Epub ahead of print. PMID: 36715705

We have covered the myth of contrast nephropathy many times. It is now quite clear that contrast is not the thing that upsets kidneys in acutely unwell patients. We should use it if it is required!

Perry DC, Achten J, Knight R, Appelbe D, Dutton SJ, Dritsaki M, Mason JM, Roland DT, Messahel S, Widnall J, Costa ML; FORCE Collaborators in collaboration with PERUKI. Immobilisation of torus fractures of the wrist in children (FORCE): a randomised controlled equivalence trial in the UK. Lancet. 2022 Jul 2;400(10345):39-47. doi: 10.1016/S0140-6736(22)01015-7. PMID: 35780790 [open access here]

Stiell IG, Clement CM, Grimshaw JM, Brison RJ, Rowe BH, Lee JS, Shah A, Brehaut J, Holroyd BR, Schull MJ, McKnight RD, Eisenhauer MA, Dreyer J, Letovsky E, Rutledge T, Macphail I, Ross S, Perry JJ, Ip U, Lesiuk H, Bennett C, Wells GA. A prospective cluster-randomized trial to implement the Canadian CT Head Rule in emergency departments. CMAJ. 2010 Oct 5;182(14):1527-32. doi: 10.1503/cmaj.091974. Epub 2010 Aug 23. PMID: 20732978

In summary – when deciding who needs a CT of their head… use your head, not the Canadian CT HEAD rule! Justin’s Full critical appraisal can be found here.

Sutiman N, Khoo ZX, Ong GYK, Piragasam R, Chong SL. Validation and comparison of the PECARN rule, Step-by-Step approach and Lab-score for predicting serious and invasive bacterial infections in young febrile infants. Ann Acad Med Singap. 2022 Oct;51(10):595-604. doi: 10.47102/annals-acadmedsg.2022193. PMID: 36317570

Anderson TS, Jing B, Auerbach A, Wray CM, Lee S, Boscardin WJ, Fung K, Ngo S, Silvestrini M, Steinman MA. Clinical Outcomes After Intensifying Antihypertensive Medication Regimens Among Older Adults at Hospital Discharge. JAMA Intern Med. 2019 Nov 1;179(11):1528-1536. doi: 10.1001/jamainternmed.2019.3007. PMID: 31424475

Rubin R. Warning About Xylazine, a Veterinary Sedative Found in Illicit Drugs. JAMA. 2022 Dec 20;328(23):2296. doi: 10.1001/jama.2022.20045. PMID: 36538321

Am I the only one thinking that this illicit drug additive seems like a really good antidote to the methamphetamine toxidromes that we are constantly managing in the ED?.

Ben Abdallah S, Mhalla Y, Trabelsi I, Sekma A, Youssef R, Bel Haj Ali K, Ben Soltane H, Yacoubi H, Msolli MA, Stambouli N, Beltaief K, Grissa MH, Khrouf M, Mezgar Z, Loussaief C, Bouida W, Razgallah R, Hezbri K, Belguith A, Belkacem N, Dridi Z, Boubaker H, Boukef R, Nouira S. Twice-Daily Oral Zinc in the Treatment of Patients With Coronavirus Disease 2019: A Randomized Double-Blind Controlled Trial. Clin Infect Dis. 2023 Jan 13;76(2):185-191. doi: 10.1093/cid/ciac807. Erratum in: Clin Infect Dis. 2023 Feb 03;: PMID: 36367144

Justin’s excellent critical appraisal and Full write up here.  Beware the possibility of P-hacking here, don’t rush out and buy shares in Zinc mining futures!

Meckler GD, Alqurashi W, Eltorki M, Curtis SJ, Doyle E, Kam AJ, Lim R, MacPhee S, Schuh S, Wright B, Johnson DW. Epinephrine metered-dose inhaler for pediatric croup. Acad Emerg Med. 2023 Feb;30(2):144-146. doi: 10.1111/acem.14616. Epub 2022 Dec 7. PMID: 36307996

Franklin D, Babl FE, George S, Oakley E, Borland ML, Neutze J, Acworth J, Craig S, Jones M, Gannon B, Shellshear D, McCay H, Wallace A, Hoeppner T, Wildman M, Mattes J, Pham TMT, Miller L, Williams A, O’Brien S, Lawrence S, Bonisch M, Gibbons K, Moloney S, Waugh J, Hobbins S, Grew S, Fahy R, Dalziel SR, Schibler A. Effect of Early High-Flow Nasal Oxygen vs Standard Oxygen Therapy on Length of Hospital Stay in Hospitalized Children With Acute Hypoxemic Respiratory Failure: The PARIS-2 Randomized Clinical Trial. JAMA. 2023 Jan 17;329(3):224-234. doi: 10.1001/jama.2022.21805. PMID: 36648469

Justin’s Full write up here

Gøtzsche PC. The terminology we use about medical drugs can be misleading. BMJ. 2023 Mar 17;380:p601. doi: 10.1136/bmj.p601. PMID: 36931639 [free full text]

Haines JD Jr, Chop WM Jr, Swyden SN. Spontaneous pneumothorax, pneumomediastinum, and pneumopericardium in a 16-year-old drug-abusing motorcyclist surrounded by a pack of coyotes. Postgrad Med. 1989 Oct;86(5):79-80. doi: 10.1080/00325481.1989.11704431. PMID: 2798277

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