First10EM Journal Club: June 2023

Hi All, we are back with another instalment of the Journal Club with Justin Morgenstern.

Big news this month is that Justin has just been invited to visit my home shop as the honorary WG Smith Fellow and deliver a series of EBM lectures to the local teams in Western Australia. So we are planning to take this show on th eraod and do some live sessions later in 2023. If you are in WA and would like to hear the nerdiness live then stay in touch and we will have updates.

This episode covers herbs that may heal sepsis, drugs that probably don’t help in Covid, we ask: do steroids help in pneumonia? There are a lot of ideas to keep your brain up to date with the latest evidence in Emergency medicine.

As always the free PDFs of the papers are available on the links below – so read them and make up your own mind. Here we go…

Liu S, Yao C, Xie J, et al. Effect of an Herbal-Based Injection on 28-Day Mortality in Patients With Sepsis: The EXIT-SEP Randomized Clinical Trial. JAMA Intern Med. 2023 May 1:e230780. doi: 10.1001/jamainternmed.2023.0780. Epub ahead of print. PMID: 37126332 

There is a full write up here by Justin. 

Caulfield T. The straw men of integrative health and alternative medicine. BMJ Best Practice. Available at:

Have a read of this short editorial, it will give you some valuable skills in the art of argumentation next time you need to engage with a Gish Galloper.

Collins AB, Beaudoin FL, Metrik J, Wightman RS.I still partly think this is bullshit”: A qualitative analysis of cannabinoid hyperemesis syndrome perceptions among people with chronic cannabis use and cyclic vomiting. Drug Alcohol Depend. 2023 May 1;246:109853. doi: 10.1016/j.drugalcdep.2023.109853. Epub 2023 Mar 24. PMID: 36996524

This is a qualitative study, based on interviews of 24 adult patients who presented to the emergency department with a presumptive diagnosis of cannabinoid hyperemesis syndrome. It is worth a read to help understand the experience of patients presenting with this difficult problem.

Bramante CT, Buse JB, Liebovitz DM, et al. Outpatient treatment of COVID-19 and incidence of post-COVID-19 condition over 10 months (COVID-OUT): a multicentre, randomised, quadruple-blind, parallel-group, phase 3 trial. Lancet Infect Dis. 2023  Jun 8:S1473-3099(23)00299-2. doi: 10.1016/S1473-3099(23)00299-2. PMID: 37302406 

This pair of trials looking at the effect of steroids in severe pneumonia. They are contrasting in that they used similar protocols but one is postive, one negative, one published early, one late….

CAPE COD: Dequin PF, Meziani F, Quenot JP, Kamel T, Ricard JD, Badie J, Reignier J, Heming N, Plantefève G, Souweine B, Voiriot G, Colin G, Frat JP, Mira JP, Barbarot N, François B, Louis G, Gibot S, Guitton C, Giacardi C, Hraiech S, Vimeux S, L’Her E, Faure H, Herbrecht JE, Bouisse C, Joret A, Terzi N, Gacouin A, Quentin C, Jourdain M, Leclerc M, Coffre C, Bourgoin H, Lengellé C, Caille-Fénérol C, Giraudeau B, Le Gouge A; CRICS-TriGGERSep Network. Hydrocortisone in Severe Community-Acquired Pneumonia. N Engl J Med. 2023 Mar 21. doi: 10.1056/NEJMoa2215145. Epub ahead of print. PMID: 36942789

ESCAPe: Meduri GU, Shih MC, Bridges L, Martin TJ, El-Solh A, Seam N, Davis-Karim A, Umberger R, Anzueto A, Sriram P, Lan C, Restrepo MI, Guardiola JJ, Buck T, Johnson DP, Suffredini A, Bell WA, Lin J, Zhao L, Uyeda L, Nielsen L, Huang GD; ESCAPe Study Group. Low-dose methylprednisolone treatment in critically ill patients with severe community-acquired pneumonia. Intensive Care Med. 2022 Aug;48(8):1009-1023. doi:  10.1007/s00134-022-06684-3. Epub 2022 May 13. PMID: 35723686

Pacheco LD, Clifton RG, Saade GR, et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. Tranexamic Acid to Prevent Obstetrical Hemorrhage after Cesarean Delivery. N Engl J Med. 2023 Apr 13;388(15):1365-1375. doi: 10.1056/NEJMoa2207419. PMID: 37043652

We have previously covered the, the WOMAN trial looking at TXA for postpartum hemorrhage and the the TRAAP2 trial looking at TXA after c-section – this is a huge repeat trial including 11,000 women undergoing section…. and it did not help.

Steitz BD, Turer RW, Lin CT, MacDonald S, Salmi L, Wright A, Lehmann CU, Langford K, McDonald SA, Reese TJ, Sternberg P, Chen Q, Rosenbloom ST, DesRoches CM. Perspectives of Patients About Immediate Access to Test Results Through an Online Patient Portal. JAMA Netw Open. 2023 Mar 1;6(3):e233572. doi: 10.1001/jamanetworkopen.2023.3572. PMID: 36939703

In the near future our patients will be able to access all of the clinical information that we write and receive – this is a brave new world for many of us. So how do patients feel about it? They really do want to see their information.

Kennedy JM, Kunzler NM, Hayes BD. Intravenous Haloperidol Has a Limited Role in the Modern Emergency Department. Ann Emerg Med. 2023 Jan;81(1):96-98. doi: 10.1016/j.annemergmed.2022.07.008. Epub 2022 Oct 19. PMID: 36270850

Lentz SA, Walsh K, Long B. Haloperidol May Be Safely Administered Intravenously in the Emergency Department. Ann Emerg Med. 2023 Jan;81(1):95-96. doi: 10.1016/j.annemergmed.2022.07.004. Epub 2022 Oct 19. PMID: 36270852

This is a pro/con debate focused on the use of intravenous haloperidol in those parts of the world where droperidol is not available…

Prandoni P, Lensing AWA, Prins MH, et al; Pulmonary Embolism Dyspnea Italian Study (PEDIS) Investigators. Prevalence of pulmonary embolism among patients with recent onset of dyspnea on exertion. A cross-sectional study. J Thromb Haemost. 2023 Jan;21(1):68-75. doi: 10.1016/j.jtha.2022.09.007. Epub 2022 Dec 22. PMID: 36695397

Understand that this paper was looking at a very unwell group of patients and has very high rates of PE on imaging. However, if you have a patient with severe unexplained exertional dyspnoea… you should definitely consider PE as a diagnosis.

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