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Prophylactic hydration to protect renal function from intravascular iodinated contrast material in patients at high risk of contrast-induced nephropathy (AMACING): a prospective, randomised, phase 3, controlled, open-label, non-inferiority trial.

Journal Club Summary
Methodology Score: 3/5                    Usefulness Score:  3.5/5 NijssenEC, et al Lancet.2017Feb 20. [Epub ahead of print] Abstract Link
Recent posts

Zika Virus – What we know and what we don’t

The Zika Virus exploded onto the international health scene in the last several months. It was first discovered in humans in 1951 and remained limited to Africa and Asia until the first major outbreak in Micronesia in 2007. Since then the virus has continued to evolve and spread from the Pacific Islands and French Polynesia to the main major outbreak in South America in early 2015 and finally to the US in January 2016.

Video Laryngoscopy vs Direct Laryngoscopy on Successful First-Pass Orotracheal Intubation Among ICU Patients: A Randomized Clinical Trial

Journal Club SummaryMethodology Score: 4/5                    Usefulness Score:  3/5
Lascarrou JB, et al. JAMA. 2017 Feb 7;317(5):483-493. Abstract Link

Risk of Acute Kidney Injury After Intravenous Contrast Media Administration

Journal Club SummaryMethodology Score: 4/5                    Usefulness Score: 3.5/5
Hinson JS, et al. Ann Emerg Med. 2017 Jan 19 [Epub ahead of print] Full Article

Pediatric Airway Management in the Emergency Department

Pediatric endotracheal intubation is an uncommon procedure in the Emergency Department (ED); even in high volume tertiary pediatric centres the incidence has been reported at 8-10/10,000 patients. While infrequent, pediatric airway management is an essential and life-saving skill that all ER physicians must be prepared for.  Much of the knowledge and skill set from the adult world is applicable here, however there are several important differences that are unique to the pediatric population.

Effect of Noninvasive Ventilation Delivered by Helmet vs. Facemask on the Rate of Endotracheal Intubation in Patients with Acute Respiratory Distress Syndrome

SummaryMethodology Score: 4/5
Usefulness Score: 3.5/5

Patel BK, et al. JAMA. 2016 Jun 14;315(22):2435-41
Full Article

Editorial: Unmasking a Role for Noninvasive Ventilation in Early Acute Respiratory Distress Syndrome. Beitler JR, et al. JAMA. 2016 Jun 14;315(22):2401-3.

This single-centre, non-blinded RCT of ICU ARDS patients, found that NIV delivered by a novel helmet, as compared to a standard NIV facemask, reduced intubations (18.2% vs. 61.5%; P <0.001) and hospital mortality (27.3% vs. 48.7%; P= 0.04). Despite its few methodological flaws, this study supports the existing literature on the advantage of oxygen delivered via helmet over facemask in avoiding intubation in ARDS, and future studies should focus on its impact in heart failure or hypercapneic respiratory failure.
By: Dr. Shannon Fernando 
Epi lesson:
Interim Analyses and Stopping Rules
In clinical trials, an interim analysis is one that is conducted before data collection has been completed to determin…

Focus on POCUS: Subacute, Progressive Dyspnea while Swimming

A male in his 60’s presents with progressive dyspnea on exertion x 1 month starting while he was swimming in the ocean. He had not been diving.  He has no significant medical history and takes no medications.

Diagnosis of Acute Cardiogenic Pulmonary Edema (ACPE) with Point-of-Care Ultrasound

Point-of-Care Ultrasonography (POCUS) is a valuable tool in the diagnostic armamentarium of the emergency physician. We have been successfully using it to the place lines, diagnose AAAs and assess the cardiac function of our dyspnea patients for awhile now. But what about the lungs? Typically air is thought of as the enemy of ultrasound, but can we successfully use it to diagnose acute respiratory conditions despite this? In this Grand Rounds review, Dr. Elizabeth Lalande goes through the use of POCUS in the diagnosis of Acute Cardiogenic Pulmonary Edema in the undifferentiated, dyspneic patient. 

Clindamycin versus trimethoprim-sulfamethoxazole for uncomplicated skin infections

Journal Club SummaryMethodology Score: 4/5                    Usefulness Score: 2/5
Miller LG, et al. N Engl J Med.2015Mar 19;372(12):1093-103. Full Article

Focus on POCUS: Palpitations and Dyspnea Post-AVR

This case is brought to you by Dr. Robert Ohle, PGY5 in emergency medicine, who assessed the patient and captured all of the ultrasound images! Case Vignette: A female in her 20's presents to the emergency department 15 days after major cardiac surgery to repair a congenital aortic valve defect. Her chief complaint is palpitations and shortness of breath, which have been constant and ongoing for the last 4 days. She has no PND or orthopnea, no calf swelling, or history of DVT/PE. She has no past medical history other than the aortic valve defect and is on no medications. Her exam shows a well looking young female in no acute distress. Her vitals are BP 110/40, HR 110, afebrile, O2 99% on room air, RR 18. Her sternotomy incision site looks healthy. Her lungs are clear and there is a loud cardiac murmur, but both the senior resident and staff are unable to tell if it is systolic or diastolic because of the patient’s tachycardia. There are no signs of DVT. Routine bloodwork including car…