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Showing posts from March, 2016

Idarucizumab for Dabigatran Reversal.

Journal Club SummaryMethodology Score: 2.5/5               Usefulness Score: 3/5
Pollack CVJr, et al. N Engl J Med. 2015 Aug 6;373(6):511-20 Full Article
This prospective cohort study demonstrated that a new dagbigatran reversal agent, idarucizumab, completely reverses dabigatran’s anticoagulant effects (as measured by dilute thrombin time and eccarin clotting time) in patients with serious bleeding or in need of an urgent procedure.  JC attendees found the following weaknesses in this study: very small sample size, was an interim analysis with only 90 patients, lacked a control group, used laboratory tests as surrogate endpoints for the primary outcome, and lacked patient orientated, clinically important/safety outcomes. Dabigatran is currently the only novel oral anticoagulant with an FDA approved reversal agent.  By: Dr. Laura Shoots (Presented February 2016)

Epi lesson: Surrogate endpoints
Can be used as a measure of effect for specific treatments and might correlate with clinical outcom…

Refugee Health: A Framework for Emergency Physicians

In our current political and social climate, refugee health is undoubtedly going to become an increasingly prevalent Emergency Department (ED) issue.  In the past few years, Canada has been accepting an average of 25 000 refugees from all over the world each year; now we have taken the same number of refugees from Syria alone in a span of just a few months.  So the need right now is huge! Yet, as ER physicians, we get almost no formal training on the subject, and most available resources are targeted at primary care providers, and don’t apply to our practice setting.

Trial of Continuous or Interrupted Chest Compressions during CPR.

Journal Club SummaryMethodology Score: 4.5/5               Usefulness Score:  4.5/5
Nichol G, et al. N Engl J Med. 2015 Dec 3;373(23):2203-14 Abstract Link
Editorial: Continuous or Interrupted Chest Compressions for Cardiac Arrest Koster RW N Engl J Med.2015; 373:2278-2279 http://www.nejm.org/doi/full/10.1056/NEJMe1513415 This is a robust cluster randomized cross-over trial of 114 EMS agencies in North America that tested modifications to the early phase of resuscitation care in out-of-hospital cardiac arrests. Results from the study showed that among patients with out-of-hospital cardiac arrest in whom high quality CPR was performed by well-trained EMS providers, continuous chest compressions with asynchronous positive-pressure ventilation (CCC) did not result in significantly higher rates of survival to discharge or favorable neurologic status when compared to the strategy of chest compressions interrupted for ventilation (ICC). This is the first randomized trial to look CCC vs ICC. The gr…

Another stroke update! (Last one! For now..)

Ischemic stroke and Transient Ischemic Attack have been a vigorously studied subject, particularly in the past few years. With numerous updates and recommendations, we will provide an updated guide for Emergency Physicians in regards to ischemic stroke and TIA management and workup.

Endovascular therapy for Ischemic Stroke:In 2013, three high quality studies published in NEJM failed to show a benefit for endovascular therapy, compared to standard treatment [1-3]. Within two years, however, there was a significant paradigm shift to alter this theory, based on five high quality studies published in NEJM, showing a benefit for endovascular therapy in ischemic stroke [4-8]. The newer studies had some fundamental differences in comparison to the earlier negative trials [9]:Strict patient selection: Most studies used stroke onset < 6 hours, with the ESCAPE trial having the longest inclusion time with stroke onset <12 hours [4]. Improved imaging selection: Demonstration of a large pro…