EM/IM Sessions

EM/IM Sessions: Impella for Refractory Cardiac Arrest

The Impella CP Device for Acute Mechanical Circulatory Support in Refractory Cardiac Arrest Vase H, Christensen S, Christiansen A, et al. Resuscitation 2017. [paper] Why I chose this study While perusing LITFL R&R I stumbled on this interesting study. As we have started seeing with increased use of ECMO and the development of tools such as

Feeling Argumentative

An Abscess Worth Packing

Feeling Argumentative In this series we are going to pick apart the arguments and evidence surrounding a common but controversial topic in Emergency Medicine. The goal is to take a hard look at the practices we are handing down to future generations of ED docs and see what is based on opinion and what is

EM/IM Sessions

EM/IM Sessions: YEARS Clinical Decision Tool for PE

Simplified Diagnostic Management of Suspected Pulmonary Embolism (the YEARS study): a Prospective, Multicentre, Cohort Study. van der Hulle, Tom, et al. The Lancet 2017 . [paper] Why I chose this study Determining if a patient has a pulmonary embolism (PE) is a routine occurrence in the emergency department (ED) and on the medicine inpatient service. I

EM/IM Sessions

EM/IM Sessions: Risk of AKI after IV Contrast

Risk of Acute Kidney Injury After Intravenous Contrast Media Administration Hinson, et al.  Annals of Emergency Medicine 2017. [paper] Why I chose this study On almost a daily basis, whether on Emergency or Internal Medicine, we all face a difficult question: “can this patient tolerate IV contrast administration for CT scan?” We are often guided

EM/IM Sessions

EM/IM Sessions: Acute MI After Influenza

Acute Myocardial Infarction after Laboratory-Confirmed Influenza Infection Kwong, JC et al. NEJM 2018. [paper] Why I chose this article In IM and EM, we are on the front lines of acute epidemics.  This year’s flu season has been a bad one and we are seeing a lot of generic flu but also complications and deaths


Inconceivable: Hypoxic

Chapter 12 – “Hypoxic” Welcome to the twelfth installment of “Inconceivable: medical terms that don’t mean what you think they mean.” You are taking care of a 32-year-old woman with a week of fever, cough, and progressive dyspnea on exertion. Her chest x-ray shows a large lobar infiltrate and you correctly diagnose her with community

EM/IM Sessions

EM/IM Sessions: Treating Acute Low Back Pain

Naproxen with Cyclobenzaprine, Oxycodone/Acetaminophen, or Placebo for Treating Acute Low Back Pain: A Randomized Clinical Trial. Friedman, BW,  et al, JAMA 2015. [paper] Why I chose this article I chose this topic because while it may not be the most exciting question it is an important one. This is a question that I seem to deal

EM/IM Sessions

EM/IM Sessions: VANISH Trial

Effect of Early Vasopressin vs Norepinephrine on Kidney Failure in Patients With Septic Shock: The VANISH Randomized Clinical Trial. Gordon, AC, et al. JAMA 2016 [paper] Why I chose this article The kidney is painfully fragile, often one of the first organs to fail in septic shock. According to the last several iterations of the Surviving Sepsis Campaign Guidelines,

EM/IM Sessions

EM/IM Sessions: High-Sensitivity Troponin T

Mokhtari A, Lindahl B, Smith JG, Holzmann MJ, Khoshnood A, Ekelund U. Diagnostic Accuracy of High-Sensitivity Cardiac Troponin T at Presentation Combined With History and ECG for Ruling Out Major Adverse Cardiac Events. Ann Emerg Med. 2016;68(6):649-658.e3.  [paper] Why I chose this article  High-sensitivity cardiac troponin T (hs-cTnT) is a relatively new biomarker assay and

EM/IM Sessions

EM/IM Sessions: Assessing Fluid Responsiveness

Bentzer P, Griesdale DE, Boyd J, MacLean K, Sirounis D, Ayas NT. Will This Hemodynamically Unstable Patient Respond to a Bolus of Intravenous Fluids?. JAMA. 2016;316(12):1298-1309. [paper] Why I chose this article We ask this question for every critically ill patient who remains hypotensive after what we believe is adequate fluid resuscitation. Knowing techniques to reassess these