EM/IM Sessions

Journal Club: Addition of Indapamide to Frusemide Increases Natriuresis and Creatinine Clearance, but not Diuresis, in Fluid Overloaded ICU Patients.

Bihari, Shailesh, Andrew W. Holt, Shivesh Prakash, and Andrew D. Bersten. “Addition of Indapamide to Frusemide Increases Natriuresis and Creatinine Clearance, but Not Diuresis, in Fluid Overloaded ICU Patients.” Journal of Critical Care 33 (2016): 200-06.  PMID: 26948252 Two caveats before we get started.  Frusemide in the title is not a misprint but rather the Australian

EM/IM Sessions

Journal Club: Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage

Qureshi MD, Adnan, et al. for the ATACH-2 Trial Investigators and the Neurological Emergency Treatment Trials Network. Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage. NEJM 10.1056/NEJMoa1603460. PMID:27276234 Background: Research and guidelines are limited in terms of specific goal blood pressure targets in patients who suffer intracranial hemorrhage, especially those with acute hypertensive responses. 

EM/IM Sessions

Journal Club: Naproxen with Cyclobenzaprine, Oxycodone/Acetaminophen, or Placebo for Treating Acute Low Back Pain

Friedman BW, Dym AA, Davitt M, et al. Naproxen With Cyclobenzaprine, Oxycodone/Acetaminophen, or Placebo for Treating Acute Low Back Pain – A Randomized Clinical Trial. Jama. 2015;314(15):1572–1580. PMID:1 Background 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

EM/IM Sessions

Journal Club: Trial of Continuous or Interrupted Chest Compressions During CPR

Nichol G, Leroux B, Wang H, et al. Trial of Continuous or Interrupted Chest Compressions during CPR. N Engl J Med. 2015:2203–2214. PMID:26550795 Background Quality chest compressions are one of the few things that have been shown to improve the chance of achieving return of spontaneous circulation  (ROSC) during cardiac arrest. They are often interrupted,

EM/IM Sessions

Journal Club: Andexanet Alfa for Reversal of Factor Xa Inhibitor Activity

Siegal DM, Curnutte JT, Connolly SJ, et al. Andexanet Alfa for the Reversal of Factor Xa Inhibitor Activity. N Engl J Med. 2015 Dec 17; 373 (25): 2413-24. PMID:26559317 Background Direct factor Xa inhibitors (apixiban, rivaroxaban, edoxaban) are the novel agents being used in the prevention of stroke in patients with non-valvular afib, secondary prevention of

EM/IM Sessions

Journal Club – Treating Fever in the ICU – HEAT Trial Discussion

Interest Nurses, families, and consultants often request that we treat our patients’ fevers. We often reflexively answer, “Yeah, sure, give ’em a gram of acetaminophen, why not.” Occasionally we might take the high road, instead replying “Why would I blunt the body’s response to infection, let it fight!” Is there a benefit to calming the inflammatory response

EM/IM Sessions

Journal Club: Challenges with HS-Troponin Elevations

Article Everett BM. Troponin and Cardiac Events in Stable Ischemic Heart Disease and Diabetes. New England Journal of Medicine. 2015 Interest Elevated troponin levels in the ED and inpatient medicine create a challenge for the best treatment methods for patients. Do all patients with elevated troponin require inpatient admission? Does surgical intervention help with outcome

EM/IM Sessions

Journal Club: Lactate Clearance Is Flawed?

Article: Lactate clearance as a target of therapy in sepsis: a flawed paradigm. PE Marik. R Bellomo. OA Critical Care 2013 Mar 01;1(1):3 Why This Article? Though not a conventional journal review article the discussion is interesting and by a credible author (PE Marik; Early goal directed therapy). As for lactate, in both the Emergency