EM/IM Sessions

EM/IM Sessions: SALT-ED Trial

Balanced Crystalloids versus Saline in Noncritically Ill Adults WH Self et al. New England Journal of Medicine, March 2018. [paper] Why I chose this article This article is another flashpoint in the long debate – typically between internists and surgeons – regarding the use of normal saline versus balanced crystalloids for resuscitation. I remember being

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

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: 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: 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

EM/IM Sessions

Journal Club: Medical Error–The Third Leading Cause of Death in the US

Makary, Martin A., and Michael Daniel. “Medical Error Third Leading Cause of Death in the US.” Bmj 353 (2016): I2139. Print. PMID: 27143499 Wheww.  That’s quite the title. 3rd leading cause of death?? Really? Background: The CDC puts together their list of most common causes of death and this determines health policy. Money and awareness is

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

High Yield for the Field

High Yield for the Field (HYFTF) 1.7.16 – By Dr. John Purakal

A new year brings a new HYFTF! In this episode, Dr. Purakal reviews talks by Dr. Eric Krueger (Derm review), Dr. George Hughes-Strange (CHF Overview) and a journal club presentation of his own on The Heart Score.

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