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This month in Journal Club, we continued our theme of prognostication papers as Corey reviewed two recent ones from Latha G. Stead’s group at Mayo.  One paper ran last year and is called “Initial Emergency Department Blood Pressure as Predictor of Survival After Acute Ischemic Stroke” (Neurology 2005, 65:1179:1183). The second paper is called “Impact of Acute Blood Pressure Variability on Ischemic Stroke Outcome” (Neurology 2006:66:1878-1881).

This is something I frankly hadn’t spent much time thinking about — all the emphasis in stroke guidelines and tPA admin has been about getting BP down into a safe range, not worrying about whose BP is too low. But the big result from the first paper was that a diastolic of < 70 mmHg, a systolic less than 155, or an MAP of less than 100 mmHg was associated with higher mortality at 90 days than those with higher BPs (even after adjusting for age, gender, NIHSS score, etc). The worst relative risk (RR) was for a diastolic less than 70; RR = 2.2 in that case, which the authors find is actually worse than the RR of having a diastolic over 105 (RR=1.9… How about that).   

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We continue to make our way through the recent pain management papers, once again turning to the August Annals (Vol 48, No 2). Chang, Gallagher et al. strike back with a second analgesia piece in this issue — from now on, Montefiore will be simply be known as the House of Pain. The paper’s called Safety and Efficacy of Hydromorphone as an Analgesic Alternative to Morphine in Acute Pain: An RCT (if you’re logged into the Sinai library, full text is here). It’s full of provocative hypotheses, good study technique, and fun historical trivia… more below!

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I wanted to highlight the NEJM’s new (well, 6 months old) internet feature, Videos In Clinical Medicine. You ought to be able to access these videos after logging into the Sinai library (with MSSM-ID and life number) and then heading over the NEJM’s recent videos page.

Many of the videos feature the work of Gary Setnik, MD, an early figure in EM. The most recent one (from Oct 26th, Vol 355, No. 17) is on basic laceration repair – so maybe it’s something you can show to your beleaguered 4th year med student while you’re busy with other things. Other videos may be more relevant to us, including thoracentesis, LP, A-line placement, and knee arthrocentesis. The videos can also be downloaded in formats for Palm OS, Windows, and iPod.

Clinicalcases.org, a very useful collection of links, videos, simulators and more, also has a page full of procedure video links, as well as some physical exam videos that may be worth brushing up on.  

If you’re aware of any other good online resources like this, let me know or share ‘em with Ted, who’s compiled a list of his own.