Journal Club

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Emergency Medicine Conference - March 3, 2010

February 25th, 2010 at 7:33 pm by Lisa

Please join us for conference this Wednesday in the 8th floor conference room at Elmhurst. We begin the day with Journal Club - please be prepared!

9a - Journal Club - Dr. Vashi (links below)
10a - Interesting Case Conference - Dr. Sarohia
11a - Trauma Conference - Dr. Weingart
12p - Joint Commission Update - Dr. Halbach
1p - M&M - Dr. Green

Anita has chosen 3 articles to review and requests that everyone comes prepared.
Residents as usual the journal articles are behind the normal logon and password.

PGY1s and 2s: Reed et al. The ROSE (Risk Stratification of Syncope in the Emergency Department) Study J ACC 2010;55(8):713-721. Paper.

PGY3s and 4s: Del Rosso et al. Clinical Predictors of Cardiac Syncope at Initial Evaluation in Patients Referred Urgently to a General Hospital: the EGSYS Score Heart. 2008;94:1620-26. Paper.

All: McGinn et al. User’s Guide to the Medical Literature XXII:How to Use Articles About Clinical Decision Rules JAMA. 2000;284(1):79-84. Paper.

Posted in Syncope, Journal Club, Events, News | No Comments »

Emergency Medicine Conference - Feb 3, 2010

January 27th, 2010 at 11:36 pm by Lisa

Please join us for conference on February 3rd in the 8th floor conference room at Elmhurst. The day begins with journal club - please come prepared!!

9a - Journal Club - Curtis (see articles below)
10a - Procedure Talk - Chiang
1030a - US Case of the Month - Chisolm-Straker
11a - Trauma Conference - Weingart
12p - M&M - Pleasant

Henry has chosen 3 articles to review and requests that everyone comes prepared.Residents as usual the journal articles are behind the normal logon and password.
PGY1s and 2s: Claassen et al. Criminal correlates of injury-related Emergency Department recidivism J Emerg Med. 2007;32(2):141-47. Paper.
PGY3s and 4s: Abbass et al. Intensive short-term dynamic psychotherapy to reduce rates of emergency department return visits for patients with medically unexplained symptoms: preliminary evidence from a pre-post intervention study CJEM. 2009;11(6):529-34. Paper.
All: Lerner and Kobernick. Return visits to the emergency department. J Emerg Med. 1987,59:359-62. Paper.

Posted in Journal Club, Events, News | No Comments »

A quick review of FAST

January 24th, 2010 at 6:39 pm by Nick

Thanks to Alan for his look at the utility of FAST exams, incorporating a pioneering study of FAST as well as some more recent work. The three papers he picked are below:

For a review of these papers, and some resources for FAST, see below!

Read More »

Posted in Trauma, Ultrasound, Journal Club, Radiology, Blog | 1 Comment »

Emergency Medicine Conference - Jan 6, 2010

December 24th, 2009 at 7:37 pm by Lisa

Please join us for conference on January 6th in the 8th floor conference room at Elmhurst. The day begins with journal club - please come prepared!!
9a - Journal Club - Huang (see articles below)
10a - Procedure Talk - Trivedi
1030a - US Case of the Month - LaCalle
11a - Trauma Conference - Weingart
12p - M&M - Asaad

Alan has chosen 3 articles to review and requests that everyone comes prepared. Residents as usual the journal articles are behind the normal logon and password.
All: Rozycki et al. Surgeon-Performed Ultrasound for the Assessment of Truncal Injuries: Lessons Learned From 1540 Patients Ann Surg. 1998;228(4):557-67. Paper.
Miller et al. Not so Fast J Trauma. 2003;54:52–60. Paper.
Schnuriger et al. The accuracy of FAST in relation to grade of solid organ injuries: A retrospective analysis of 226 trauma patients with liver or splenic lesion. BMC Medical Imaging 2009, 9:3. Paper.

Posted in Journal Club, Events, News | No Comments »

Managing Agitation in the ED

December 18th, 2009 at 4:54 pm by Nick

Kudos to Dan for his thoughtful analysis of three papers highlighting aspects of agitation management in the emergency department.

Take-home points from Journal Club this week:

* 5mg of midazolam (versed) was significantly faster at causing sedation in violently agitated patients at a large academic ED, compared to 5mg of haldol and 2mg of lorazepam (ativan). Patients getting midazolam also had significantly faster times to recover from sedation, also the least incidence of sedation failure.

* Droperidol has an FDA black box warning for QT prolongation leading to torsades de pointes and death. While the association between droperidol use and QT prolongation is clear, the risk of sudden cardiac death as caused by droperidol is much less clear. Many centers still use droperidol to good effect; an ECG after administration and prior to discharge is strongly recommended (and, if possible, prior to use).

* In treating behavioral emergencies, the accepted and endorsed practice in this country is to confront the violent or uncooperative patient with a ‘show of force’ to obtain consent, and if that fails, forcible medication ensues. Covert administration of meds, while maybe expedient or supported by the patient’s family, threatens the therapeutic alliance and exposes the institution to liability and the practitioner to claims of criminal battery. There exists an opportunity for further study and policymaking, both within our institution and beyond.

An in-depth discuss of the three papers awaits you, below.

Read More »

Posted in Post-Conference Letter, Psychiatry, Arrhythmias, Journal Club, Blog | No Comments »

Emergency Medicine Conference - Dec 16, 2009

December 10th, 2009 at 12:26 am by Lisa

Please join us for conference this Wednesday in the 8th floor conference room at Elmhurst. Please note the early start time for cardiology conference and don’t forget to come prepared for Journal Club.

8a - Joint Cardiology Conference - Dr. Young Yoon
9a - Toxicology Lecture - Dr. Ruben Olmedo
10a - Neck Trauma - Dr. Kaushal Shah
11a - Journal Club - Dr. Daniel Fawaz.

Residents you can find the journal club articles behind the usual logon/password. Dan has chosen 3 different articles to review and requests that each class come prepared. Read the Lewin article and the article assigned for your class.

All: Lewin et al. An Unusual Case of Subterfuge in the Emergency Department: Covert Administration of Antipsychotic and Anxiolytic Medications to Control an Agitated Patient. Ann Emerg Med. 2006;47:75-78. Paper.

PGY1s and 2s: Kao et al. Droperidol, QT Prolongation, and Sudden Death: What Is the Evidence? Ann Emerg Med 2003;41(4):546-58.Paper.

PGY3s ad 4s: Nobay et al. A Prospective, Double-blind, Randomized Trial of Midazolam versus Haloperidol versus Lorazepam in the Chemical Restraint of Violent and Severely Agitated Patients. Acad Emerg Med 2004;(11)7:744-9.Paper.

Posted in Journal Club, Events, News | 1 Comment »

Emergency Medicine Conference - Oct. 21, 2009

October 18th, 2009 at 8:48 pm by Lisa

Please join us for conference this wednesday in the 8th floor conference room at Elmhurst. Much of the day will have a cardiology spin with a not to be missed ECG conference with Dr Kamenetsky to finish up the day!

8am - Joint Cardiology Conference - Kanika Gupta
9am - Journal Club - Lisa Jacobson (see articles below)
10am - Black Box Tox - Dr. Sharma
11am - Intravenous Pacing Procedures - Anita Vashi
1145am - ECG Conference - Dr. Kamenetsky

Residents: The following journal club articles are accessible by entering the usual login and password. Please read your two assigned articles below.
1st and 2nd Years: Fesmire. Delta CK-MB outperforms delta troonin I at 2 hours during the ED rule out of acute myocardial infarction AJEM 2000 18(1):1-8. Paper.
3rd and 4th Years: Zarich et al. Value of a single troponin T at the time of presentatin as compared to serial CK-MB determinations in patients with suspected myocardial ischemia Clinica Chem 2002; 326:185-192. Paper.
Everyone: Young et al. Serial creatine-kinase-MB results are a sensitive indicator of acute myocardial infarction in chest pain patients with nondiagnostic electrocardiograms: the second emegency medicine cardiac research group study Acad Emerg Med 1997; 4(9)869-877. Paper.

Posted in Journal Club, Events, News | No Comments »

Journal Club Recap

September 14th, 2009 at 1:36 pm by Lisa

Last week’s journal club topic was risk for CVA following a TIA. It has been noted that patients who present with a TIA have a 15-30% risk for stroke within the following 30 days. The ABCD and ABCD2 systems were created to risk stratify patients for either inpatient or outpatient follow up based on the factors of age, blood pressure, neurologic character of the TIA, duration of symptoms, and diabetes. The two articles discussed were:

P M Rothwell, M F Giles, E Flossmann, C E Lovelock, J N E Redgrave, C P Warlow, Z Mehta. A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack.
Lancet 2005; 366: 29–36.
Thomas Zambelis, Nikolaos Zakopoulos and Demetrios Vassilopoulos Georgios Tsivgoulis, Konstantinos Spengos, Panagiota Manta, Nikolaos Karandreas. Stroke After a Transient Ischemic Attack: A Hospital-Based Case Series Study. Stroke 2006;37;2892-2897.

The Lancet article was published by the group from England who originally created the ABCD criteria. They used two cohort databases to retrospectively determine 7-day risk of stroke in a group of TIA patients. They determined that an ABCD score of five or greater vastly increased a patient’s risk of stroke within the seven days, and that these patients should be hospitalized.

The group also did a concurrent validation study. We discussed that this is unusual since a validation study is meant to prove generalizability of research, and therefore a subject population should be chosen that is different from, rather than identical to, the original subjects.

The article from Stroke was a retrospective case series. The subjects were consecutive hospital-admitted patients following episodes of TIA. The study found that the ABCD scores correlated to a 30-day risk of CVA and recommended that patients with a score of four or greater be admitted to the hospital.
Our discussion of this article brought up several points. First, the study only included admitted patients, which would have presumably excluded many TIA patients who were discharged. Second, the authors’ statistics include continuous data placed into a binary format, which was statistically significant. Third, there were many patients lost to follow up.
We then discussed how these articles relate to our practice, and how they might change our management. Points that were brought up included:
?In tertiary care centers, the admission decision ultimately rests with the neurology service.
?What level of risk are we willing to accept? Is a 2.5% 7-day risk too high for discharge?
?The work-up for stroke includes an echocardiogram, carotid Doppler ultrasound, and an MRI/MRA of the head and neck. Our patient population at Elmhurst has a low level of education and relatively poor reliability. This work up as an outpatient is complicated and has long waiting times. Often, hospital admission is the only way to guarantee that it will occur.
?An argument in favor of admission of TIA patients was that many patients live alone, or have poor understanding. It is unlikely that they would quickly return to the hospital when they developed acute symptoms of TIA/CVA. Therefore, admission greatly increased the likelihood that these patients would be candidates for thrombolysis.

Posted in Journal Club, Blog | No Comments »

Emergency Medicine Conference - Sept. 2, 2009

August 27th, 2009 at 9:41 am by Lisa

Please join us for conference this Wednesday, September 2nd and 9am in the 8th floor conference room at Elmhurst Hospital. We’ll begin our day with journal club which looks to be an interesting discussion. Please read the articles below before joining us.

9am - Journal Club - Dr. J Chiang
10am - IRB 101 - Dr. I Wilets
11am - Trauma Conference - Dr. S Weingart
12pm - M&M - Dr. S Nadindla
1pm - US Case of the Month - Dr. B Ferguson

Residents: The following journal club articles are accessible by entering the usual login and password.Rothwell et al. A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischaemic attack The Lancet 2005 July 2; 366:29-36. PMID: 15993230. Paper.
Tsivgoulis et al. Validation of the ABCD Score in Identifying Individuals at High Early Risk of Stroke AFter a Transient Ischemic Attack: A Hospital-Based Case Series Study Stroke 2006; 37:2892-2897. PMID: 17053179. Paper.

Posted in Journal Club, Events, News | No Comments »

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