Objectives Describe the pathophysiology of Pulmonary Hypertension (PH), and how it can be dangerous Who to suspect and workup for PH in the ED Describe the POCUS findings in PH Describe the management of these patients and how to avoid causing harm Physiology Definition Pulmonary hypertension (PH) is defined as a pulmonary artery mean pressure >25 mmHg by right heart catheterization at rest. Transthoracic echocardiography is used as a screening tool with a right ventricular systolic pressure (RVSP) > 40 being suggestive but not diagnostic of PH (1,2). Classification PH can b ..read more

Under Pressure, the 1981 classic by Queen in collaboration with David Bowie Objectives: Explore the data for safety and efficacy of urgent BP lowering in hemorrhagic stroke. Is there any benefit from management of elevated BP in acute ischemic stroke that is not a candidate for tPA? What is the data for BP target in aSAH awaiting definitive management? PART 1 Acute hemorrhagic stroke, which is the least treatable form of stroke, affects more than 1 million people worldwide annually, with the outcome determined by the volume and growth of the underlying hematoma. Blood press ..read more

Journal Club Summary Methodology Score: 4/5  Usefulness Score: 4.5/5 D'Onofrio G, et al JAMA. 2015 Apr 28;313(16):1636-44. Full Article This single, urban center RCT including 329 patients showed that buprenorphine initiated in the ED was more likely to increase engagement in addiction care at 30 days (78%) compared to referral (37%) or brief intervention (45%), with a NNT of 2 for the buprenorphine vs referral groups. There were some concerns raised around the slightly greater proportion of patients seeking addiction treatment in the buprenorphine group and the possibility of crossover ..read more

Journal Clubs Summary Methodology Score: 3/5  Usefulness Score: 3.5/5 Rehrer MW, et al. Ann Emerg Med. 2016 Nov;68(5):608-613. Abstract Link This single centre, randomized, triple-blinded, control trial did not demonstrate noninferiority of a single dose of dexamethasone compared to standard 5 day course of prednisone for adult asthma exacerbations. In most patients, prednisone for 5 days should still be used. A select group of patients with poor compliance may still benefit from a single dose of dexamethasone although further studies are needed.  By: Dr. Simeon Mitchell Epi lesso ..read more

What is Quality Improvement (QI)? You have all heard the latest buzzword in healthcare: “quality improvement”, or QI. Yet many healthcare professionals still only have a vague idea of what that truly means, and likely an even poorer understanding of how it might apply to their frontline practice. Conceptually, QI can be defined as the “combined and unceasing efforts of everyone - healthcare professionals, patients and their families, researchers, payers, planners and educators - to make the changes that will lead to better patient outcomes (health), better system performance (care) and bette ..read more

Journal Club Summary Methodology Score: 4/5                    Usefulness Score: 4/5 Stanley AJ, et al. BMJ. 2017 Jan 4;356:i6432. Full Article This multicentre, multinational study assessed the ability of five upper gastrointestinal bleeding scores to predict outcomes including death, re-bleeding, need for endoscopy, transfusion, surgery or interventional radiology, and length of hospital stay, finding that the Glasgow Blatchford score is best at predicting the composite outcome of i ..read more

Journal Club Summary Methodology Score: 3/5                    Usefulness Score:  3.5/5 Nijssen EC, et al Lancet. 2017 Feb 20. [Epub ahead of print] Abstract Link  This prospective, open-label, single centre, randomized trial of 660 patients found no hydration (2.7% incidence CIN) to be non-inferior compared to iv hydration (2.6% incidence CIN) in preventing contrast induced nephropathy in patients with reduced renal function undergoing elective procedures requi ..read more

The Zika Virus exploded onto the international health scene in the last several months. It was first discovered in humans in 1951 and remained limited to Africa and Asia until the first major outbreak in Micronesia in 2007. Since then the virus has continued to evolve and spread from the Pacific Islands and French Polynesia to the main major outbreak in South America in early 2015 and finally to the US in January 2016. The virus itself is a single stranded RNA virus from the flavivirus family. This family also includes dengue, chikungunya, West Nile and yellow fever. Zika is mainly transmitt ..read more

Journal Club Summary Methodology Score: 4/5                    Usefulness Score:  3/5 Lascarrou JB, et al. JAMA. 2017 Feb 7;317(5):483-493. Abstract Link   This study was an open-label, randomized clinical trial conducted at 7 ICUs in France that found video laryngoscopy compared with direct laryngoscopy did not improve first-pass orotracheal intubation rates or median time to successful intubation in an ICU population. Overall, this study adds to a growing body of evidence that ..read more

Journal Club Summary Methodology Score: 4/5                    Usefulness Score: 3.5/5 Hinson JS, et al. Ann Emerg Med. 2017 Jan 19 [Epub ahead of print] Full Article  In this large, well-designed retrospective study of AKI following contrast administration for CT in ED patients, IV contrast was not found to be associated with an increased frequency of AKI or subsequent renal failure. When combining this data with emerging recent evidence, local protocols should be updated to reflect ..read more