Helpful EBM Resources
University of Cincinnati HSL EBM Resources - Links to JAMAEvidence, EBM Tutorials, EBM Worksheets and more
McMasters EBCP Course Site - Contains several good videos on likelihood ratios, odds ratios, as well as some other educational resources
Washington University EM Journal Club Toolbox - Many useful links to other EM Journal Clubs and EBM resources
Searching for the Evidence
PubMed Clinical Queries - (requires UC login)
Dynamed - link on popular resources page in UC HSL (requires UC login)
PubMed MESH Search - (requires UC login)
Recent Journal Club Recaps
Can the addition of high-dose methylprednisolone to the treatment of out-of-hospital cardiac arrest make a meaningful difference? In this post-hoc analysis of a placebo-controlled randomized control trial comparing high-dose methylprednisolone versus placebo in out-of-hospital cardiac arrest (OHCA), the authors aimed to assess the hemodynamic effects of prehospital high-dose glucocorticoid treatment in resuscitated comatose OHCA patients.
With the advent of fast-acting subcutaneous insulin analogs over the past 20 years, multiple studies have demonstrated that subcutaneous insulin protocols for treatment for treatment of mild-to-moderate severity DKA are safe and cost-effective when compared to intravenous insulin infusion protocols in non-ICU settings. In the context of increasing ED and hospital crowding as well as limited ICU availability, this study aimed to evaluate the impact of a subcutaneous insulin (SQuID) protocol in the treatment of DKA on emergency department length-of-stay (EDLOS) and ICU admissions
Rib fractures occur in up to 10% of all traumatically injured patients and these fractures are frequently associated with respiratory complications such a pneumonia. In the ED, our typical protocol to decrease the incidence of these respiratory complications is early initiation of aggressive pain control and pulmonary hygiene. These patients often will receive systemic analgesia with opiates to decrease the incidence of these respiratory complications, which leads to its own set of opiate associated-complications, including constipation, delirium and dependence.
Shoulder injury and dislocations are common reasons for patients to present to the emergency department (ED) for evaluation. As ED physicians we often must determine whether the shoulder is fractured, dislocated, or both. Most of the time this is done through the use of physical examination in addition to the use of a plain film radiograph of the shoulder.
The use of ultrasound in the diagnosis and management of musculoskeletal injuries is becoming more common. While it currently does not supplant the use of radiographs, it can be a useful adjunct to the management of these patients.
The anterior cruciate ligament (ACL) is one of the most commonly injured knee ligaments, with nearly 200,000 injuries annually in the US, with ~100,000 requiring reconstruction. The ACL prevents anterior translation of the tibia relative to the femur and is a secondary restraint to tibial and varus/valgus rotation. Accurately diagnosing ACL injuries in the ED after an acute knee injury remains difficult. The diagnosis is complicated because clinical tests are performed on an acutely injured knee, which is likely swollen and painful, leading to muscle contractures and patient apprehension. As Emergency Medicine physicians, we must have some confidence in suspicion of an ACL tear because not all patients can or should be referred for prompt orthopedic follow-up.
More than 1.5 million adults undergo tracheal intubation outside of the operating room each year in the United States. Traditionally, this has been performed with direct laryngoscopy, where a clinician displaces the patient’s tongue and epiglottis with a laryngoscope blade to visualize the vocal cords through the mouth, allowing for direct visualization of the passage of an endotracheal tube. An alternative method for tracheal intubation is video laryngoscopy, where a camera on the distal half of the blade transmits an image to a screen allowing for indirect visualization of the vocal cords and passage of an endotracheal tube without direct line of site.
Rapid sequence intubation (RSI) is frequently performed under emergent conditions in acutely ill patients. RSI is a technique for managing the emergency airway that induces immediate unresponsiveness (induction agent) and muscular relaxation (neuromuscular blocking agent). In properly selected patients, it is a quick, safe, and effective approach that results in optimal intubating conditions. However, one of the feared complications of RSI is post-intubation hypotension leading to cardiovascular collapse. Although there are multiple possible reasons for hypotension post-intubation, the choice and dosing of induction agents has been implicated.
The workup of febrile infants (<60 days) can be extensive and invasive. This post and podcast covers a recent paper by the PECARN research group that sought an answer to the question: What is the prevalence of bacteremia and/or bacterial meningitis (“invasive bacterial illness”, ISI) in febrile infants ≤60 days of age with a positive urinalysis (UA) result?
Boarding of admitted patients in the ED and subsequent overcrowding of ED’s continues to plague hospitals in the United States and Internationally. The Covid-19 pandemic exacerbated an already growing problem regarding capacity management and patient flow. In this current climate, the Emergency Physician’s responsibilities continue to shift toward the front-end of the process, mainly patients waiting to be seen in the lobby. As such, identifying sick patients in a timely manner and utilizing additional resources to predict patients at risk of clinical deterioration will be paramount moving forward.
Sepsis is a leading cause of mortality for hospitalized patient’s both worldwide and in the United States. The surviving sepsis guidelines weakly recommend invasive arterial blood pressure monitoring (IABP) over noninvasive blood pressure monitoring (NIBP) with a blood pressure cuff supported by low quality evidence.(1) Data comparing the accuracy between IABP and NIBP measurements are limited. The largest analysis of 736 critically ill patients found a mean difference of 1 mmHg which was not statistically significant, however, there was only one measurement recorded per patient.(2) Arterial lines have several drawbacks compared with non-invasive methods such as: training requirements for caregivers, potential for pain and increased pain medications, limitation of participation in physical therapy, risk of digital ischemia, and risk of iatrogenic infection.(3) In this journal club recap, we analyze an article looking at the relationship between invasive arterial line blood pressure readings and non-invasive cuff measurements.