Skip to main content

A new and rapid method for epistaxis treatment using injectable form of tranexamic acid topically: a randomized controlled trial

Methodology Score: 2/5                 

Usefulness Score: 3.5/5

Zahed R, Moharamzadeh P, Alizadeharasi S, Ghasemi A, Saeedi M.

Am J Emerg Med. 2013 Sep;31(9):1389-92

This single centre, ED based, parallel group randomized control trial found that the topical application of an injectable form of tranexamic acid (TXA) was better than anterior nasal packing (ANP) for halting bleeding within the first 10 minutes (ARR=40%, P=<0.001) and discharging the patient from the department within the first 2 hours (ARR=89%,  P=<0.001). The DEM journal club identified several errors in the paper which compromised the validity of the results; however, the overall cost effectiveness (500mg TXA at The Ottawa Hospital = $5.90) and the potential for significantly decreasing patient discomfort made this low-risk intervention very appealing to attendees. 
By: Dr. Nicholas Costain
(Presented January 2014)

Epi lesson: p values in baseline characteristic tables

Whether or not to present p values in Table 1 of baseline characteristics for an RCT is controversial. The risk in doing so, however, is that you assume that a significant difference between both groups highlighted by a statistically significant p value means that there was a problem with the randomization procedures. If there are a large number of characteristics, it is increasingly likely that a significant p value is due to chance rather than a problem with randomization. More important is to examine whether there are any clinically significant differences between both groups and then to ask yourself whether this characteristic is likely to influence the primary outcome, requiring an adjustment in the analysis. 
By: Dr. Lisa Calder


Popular posts from this blog

Tips for Success in your Emergency Medicine Rotation

Our wonderful medical students are preparing to start their first clinical rotations. With this in mind here are some of the top tips for success in your EM rotation
1)Be On Time – show up to your shifts on time, better yet 5 minutes early.That first impression is immensely important.
2)Introduce yourself to the team - “Hi my name is John Doe, I am the medical student on shift today” introduce yourself to the attending, residents, nurses, etc.You will be called on a lot more to help when there is something interesting going on if they know your name.
3)Be goal-oriented – have a goal for each shift, whether it’s a procedure or a type of presentation to see.
4)Don’t just stand there, do something – whenever there is a trauma or code, come to the bedside.Get gowned up for traumas and pay attention.Help with things that are within your scope of practice: chest compressions, moving patient, cardioversion
5)Don’t just stand there, do nothing – there are times in medicine when the best thing to d…

2014 Canadian Guidelines for AF Management: Part 1: Introduction and CCS “CHADS-65” Algorithm

by Ian Stiell MD @EMO_Daddy

In this and subsequent postings we will discuss the latest recommendations for ED management of atrial fibrillation (AF) as presented in the newly published 2014 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation. The Guidelines PDF can be downloaded from the CCS website at 2014 Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation
The 2014 Focused Update uses the GRADE system of evidence evaluation as was the case in the comprehensive 2010 AF Guidelines and the 2012 Update. The CCS AF Guidelines Panel is comprised of Canadian cardiologists plus physicians from internal medicine, family medicine, neurology, and emergency medicine. This 2014 Update provides evidence review and recommendations for 8 aspects of AF care, including ED Management (written by myself and Dr. Laurent Macle of the Montreal Heart Institute). The 2014 Update focuses on advances in oral anticoagulant (O…

You CAN reverse that! Reversal of NOAC's and more..

We have seen a large surge of the utilization of New Oral Anticoagulants (NOAC's) in the past few years, as such, it has been a novel challenge when these patients present to the Emergency Department (ED) with life threatening bleeding. Dr. Michael Ho looks to discuss treatment options, and future options in these patients. 
NOACs vs WarfarinDabigatran, Rivaroxaban and Apixaban have seen a dramatic increase in use since their approval in Canada. Dabigatran is a direct thrombin (Factor II) inhibitor, while the latter two are direct Xa inhibitors. These drugs are collectively referred to as novel oral anticoagulants (NOACs). They have also been called direct, or target-specific oral anticoagulants (DOACs or TSOACs) [1]. 
The NOACs have many practical advantages over warfarin: Rapid onset of actionShorter half-lifeLess food and drug interferencePredictable pharmacokineticsEase of use and no requirement for monitoringThe downsides to NOACs are the higher cost to the patient, the inabilit…