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Showing posts from October, 2015

Intravenous Subdissociative-Dose Ketamine Versus Morphine for Analgesia in the Emergency Department: A Randomized Controlled Trial

Methodology Score: 3.5/5               Usefulness Score: 2/5
Motov S, Rockoff B, Cohen V, et al. Ann Emerg Med. 2015 Mar 26. pii: S0196-0644(15)00191-2.
Abstract Link

This prospective, RCT found sub-dissociative ketamine (0.3mg/kg) and morphine (0.1mg/kg) were similarly effective at reducing moderate to severe pain using a visual analogue pain scale at 30 minutes (mean difference 0.2; 95% confidence interval 1.19 to 1.46; P=0.97), but with increased minor side effects in the ketamine group. JC attendees discussed the limitations of using a continuous variable as a primary outcome, likely making this an underpowered study. Additionally, JC attendees thought the significantly increased side effects and short duration of ketamine would limit implementation into clinical practice. By: Dr. Nathan Hecht (Presented May 2015)

Epi lesson:  Sample Size in Clinical Trials All intervention studies should indicate how the sample size was estimated including the desired alpha error (usually 0.05), power…

Randomized assessment of rapid endovascular treatment of ischemic stroke

Methodology Score: 4/5                  Usefulness Score: 4/5
Goyal M, Demchuk AM, Menon BK, et al. N Engl J Med. 2015 Mar 12;372(11):1019-30
Full Article
This multi-centre open label RCT compared endovascular treatment +/- tPA vs. standard therapy for a specific sub-group of patients with acute ischemic stroke who had a proximal artery occlusion and evidence of a small infarcted core with a larger at risk area of brain. Endovascular treatment improved outcomes, with NNT of 4 for independence at 90 days. This adds to the growing body of literature suggesting endovascular treatment is beneficial for carefully selected stroke patients.  By: Dr. Sebastian Dewhirst (Presented May 2015)

Epi lesson: Number Needed to Treat (NNT) The NNT concept was created by Canadian Clinical Epidemiologist Dr Andreas Laupacis in 1988 to quantify the benefit of a new intervention.NNT is the average number of patients who need to be treated to prevent one additional bad outcome (e.g. the number of patients that need…

Emerging drugs of abuse!

Guest post by: Dr. Valerie Charbonneau

This isn't your parent's marijuana, thats for sure. As we continue to develop as a species, individuals are continuously attempting to develop newer and greater drug highs. As a result, the toxicologic world is continuously expanding, and in Emergency Medicine it is our job to keep up with trends in toxicology, and familiarize ourselves with emerging drugs of abuse.  Focus:  Discuss trends in cannabis and cannabis-derived product use.Review the recent Fentanyl epidemic.Look at trends in NPS (New Psychoactive Substances), including synthetic cannabinoids, phenethylamines and cathinones.Discuss local prevalence and monitoring methods for emerging drugs of abuse.Cannabinoids: Psychoactive compounds mainly consist of THC and CBD; which have opposite effects upon cannabinoid receptors. Historically, cannabis contained 2-4% THC and an equivalent proportion of CBD; which contained antipsychotic properties. Modern products contain 12-18% THC, and und…