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Showing posts from November, 2016

Emergency department point-of-care ultrasound in out-of-hospital and in-ED cardiac arrest

Journal ClubMethodology Score: 3/5
Usefulness Score: 3.5/5

Gaspari R, et al.
Resuscitation. 2016 Sep 28;109:33-39.

Abstract Link

This prospective, per-protocol observational study is now the largest study on the point of care ultrasound in cardiac arrest (specifically PEA/asystole). It demonstrates that the presence of cardiac activity is the variable most associated with survival in cardiac arrest (more than bystander CPR, for example), with an OR of 3.6 for survival to admission, and 5.7 for survival to discharge. Ultrasound may also allow one to diagnose tamponade or right heart strain (due to massive PE) as potential causes of an arrest. Hence, it should likely be included as a part of any PEA/asystole resuscitation algorithm.

However, it should be noted that the strength of this study is limited by the potential selection bias that occurred with convenience sample enrolment, as well as the performance bias that resulted from it being unblinded (allowing clinicians to alter their care…

Clinical Risk Score for Persistent Postconcussion Symptoms Among Children With Acute Concussion in the ED

Journal Club SummaryMethodology Score: 4/5                    Usefulness Score:  2/5
Zemek R, et al. JAMA. 2016 Mar 8;315(10):1014-25. Full Article
Editorial: Identifying Children and Adolescents at Risk for Persistent Postconcussion Symptoms. BabcockL, et al. JAMA.2016Mar 8;315(10):987-8.
This was a prospective multicenter cohort study of pediatric patients with acute concussion that derived and validated a clinical decision rule with modest discrimination to assess risk of persistent postconcussion symptoms at 28 days.  The group felt that while very methodologically sound it would have limited role in the ED given the lack of validated treatment options for concussion but it may have a role to develop a high risk group to target further research. By: Dr. Rory Connolly

Epi lessonWhat is Collinearity? Why does it Matter? How do you Measure it?Collinearity means that two of the predictors entered in a regression analysis model correlate with each other (they measure almost the same thing, e.g…

What We Know About Lyme Disease.

Background Relative to its incidence and prevalence, Lyme disease has gathered a tremendous amount of attention, particularly in the last decade or so. This can be attributed, in part, to the perceived difficulty in properly diagnosing and treating the disease. However, the bulk of its recent attention stems around controversies surrounding chronic Lyme disease. It has made its way into mainstream pop culture, celebrities are becoming increasingly vocal and activists are devout.
What is all the buzz about? As healthcare providers, we owe it to our patients to know the facts in order to provide the best care possible.
Agent / Vector The causative agent of Lyme disease,Borrelia burgdorferiis a tick-borne spirochetal bacteria that was discovered and named after Dr. Willy Burgdorfer. This discovery took a while… over a decade after Dr. Allen Steere began his investigation into an unusual cluster of suspected juvenile rheumatoid arthritis in Lyme, Connecticut1. There are other species ofBorrel…