Thanks to Dr Szechi Freidanck for her presentation.
Take home points:
- The quality of a systematic review is determined by the relative quality of the included and excluded studies. The AMSTAR tool is a way to assess the methodological rigor of the systematic review
- A Likelihood ratio of close to 1 means a test is not practically useful
- Aim to rapidly assess headaches to facilitate CT brain early where possible; but beware of diagnostic momentum – the history is king in cases of headache, and poor initial assessments can have downstream effects for the patient
Thanks to Prof Anne-Maree Kelly – we reviewed these articles this week:Caputo_et_al-2017-Academic_Emergency_Medicine
Take home points:
- critically unwell patients in whom desaturation was particularly critical were not included
- not statistically powered to detected clinically significant desaturations
- apnoeic oxygenation has minimal harm – and its introduction likely has had intangible effects on our practice in terms of adherence to checklists
Take home points
- a well designed study with patient centred outcomes
- some methodology issues in that pain rating was surveyed after the intervention
- your armamentarium for shoulder reduction should include at least one non sedation technique, and using a patient centred self-reduction technique allows the patient control over their medical experience
Thanks Dr Peter Ritchie for forwarding this article about an interesting case.
- Rarer diagnoses are often encountered in daily ED practice hidden amongst common symptoms
- attention to details that do not fit usual patterns (eg. in this case abnormal renal function that was not accountable by dehydration, abnormal liver function tests; band forms on full blood count) may re-direct the clinician to new differentials and help stall diagnosis momentum
Thanks Elliott Adamson for this presentation about the PEAPETT study.
- Suggests that thrombolysis with tPA in PEA arrest with confirmed PE has benefit
- Logically contrasts with other studies of thrombolysis in PEA arrest (all causes) which does not appear to show particular benefit
- Despite minimal proven benefit of thrombolysis in PEA arrest where cause is unclear, consideration of thrombolysis is still important (reversible causes – 4Hs and 4Ts) particularly in younger patients where overall outcome likely to be better
- single centre, retrospective cohort study
- 503 patients with sepsis – (263 without new onset AF; 240 with new onset AF)
- sinus rhythm restored in 165 of 240; mix of amiodarone / beta-blockers / calcium channel blocker / digoxin / DCR
- mortality of new onset AF group highest (61.3%) vs new AF with restored sinus rhythm (26.1%) vs no new AF (17.5%)
- hypothesis that restoring sinus rhythm may improve outcomes
- excluded patients with ICU stay < 3 days and those > 90 yrs old
- new onset AF group were older, higher prevalence of hypertension, CCF and coronary artery disease
- new onset AF group had higher Sepsis-related Organ Failure Assessment (SOFA) score (9.3 vs 7.0) and APACHE II scores (24.6 vs 21.6) to no AF group
- applicability to ED management already limited given exclusion criteria of ICU patients staying < 3 days
- higher mortality may simply reflect higher sepsis burden +/- co-morbidities
- Unclear if intervention or sepsis management resulted in reversion to sinus
- no single intervention tested in this study
Euthanasia and physician assisted suicide is a recurring topic of public discourse.
The Australian Medical Association (AMA) has released their position statement which highlights:
- prioritisation of good quality end of life care
- ensuring that co-morbid conditions that may impact on a patient’s desire for euthanasia have been adequately and optimally managed (e.g. mental health conditions, cognitive disorders, chronic disease)
The AMA does not endorse euthanasia but acknowledges that there is a diverse range of opinion both within the medical profession and public and that ongoing conversation about the ethical and legal implications is important.
See the full statement (2016) below: