EMOttawa - Emergency Medicine Ottawa

Methodology Score: 3/5        Usefulness Score: 2/5
Boutis K, et al. CMAJ. 2013 Oct 15;185(15):E731-8
Full Article
This multicenter implementation study of a pediatric Low Risk Ankle Rule demonstrated an initial and sustained 20% decrease in radiography rate. Although the rule maintained 100% sensitivity for clinically significant injuries, our local practice is to refer Salter Harris II injuries for orthopedic follow-up, which this rule would classify as a low-risk injury not requiring an x-ray. Additionally, JC attendees felt that the Ottawa Ankle Rule has undergone multiple external validations in pediatric populations, and feel more comfortable with its use.   By: Dr. Omer Yusuf (Presented October 2014)

Epi lesson: Stages of Clinical Decision Rule Development

Below is a fantastic list of the most relevant articles from 2014, some are practice changing, some will make you think and others remind you not to do things in the ED that don't help our patients. The list below was presented by Drs. Stella Yiu @Stella_Yiu and Jeff Freeman at the 2015 NCCEM Conference.
Critical Plays1.Arandomized trial of protocol-based care for early septic shock N Engl J Med 2014; 370:1683-1693 doi: 10.1056/NEJMoa1401602 Full Article -Multicenter, RCT Protocolized Care for Early Septic Shock (ProCESS) at 31 US hospitals -Results: n = 1351, in 1st 6 h, more fluids in the protocol-based standard-therapy group -No difference in mortality at 60/90/365 days (18-20%) or organ support -Bottom line:Identify sepsis quickly, with early fluids and antibiotics. Management with ScvO2 monitoring, pressors or specific MAP targets still unproven (independently) to change mortality.

2. Goal-DirectedResuscitation for Patients with Early Septic Shock ARISE Abstract Link N Engl J Med 201…