EMOttawa - Emergency Medicine Ottawa

This is a summary of a talk given by Drs. Krishan Yadav and Maggie Kisilewicz at the National Capital Conference in Emergency Medicine. Below are brief summaries and a bottom line, but of course you'll have to read the literature yourself to make your own decisions! 1) Intensive Blood-Pressure Lowering in Patients with Acute Cerebral Hemorrhage ATACH-2  Qureshi et al. N Engl J Med 2016; 375: 1033 – 1043.
DOI: 10.1056/NEJMoa1603460.

• RCT to assess if aggressive SBP reduction within 4.5 hours of spontaneous intracranial hemorrhage results in decreased death or disability at 3 months.
• Main Finding: No difference in death or disability at 3 months for Intensive BP (110 – 139 mmHg) vs. Standard BP (140 – 179 mmHg) group.
o Caution: this trial really compared SBP targets of 129 mmHg vs. 141 mmHg (see Figure 1)
• Bottom Line: BP reduction to 140 mmHg is safe. Aim for a SBP target of 160 mmHg in  spontaneous ICH – if the patient continues to deteriorate, revise target to 140 mmHg.

2) …

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…

The ability to administer peripheral nerve blocks in the ED has the potential to provide fast and direct analgesia with less systemic side effects compared to parenteral medications. When administered by an experienced provider, studies have shown that peripheral nerve blocks can provide reliable and prolonged analgesia. There is also evidence that nerve blocks can decrease overall length of stay in the emergency department for specific procedures. While there are various peripheral nerve blocks that are appropriate in the ED setting, there are three in particular that are further supported by evidence:

Interscalene BlockRegional Nerve Blocks of the HipNerve Blocks for Headache
The clinical use of these blocks is discussed here. Specific details and step by step instructions are described in the reference articles below.

The Interscalene Block The main indications for this block include:
Instant analgesia for upper-extremity fractures (proximal humerus, midshaft humerus)Exploration, debri…