EMOttawa - Emergency Medicine Ottawa

Journal Club Summary
Methodology Score: 2.5/5                 Usefulness Score:  3/5
Motov S, et al. Ann Emerg Med. 2016 Dec 14. pii: S0196-0644(16)31244-6. Abstract Link
This randomized, double-blind study of the analgesic efficacy of ketorolac at three different doses (10mg, 15mg, 30mg) in 240 ED patients with acute pain, demonstrated no difference in verbal numeric rating scores of pain at 30 minutes. The results suggest an analgesic ceiling of ketorolac dosing at 10mg IV but significant methodological flaws preclude definitive conclusions (heterogeneous patient population, use of a continuous rather than binary outcome, not stratifying by pain severity or condition).  By: Dr. Peter Reardon
Epi lessonUse of Continuous Data as Primary Outcome
Beware of studies that compare the effectiveness of interventions by using continuous data outcomes, such as pain scales (1-100), oxygen saturation values, and minutes to pain relief. These kinds of data can produce statistically significant differenc…

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…

Journal Club SummaryMethodology Score: 4.5/5                 Usefulness Score:  3.5/5
Pathan SA, et al. Lancet.2016 May 14;387(10032):1999-2007  Abstract Link Editorial:Non-steroidalanti-inflammatory drugs for renal colic Knoedler JJ, et al. Lancet.2016 May 14;387(10032):1971-2.
This three-arm RCT of 1,645 renal colic patients in Qatar found that IM diclofenac was slightly more effective than IV morphine or IV paracetamol, with fewer adverse effects.The utility of the study is limited by use of drugs not available in North America, and the lack of an NSAID + opioid treatment arm; while not currently practice-changing for us, this article generates critical thought on the use of opioids during a time where narcotic abuse is increasingly problematic. By: Dr. Thara Kumar
Epi lessonUse of Continuous Data as Primary Outcome
Beware of studies that compare the effectiveness of interventions using continuous data outcomes, such as pain scales (1-100), oxygen saturation values, and minutes to pain re…