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Showing posts from October, 2015

Intravenous Subdissociative-Dose Ketamine Versus Morphine for Analgesia in the Emergency Department: A Randomized Controlled Trial

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Methodology Score: 3.5/5               Usefulness Score: 2/5
Motov S, Rockoff B, Cohen V, et al. Ann Emerg Med. 2015 Mar 26. pii: S0196-0644(15)00191-2.
Abstract Link

This prospective, RCT found sub-dissociative ketamine (0.3mg/kg) and morphine (0.1mg/kg) were similarly effective at reducing moderate to severe pain using a visual analogue pain scale at 30 minutes (mean difference 0.2; 95% confidence interval 1.19 to 1.46; P=0.97), but with increased minor side effects in the ketamine group. JC attendees discussed the limitations of using a continuous variable as a primary outcome, likely making this an underpowered study. Additionally, JC attendees thought the significantly increased side effects and short duration of ketamine would limit implementation into clinical practice. By: Dr. Nathan Hecht (Presented May 2015)

Epi lesson:  Sample Size in Clinical Trials All intervention studies should indicate how the sample size was estimated including the desired alpha error (usually 0.05), power…
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Randomized assessment of rapid endovascular treatment of ischemic stroke

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Methodology Score: 4/5                  Usefulness Score: 4/5
Goyal M, Demchuk AM, Menon BK, et al. N Engl J Med. 2015 Mar 12;372(11):1019-30
Full Article
This multi-centre open label RCT compared endovascular treatment +/- tPA vs. standard therapy for a specific sub-group of patients with acute ischemic stroke who had a proximal artery occlusion and evidence of a small infarcted core with a larger at risk area of brain. Endovascular treatment improved outcomes, with NNT of 4 for independence at 90 days. This adds to the growing body of literature suggesting endovascular treatment is beneficial for carefully selected stroke patients.  By: Dr. Sebastian Dewhirst (Presented May 2015)

Epi lesson: Number Needed to Treat (NNT) The NNT concept was created by Canadian Clinical Epidemiologist Dr Andreas Laupacis in 1988 to quantify the benefit of a new intervention.NNT is the average number of patients who need to be treated to prevent one additional bad outcome (e.g. the number of patients that need…
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Emerging drugs of abuse!

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Guest post by: Dr. Valerie Charbonneau




This isn't your parent's marijuana, thats for sure. As we continue to develop as a species, individuals are continuously attempting to develop newer and greater drug highs. As a result, the toxicologic world is continuously expanding, and in Emergency Medicine it is our job to keep up with trends in toxicology, and familiarize ourselves with emerging drugs of abuse.  Focus:  Discuss trends in cannabis and cannabis-derived product use.Review the recent Fentanyl epidemic.Look at trends in NPS (New Psychoactive Substances), including synthetic cannabinoids, phenethylamines and cathinones.Discuss local prevalence and monitoring methods for emerging drugs of abuse.Cannabinoids: Psychoactive compounds mainly consist of THC and CBD; which have opposite effects upon cannabinoid receptors. Historically, cannabis contained 2-4% THC and an equivalent proportion of CBD; which contained antipsychotic properties. Modern products contain 12-18% THC, and und…
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