EMOttawa - Emergency Medicine Ottawa

Journal Club SummaryMethodology Score: 4/5                    Usefulness Score: 2/5
Miller LG, et al. N Engl J Med.2015Mar 19;372(12):1093-103. Full Article

This case is brought to you by Dr. Robert Ohle, PGY5 in emergency medicine, who assessed the patient and captured all of the ultrasound images! Case Vignette: A female in her 20's presents to the emergency department 15 days after major cardiac surgery to repair a congenital aortic valve defect. Her chief complaint is palpitations and shortness of breath, which have been constant and ongoing for the last 4 days. She has no PND or orthopnea, no calf swelling, or history of DVT/PE. She has no past medical history other than the aortic valve defect and is on no medications. Her exam shows a well looking young female in no acute distress. Her vitals are BP 110/40, HR 110, afebrile, O2 99% on room air, RR 18. Her sternotomy incision site looks healthy. Her lungs are clear and there is a loud cardiac murmur, but both the senior resident and staff are unable to tell if it is systolic or diastolic because of the patient’s tachycardia. There are no signs of DVT. Routine bloodwork including car…

Journal Club SummaryMethodology Score: 4/5
Usefulness Score:  3.5/5

Ferguson I, et al.
Ann Emerg Med. 2016 Nov;68(5):574-582.
Abstract Link

Use of the term “sepsis” continues to be controversial. We understand that patients with infection can manifest an immune-mediated systemic response, and are at risk of deterioration, organ dysfunction, and death. At what point in that cascade the patient is termed “septic” remains the centre of ongoing debate. In 2016, under the coordination of Drs. Mervyn Singer and Cliff Deutschman, a task force of experts in sepsis research were assembled to create The Third International Consensus Definitions and Clinical Criteria of Sepsis and Septic Shock (Sepsis-3)[1]. Prior to this, the most recent set of definitions were released in 2001[2], and our understanding of sepsis has since changed. Thus, the definition of sepsis required an update. These definitions have been a source of major disagreement, but their major tenets must be known and understood by Emergency Department (ED) physicians, in order to apply them correctly.