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Getting it ‘Right’: Pulmonary Hypertension in the ED

ObjectivesDescribe the pathophysiology of Pulmonary Hypertension (PH), and how it can be dangerousWho to suspect and workup for PH in the EDDescribe the POCUS findings in PHDescribe the management of these patients and how to avoid causing harm PhysiologyDefinition Pulmonary hypertension (PH) is defined as a pulmonary artery mean pressure >25 mmHg by right heart catheterization at rest. Transthoracic echocardiography is used as a screening tool with a right ventricular systolic pressure (RVSP) > 40 being suggestive but not diagnostic of PH (1,2).
Classification PH can be divided broadly into conditions primarily affecting pulmonary arterioles (Group 1) or secondary causes that progressively lead to changes in the pulmonary arteries (Groups 2-5). 
Group 1 is pulmonary arterial hypertension that is:  idiopathicheritabledrug-induceassociated with other conditions (eg. HIV, schistosomiasis, portal hypertension) The secondary causes include:  Group 2: Left sided heart disease (eg. valvu…
Recent posts

Under Pressure: Review of Management of Hypertension in Neurological Emergencies

Objectives: Explore the data for safety and efficacy of urgent BP lowering in hemorrhagic stroke.Is there any benefit from management of elevated BP in acute ischemic stroke that is not a candidate for tPA?What is the data for BP target in aSAH awaiting definitive management?

Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial

Journal Club SummaryMethodology Score: 4/5 Usefulness Score: 4.5/5

D'Onofrio G, et al
JAMA. 2015 Apr 28;313(16):1636-44.
Full Article

A Randomized Controlled Noninferiority Trial of Single Dose of Oral Dexamethasone Versus 5 Days of Oral Prednisone in Acute Adult Asthma

Journal Clubs Summary Methodology Score: 3/5 
Usefulness Score: 3.5/5 Rehrer MW, et al.
Ann Emerg Med. 2016 Nov;68(5):608-613.
Abstract Link

The ABCDE’s of Quality Improvement

What is Quality Improvement (QI)? You have all heard the latest buzzword in healthcare: “quality improvement”, or QI. Yet many healthcare professionals still only have a vague idea of what that truly means, and likely an even poorer understanding of how it might apply to their frontline practice. Conceptually, QI can be defined as the “combined and unceasing efforts of everyone - healthcare professionals, patients and their families, researchers, payers, planners and educators - to make the changes that will lead to better patient outcomes (health), better system performance (care) and better professional development (learning)”1. 

Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study.

Journal Club Summary Methodology Score:4/5 Usefulness Score:4/5 Stanley AJ, et al. BMJ. 2017 Jan 4;356:i6432. Full Article This multicentre, multinational study assessed the ability of five upper gastrointestinal bleeding scores to predict outcomes including death, re-bleeding, need for endoscopy, transfusion, surgery or interventional radiology, and length of hospital stay, finding that the Glasgow Blatchford score is best at predicting the composite outcome of intervention or death, although AIMS65 was best at predicting mortality. While applying the scores as recommended may result in missing a small number of significant outcomes, they are easy to apply and can help expedite disposition planning, whether outpatient management or hospital-based intervention. By: Dr. Daniel James
Epi lessonComposite OutcomesIt is not unusual for studies to select a composite outcome as their primary outcome measure. The necessity to do so is often justified by the rare occurrence of the primary outcome of t…

Prophylactic hydration to protect renal function from intravascular iodinated contrast material in patients at high risk of contrast-induced nephropathy (AMACING): a prospective, randomised, phase 3, controlled, open-label, non-inferiority trial.

Journal Club Summary
Methodology Score: 3/5                    Usefulness Score:  3.5/5 NijssenEC, et al Lancet.2017Feb 20. [Epub ahead of print] Abstract Link

Zika Virus – What we know and what we don’t

The Zika Virus exploded onto the international health scene in the last several months. It was first discovered in humans in 1951 and remained limited to Africa and Asia until the first major outbreak in Micronesia in 2007. Since then the virus has continued to evolve and spread from the Pacific Islands and French Polynesia to the main major outbreak in South America in early 2015 and finally to the US in January 2016.

Video Laryngoscopy vs Direct Laryngoscopy on Successful First-Pass Orotracheal Intubation Among ICU Patients: A Randomized Clinical Trial

Journal Club SummaryMethodology Score: 4/5                    Usefulness Score:  3/5
Lascarrou JB, et al. JAMA. 2017 Feb 7;317(5):483-493. Abstract Link

Risk of Acute Kidney Injury After Intravenous Contrast Media Administration

Journal Club SummaryMethodology Score: 4/5                    Usefulness Score: 3.5/5
Hinson JS, et al. Ann Emerg Med. 2017 Jan 19 [Epub ahead of print] Full Article